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BackgroundRecent emphasis on value based care and population management, such as Accountable Care Organizations in the United States, promote patient navigation to improve the quality of care and reduce costs. Evidence supporting the efficacy of patient navigation for chronic disease care is limited. The objective of this study was to evaluate the effect of a patient navigation program on medical and administrative outcomes among patients with diabetes in an urban, safety-net hospital clinic setting.MethodsA retrospective cohort study with pre- and post-intervention periods was conducted. Eligible patients were those with A1C ≥ 8.5% and at least one appointment no-show in the previous 12 months. The intervention and reference groups were balanced on observed characteristics and baseline outcome levels using propensity score matching. The effect of patient navigation was isolated using the difference-in-differences approach. Primary outcomes were A1C, low-density lipoprotein cholesterol, triglycerides, random urine microalbumin, the number of scheduled appointments, clinic visits, emergency visits, and inpatient stays, and the percentage of arrivals, cancellations, and no-shows to scheduled appointments.ResultsOf 797 eligible patients, 328 entered the navigation program. Matching reduced the sample size to 392 individuals (196 in each group). Patient navigation resulted in improved A1C (−1.1 percentage points; p < .001), more scheduled appointments (+ 5.3 per year; p < .001), more clinic visits (+6.4 per year; p < .001), more arrivals to scheduled appointments (+7.4 percentage points; p = .009) and fewer no-shows (−9.8 percentage points; p < .001).ConclusionsNavigation was associated with improved glycemic control and better clinic engagement among patients with diabetes. Further research is important to identify what features of navigation in diabetes care are critical to achieving success and to understand navigators’ role in other settings.Electronic supplementary materialThe online version of this article (10.1186/s12913-017-2700-7) contains supplementary material, which is available to authorized users.

Purpose -The purpose of this paper is to introduce a framework for the design and management of a Kaizen event program where short-term improvement projects (Kaizen events) are systematically used to introduce rapid change in targeted work areas, often relying on lean work system principles. Design/methodology/approach -To develop the framework and the assessment approach, a comprehensive literature review and a field study of Kaizen event programs in three organizations were conducted. To illustrate the potential usefulness of the framework and the assessment approach, this paper presents a case study of how the framework was applied to design and improve a Kaizen event program in the Belgian Armed Forces. Findings -Use of the framework as a design and assessment tool appeared to make the Kaizen event program more effective in the case study organization. Specific areas of improvement identified included: clearly defining event goals, scheduling extended follow-up activities, defining measures to track results, assigning roles for Kaizen event evaluation activities, and sharing lessons learned in areas of the organization outside the work processes targeted by Kaizen events. Originality/value -With the increased use of lean work system practices in recent years, many organizations are using Kaizen events to rapidly introduce change and to create a culture of continual improvement (or kaizen). However, organizations lack systematic, research-based guidance on how to best design and implement Kaizen event improvement programs and how to best assess results. The proposed framework attempts to address these gaps.

PurposeDespite the increased adoption and reported benefits of kaizen event (KE) programs, there is a lack of empirical research documenting their design, implementation and outcomes, as well as what designs may be more vs less effective. This paper aims to present an empirical study describing the characteristics, including outcomes achieved, program attributes, and implementation problems, of 16 established KE programs. Although this study is primarily exploratory and descriptive, the goal is to identify areas for future research, including attributes that appear to support or detract from program success, and the outcomes and implementation problems experienced.Design/methodology/approachUsing semi‐structured interviews, qualitative data were collected to characterize established KE programs in 16 manufacturing, service, and government organizations. The data were examined using content analysis to identify the most frequent codes for each characteristic, which were then compared to KE program characteristics synthesized from a systematic review of published KE sources. Based on this, a set of propositions were identified to guide future research on KE programs.FindingsThe majority of the 16 organizations reported successful programs, although there was noted variation in organization success. The organizations also neglected to measure many aspects of program success which they considered to be highly important, in particular, human resource outcomes. In addition, the organizations appeared to struggle with sustainability and believe that sustainability problems could threaten long‐term KE program viability. Other potentially influential factors include the types of processes targeted, event types, catalysts for events, and KE resources. The findings were used to develop propositions for future research in these and other specific areas.Practical implicationsThe study provides a better understanding of the characteristics of established KE programs, as well as common areas in need of improvement even in these programs, and can be used by practitioners in establishing or improving their KE programs.Originality/valueBy documenting established KE programs across organizations and comparing actual practices to published sources, this study contributes to the development of KE theory and also provides direction for future empirical research.