Lean implementation in healthcare supply chain: a scoping review

Borges, Gabriela Aline; Tortorella, Guilherme Luz; Rossini, Matteo; Staudacher, Alberto Portioli

doi:10.1108/jhom-06-2018-0176

Cited by 69 publications

(62 citation statements)

References 100 publications

(87 reference statements)

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“…In the pharmacy area, the VSM and unfolding tools stand out. This practice is usually cited as one of the first initiatives in the improvement implementation process, however as Borges et al (25) discusses, it is common the usage of value streams in the healthcare field as process flows or even a work operation (26) which may include materials, patients, medicines, equipment, services, among others.…”

Section: Lean Principles and Tools Usage In The Healthcare Fieldmentioning

confidence: 99%

Lean Healthcare applied toward turning a Pharmacy Service Patient Centered

Zanotto

Bittencourt²,

Tortato³

et al. 2020

VITTALLE, ISSN 1413-3563, Rio Grande, Brasil

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Introduction. Pharmaceutical service optimization requires a comprehensive understanding of resource usage. The aim of the study is to analyze how Lean Healthcare principles can contribute toward turning a pharmacy service patient-centered and value oriented. Methods. Understand how clinical pharmacists’ resources are effectively used by patients in an academic hospital using lean tools, such as value stream mapping and activity designation matrix, determine the amount of time each professional is involved in specific activities, and identify activities that add value. The data were mainly obtained through interviews with professionals, time-motion observational studies, chronoanalysis and meetings with the head of the unit. Results. A process flow map is designed for clinical pharmacy services, and it considers the relationship between the activities and their added value base. An exploration of the map shows that the activity “clinical rounds” is the most time consuming (27%) and not necessarily considered value-added by both parties (pharmacists staff and head of service). It is notable the opportunity the service has to prioritize the high-risk patients and to make a good time management; furthermore, activities that are of high value to patients are being performed and monitored by interns. Conclusions. The role of pharmacists should evolve from now on to be congruent with the new realities of healthcare. When value is questioned, we are encouraged to reflect on the activities engaged in by professional pharmacists in a clinical/surgical unit of a hospital. Through these tools, we could infer how the system is engaged and how it can be transformed toward added value.

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Section: Lean Principles and Tools Usage In The Healthcare Fieldmentioning

confidence: 99%

Lean Healthcare applied toward turning a Pharmacy Service Patient Centered

Zanotto

Bittencourt²,

Tortato³

et al. 2020

VITTALLE, ISSN 1413-3563, Rio Grande, Brasil

View full text Add to dashboard Cite

show abstract

“…This is considered important because of a widely felt need to improve the quality, accessibility and affordability of healthcare systems [5] and of hospitals in particular, given the fact that hospitals are a major cost item of the healthcare system [6]. There is a wide consensus in literature that an integrated perspective on hospitals, which is a central concept in supply chain management, and in lean and other operations management theories, can contribute to the improvement of hospital performance [4,[7][8][9][10][11][12]. Integrated hospitals plan patient processes and resources from the perspective of the total system [9].…”

Section: Introductionmentioning

confidence: 99%

“…Ludwig et al found evidence that hospitals that perform well score high on cooperation, while efficient departments within a hospital don’t necessarily contribute to the hospital’s overall efficiency [ 8 ]. There are, however, a few studies that show system-wide performance improvement when adapting integrative practices such as lean [ 12 ]. In an earlier scoping study [ 13 ] we found that research on logistics in hospitals typically focuses on one specific logistical flow (patients, material or staff) or on specific departments, but not on a system-wide level.…”

Section: Introductionmentioning

confidence: 99%

Identifying integration and differentiation in a Hospital’s logistical system: a social network analysis of a case study

