Towards a Resilient and Lean Health Care

Saurin, Tarcísio Abreu; Rosso, Caroline Brum; Colligan, Lacey

doi:10.1201/9781315366838-3

Cited by 12 publications

(20 citation statements)

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“…There were 10 processes explored using the FRAM (Table 2): safety and risk identification (n = 8; 25.8%), 10,26,28,34,39,42,43,45 medication administration (n = 6; 19.4%), 21-23,27,31,38 transitional care (n = 4; 12.9%), 2,7,19,36 hospital management (n = 3; 9.7%), 24,32,33 blood sampling (n = 3; 9.7%), 37,39,41 identification and management of sepsis (n = 3; 9.7%), 25,29,35 and management of anticoagulation therapy (n = 2; 6.4%) 20,40 . The remaining processes were each examined in one (3.2%) paper: identification of the referral process from primary care to specialized practitioners, 18 operationalization of a fluoride varnish program, 30 and radiopharmaceutical dispatch process 44…”

Section: Resultsmentioning

confidence: 99%

“…By engaging those closest to the process, users of the FRAM are able to differentiate between how processes are intended to unfold under ideal conditions and how they actually take place in practice to accommodate individual circumstances and environmental conditions 2,18-21,24,25,28,30,31,33,34,36,38,41 . The differentiation between how things are designed to transpire and how they occur in practice is referred to as “work as imagined” and “work as done.” 10…”

Section: Discussionmentioning

confidence: 99%

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The Functional Resonance Analysis Method as a health care research methodology: a scoping review

McGill

Smith

Morris

et al. 2021

JBI Evidence Synthesis

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Objective:The objective of this review was to examine and map the literature on the use of the Functional Resonance Analysis Method (FRAM) in health care research.Introduction:The FRAM is a resilient health care tool tat offers an approach to deconstruct complex systems by mapping health care processes to identify essential activities, how they are interrelated, and the variability that emerges, which can strengthen or compromise outcomes. Insight into how the FRAM has been operationalized in health care can help researchers and policy-makers understand how this method can be used to strengthen health care systems.Inclusion criteria:This scoping review included research and narrative reports on the application of the FRAM in any health care setting. The focus was to identify the key concepts and definitions used to describe the FRAM; the research questions, aims, and objectives used to study the FRAM; the methods used to operationalize the FRAM; the health care processes examined; and the key findings.Methods:A three-step search strategy was used to find published and unpublished research and narrative reports conducted in any country. Only papers published in English were considered. No limits were placed on the year of publication. CINAHL, MEDLINE, Embase, PsycINFO, Inspec Engineering Village, ProQuest Nursing & Allied Health were searched originally in June 2020 and again in March 2021. A search of the gray literature was also completed in March 2021. Data were extracted from papers by two independent reviewers using a data extraction tool developed by the reviewers. Search results are summarized in a flow diagram, and the extracted data are presented in tabular format.Results:Thirty-one papers were included in the final review, and most (n = 25; 80.6%) provided a description or definition of the FRAM. Only two (n = 2; 6.5%) identified a specific research question. The remaining papers each identified an overall aim or objective in applying the FRAM, the most common being to understand a health care process (n = 20; 64.5%). Eleven different methods of data collection were identified, with interviews being the most common (n = 21; 67.7%). Ten different health care processes were explored, with safety and risk identification (n = 8; 25.8%) being the most examined process. Key findings identified the FRAM as a mapping tool that can identify essential activities or functions of a process (n = 20; 64.5%), how functions are interdependent or coupled (n = 18; 58.1%), the variability that can emerge within a process (n = 20; 64.5%), discrepancies between work as done and work as imagined (n = 20; 64.5%), the resiliency that exists within a process (n = 12; 38.7%), and the points of risk within a process (n = 10, 32.3%). Most papers (n = 27; 87.1%) developed models representing the complexity of a process.Conclusions:The FRAM aims to use a systems approach to examine complex processes and, as evidenced by this review, is suited for use within the health care domain. Interest in the FRAM is growing, with most of ...

