In the past decade, a number of healthcare setups have adopted LSS methodology to reduce wastages and improve efficiency in the service delivery and patient flow. But there is partial research done on understanding the sequence to be followed by healthcare organizations to implement LSS in their different departments. The applicability of various LSS tools in different kinds of healthcare settings is also not conclusive. This article focuses on mending this gap by mapping the current state of LSS in healthcare and identifies directions for future research. The authors have explained key concepts of LSS and investigated the existing knowledge of LSS implementation between 2006 and 2018 in various healthcare settings all over the world to answer key research questions on the application of LSS in various healthcare areas. Further, this paper is one of the first comprehensive studies that attempted to tabulate the LSS tools and techniques used in different healthcare delivery areas. The paper concludes that different healthcare services poses different types of challenges for LSS implementation due to their distinctive service delivery, but a single framework can be applied with a slight change in the usage of tools and techniques within the steps of that framework. Also, research opportunities exist to determine the appropriate path which a hospital should follow while implementing LSS, to identify the most suitable set of LSS tools and thereby empirically validating the benefits of LSS.
Research in Tolerance and Chimerism by Transplant immunologists for over half a century is akin to the pursuit of the Holy Grail. Animal experiments for inducing tolerance may not have been successful initially but in that process, our knowledge of the fascinating immune system has been greatly enriched. Understanding of innate and adaptive immune systems has paved the way for development of potent immunosuppression. However, achieving clinical or operational tolerance long term in renal transplant recipients in the absence of immunosuppression is the ultimate goal for clinicians. Reduction in immunosuppression will lower morbidity and mortality associated with heavy burden of immunosuppression. This review article will be of particular interest to clinicians involved in delivering care to renal transplant recipients. We have elucidated mechanisms of self-tolerance through central and peripheral tolerance, evolution of tolerogenic strategies, difference between macro and micro-chimerism, overview of successful protocols for inducing tolerance and recent work in the development of expanding regulatory cell lines. It is most encouraging to note progress using cellular therapies as reported by Immune Tolerance Network and by Transplant Research & Immunology group at Oxford. We may not be far from achieving clinical tolerance albeit with minimal if not completely immunosuppression free regimens in the longer term. Review Article Tolerance in TransplantationThe highest result of education is toleranceHelen Keller [1], Tolerance is derived from 'tolero' in Latin, which means to endure. Achieving transplant tolerance has been the subject of research for over half a century and our current understanding of tolerance has evolved during that time. It is by no means complete and the search for true tolerance continues.Tolerance is the ability of a foreign tissue or organ to survive in a host without immunosuppression. It can be described as donor specifi c non-reactivity in experimental models [2]. "Clinical operational tolerance" is described as a well-functioning graft lacking histological signs of rejection in absence of immunosuppression for at least 1 year in an immunocompetent host capable of responding to other challenges including infections [3,4].In contrast, "Immunological tolerance" is no detectable immune reaction towards the allograft in absence of immunosuppression. It is a state of permanent and specifi c immunological acceptance of the allograft by the host immune system in the absence of immunosuppression. Self-toleranceThe concept of tolerance towards transplanted organs is best understood through learning about self-tolerance. The lymphoid system, which consists of T and B-lymphocytes, controls the immune system protecting the host from foreign pathogens. In the developmental pathway of the lymphoid system, T cells and B cells undergo education and maturation in the central lymphoid organs; the thymus and bone marrow. During this maturation process, T and B cells learn to differentiate between s...
Purpose – The present study aims at explaining the patients’ opinion towards the Outpatient Department (OPD) facility of tertiary care hospitals in Delhi-NCR region during Covid pandemic. The research focuses on the quality of healthcare services provided by the OPD and examines the comparative importance of quality measurements in finding out the patients’ satisfaction. Design – A total 408 respondents took part in a questionnaire survey from the Delhi- NCR region who has visited OPD facilities of either private or Government hospital on one pretext or other. Data was analyzed through descriptive statistics, reliability study, correlation and multivariate regression on SPSS to examine customer perceptions of service quality and how the quality of services stimulates an overall satisfaction index towards OPD facilities in healthcare sectors. Findings – As per the findings of this paper, the maximum number of respondents had a good overall experience in the outpatient departments of the tertiary hospitals and therefore assessed the services on a positive scale. Doctors’ knowledge and communication, waiting time, and online consultation in the era of pandemic emerged as the most vital factors of outpatient satisfaction. Originality – The service quality factors in healthcare, i.e., physical facilities, responsiveness, and communication were assessed and new dimension of service quality, online consultation, was added, which is believed to be an important parameter for measuring patients’ satisfaction in the current situation, where physical communications have been limited to emergencies only. Practical Implications – The outcomes will enable hospital managers to formulate effective strategies to enhance service quality of healthcare, especially in OPD, which is the most frequented area of healthcare service systems.
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