Ham

Merode

Ruwaard

et al. 2020

BMC Health Serv Res

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Background Integration, the coordination and alignment of tasks, has been promoted widely in order to improve the performance of hospitals. Both organization theory and social network analysis offer perspectives on integration. This exploratory study research aims to understand how a hospital’s logistical system works, and in particular to what extent there is integration and differentiation. More specifically, it first describes how a hospital organizes logistical processes; second, it identifies the agents and the interactions for organizing logistical processes, and, third, it establishes the extent to which tasks are segmented into subsystems, which is referred to as differentiation, and whether these tasks are coordinated and aligned, thus achieving integration. Methods The study is based on case study research carried out in a hospital in the Netherlands. All logistical tasks that are executed for surgery patients were studied. Using a mixed method, data were collected from the Hospital Information System (HIS), documentation, observations and interviews. These data were used to perform a social network analysis and calculate the network metrics of the hospital network. Results This paper shows that 23 tasks are executed by 635 different agents who interact through 31,499 interaction links. The social network of the hospital demonstrates both integration and differentiation. The network appears to function differently from what is assumed in literature, as the network does not reflect the formal organizational structure of the hospital, and tasks are mainly executed across functional silos. Nurses and physicians perform integrative tasks and two agents who mainly coordinate the tasks in the network, have no hierarchical position towards other agents. The HIS does not seem to fulfill the interactional needs of agents. Conclusions This exploratory study reveals the network structure of a hospital. The cross-functional collaboration, the integration found, and position of managers, coordinators, nurses and doctors suggests a possible gap between organizational perspectives on hospitals and reality. This research sets a basis for further research that should focus on the relation between network structure and performance, on how integration is achieved and in what way organization theory concepts and social network analysis could be used in conjunction with one another.

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“…found evidence that hospitals that perform well score high on cooperation, while efficient departments within a hospital don't necessarily contribute to the hospital's overall efficiency [8]. There are, however, a few studies that show system-wide performance improvement when adapting integrative practices such as lean [12]. In an earlier scoping study [13] we found that research on logistics in hospitals typically focuses on one specific logistical flow (patients, material or staff) or on specific departments, but not on a system-wide level.…”

Section: Introductionmentioning

confidence: 99%

Identifying Integration and Differentiation in a Hospital’s Logistical System: A social network analysis of a case study

Ham

Merode

Ruwaard

et al. 2020

Preprint

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Background Integration, the coordination and alignment of tasks, is widely promoted in order to improve the performance of hospitals. Both organization theory and social network analysis offer perspectives on integration, but studies using a system-wide perspective are rare. This exploratory study describes the tasks that are performed in arranging the logistics for surgery patients in a hospital and in what way the agents involved in these tasks interact. In addition, the extent to which tasks are segmented into subsystems, which is referred to as differentiation, and whether these tasks are coordinated and aligned, thus achieving integration, is analyzed. Methods The study is based on case study research carried out in a hospital in the Netherlands. All logistical tasks that are executed for surgery patients were studied. Using a mixed method, data were collected from the Hospital Information System, documentation, observations and interviews. These data were used to perform a social network analysis and calculate network metrics of the hospital network. Results This paper shows that 23 tasks are executed by 635 different agents who interact through 31,499 interaction links. The social network of the hospital demonstrates both integration and differentiation. The network appears to function differently from what is assumed in literature with regard to hospitals, as the network does not reflect the formal organizational structure of the hospital and tasks are mainly executed across functional silos. Nurses and physicians perform integrative tasks and there are two agents who mainly coordinate the tasks in the network, without having a hierarchical position towards other agents. The Hospital Information System (HIS) does not seem to fulfill the interactional needs of agents. Conclusions This exploratory study reveals the network structure of a hospital. The cross-functional collaboration, the integration found and position of managers, coordinators, nurses and doctors suggests a possible gap between organizational perspectives on hospitals and reality. This research sets a basis for further research that should focus on the relation between network structure and performance, on how integration is achieved and in what way organization theory concepts and social network analysis could be used in conjunction with one another.

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Lean implementation in healthcare supply chain: a scoping review

Cited by 69 publications

References 100 publications

Lean Healthcare applied toward turning a Pharmacy Service Patient Centered

Lean Healthcare applied toward turning a Pharmacy Service Patient Centered

Identifying integration and differentiation in a Hospital’s logistical system: a social network analysis of a case study

Identifying Integration and Differentiation in a Hospital’s Logistical System: A social network analysis of a case study

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