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Functional Resonance Analysis Method as a health care research methodology: a scoping review

McGill

Smith

Morris

et al. 2021

JBI Evidence Synthesis

View full text Add to dashboard Cite

show abstract

“…Practitioners should also consider that although the tactics presented in this article can help optimise processes in OTs, it is nonetheless important to highlight that excessively leaning a system can reduce its capacity to cope with unexpected events making it less resilient (Sheps and Cardiff, 2017). Paying particular attention to how LM may impact resilience capabilities is key, especially in OTs where teams are often operating in rapidly changing and sometimes unpredictable conditions (Mahmoud et al, 2021;Saurin et al, 2017).…”

Section: Defectsmentioning

confidence: 99%

Access to surgical care as an efficiency issue: using lean management in French and Australian operating theatres

Mahmoud

Angelé-Halgand

Churruca

et al. 2021

JHOM

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PurposeMillions around the world still cannot access safe, timely and affordable surgery. Considering access as a function of efficiency, this paper examines how the latter can be improved within the context of operating theatres. Carried out in France and Australia, this study reveals different types of waste in operating theatres and a series of successful tactics used to increase efficiency and eliminate wastefulness.Design/methodology/approachData for this qualitative study were collected through 48 semi-structured interviews with operating theatre staff in France (n = 20) and Australia (n = 28). Transcripts were coded using a theory-driven thematic analysis to characterise sources of waste in operating theatres and the tactics used to address them.FindingsThe study confirmed the prominence of seven types of waste in operating theatres commonly found in industry and originally identified by Ohno, the initiator of lean: (1) underutilised operating rooms; (2) premature or delayed arrival of patients, staff or equipment; (3) need for large onsite storage areas and inventory costs; (4) unnecessary transportation of equipment; (5) needless staff movements; (6) over-processing and (7) quality defects. The tactics used to address each of these types of waste included multiskilling staff, levelling production and implementing just-in-time principles.Originality/valueThe tactics identified in this study have the potential of addressing the chronic and structurally embedded problem of waste plaguing health systems' operating theatres, and thus potentially improve access to surgical care. In a global context of resource scarcity, it is increasingly necessary for hospitals to optimise the ways in which surgery is delivered.

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“…In this way, it is important to monitoring and executing periodical evaluations of processes that comprises activities conducted in a hospital emergency pharmacy, allowing the investigation of necessary developments on service quality, something crucial for improving financial aspects, resilience and well-being of the ones involved (SAURIN et al, 2015). One way of describing the work environment and promoting continuous improvement is through the use of Ergonomic Work Analysis (EWA).…”

Section: Independent Journal Of Management and Production (Ijmandp)mentioning

confidence: 99%

Work Analysis of Drug-Dispensing Process in a Hospital Emergency Pharmacy

Rosso

Vieira

Silva

et al. 2016

Ind. Jour. Man. & Prod.

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The work organization performs a crucial role in activities that involves problem resolution and decision making. A hospital emergency pharmacy consists in an example where the work environment has several kinds of demands that might be inconsistent and influenced by overcrowding-common situation in Brazilian hospitals-causing harm to work organization and suitability of workload. The objective of this study is to evaluate labor conditions of professionals that work in the emergency pharmacy of a university public hospital, seeking improvement opportunities. A transversal study was developed with a descriptive character to analyze the work conditions. An ergonomic work analysis was conducted and, for fulfillment of its steps, observations in loco were performed and methods Deparis, RULA and ABC analysis were used, pursuing to analyze data collected and rearranging the work situation. The findings allowed propositions of improvement, related mainly to the process of drug dispensation, organization and arrangement of the work environment.

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Towards a Resilient and Lean Health Care

Cited by 12 publications

References 0 publications

The Functional Resonance Analysis Method as a health care research methodology: a scoping review

The Functional Resonance Analysis Method as a health care research methodology: a scoping review

Access to surgical care as an efficiency issue: using lean management in French and Australian operating theatres

Work Analysis of Drug-Dispensing Process in a Hospital Emergency Pharmacy

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