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Applying lean in healthcare a collection of international case studies

Group technology and cellular layout. Guidelines for lean healthcare implementation were extracted from Figure 1 ; these may help hospital operations improve care quality and efficiency. Patients are processed in, among others, surgery, emergency, chemotherapy, and outpatient processes.

Materials are processed in warehouse, pharmacy, laboratories, OPSM, and laundries.

Information is the focus of changes in medical record, surgical scheduling, bed management, and invoice and billing central control processes. Contracting specialized consulting services. An external view may be a key factor to the success of lean healthcare implementation, especially in organizations where the technical staff has no experience with lean philosophy.

In Hospital A, lean healthcare implementation began with the direct help of consultants and continued for three years; Hospital B had the help of a consulting company in the initial phase of implementation. In Hospital C, direct participation of consultants only occurred six years after the beginning of lean healthcare implementation, at the time of its expansion.

Establishing improvement teams ad hoc and a fixed process management team. Ad hoc teams were established in the three hospitals to conduct the projects. In Hospital A, a fixed team was trained to lead lean healthcare implementation from the beginning.

Hospital C also established a fixed team for this purpose, composed by a quality manager and four flow coordinators. Linking lean healthcare to strategic planning to promote higher commitment. Lean healthcare implementation was linked to strategic planning, thereby increasing its efficiency through actions to achieve performance targets.

This may be performed by the fixed team responsible for managing lean healthcare implementation, by the consulting company and managers in improvement teams.

Adopting cyclical continuous improvement tools: Improvement projects must be performed for critical processes, defining scope and targets. In all studied cases, senior management decided to begin LP implementation with processes considered problematic, of high volume, or essential to profitability, based on daily coexistence with the processes and available indicators.

  • The in-depth analysis of the LP implementation process allowed the identification of some determinant factors for the success of lean healthcare, and helped building a conceptual basis for this process;
  • In Hospital A, a fixed team was trained to lead lean healthcare implementation from the beginning.

LP implementation was operationalized through improvement projects with defined scope, participants and targets, and the support of the senior management. Conducting theoretical and practical training sessions. The practical component may consist of knowledge application through improvement projects. The first methods applied must be kaizen and VSM. VSM was used to identify process waste.

The studied hospitals then performed interventions to eliminate or decrease process waste, and simultaneously implemented other methods 5S, standardization, workload leveling, visual control, zero defects quality control, etc.

LP implementation must consider the quality-productivity relationship. The safety of processes and patients must be prioritized; that is, productivity increases are only viable if they do not negatively affect quality. Developing the continuous improvement culture. Although the projects had targets, and consequently results, the focus of the senior management was to implement LP systemically and effect a cultural change, promoting the improvement culture.

In agreement with previous reports, the studied cases showed that LP implementation encompasses patient, material, and information flows. Because hospitals are complex organizations, LP success would be difficult if it focused only on the improvement of one type of flow. Although patient flow is the most representative in certain cases, its performance would not be good without the support of material and information flows.

Regarding the implementation structure, Bertani 2012 suggested the formation of ad hoc teams, and a fixed internal team to manage the whole process. In agreement with previous reports, these teams were formed and conducted the projects in the three studied cases. In agreement with Costa et al. In addition, as suggested by Zidel 2006LP implementation began with the contracting of a consulting company.

The data reported in the consulted literature did not allow to understand the process of LP implementation in health services. Hence, among the contributions of the present study was the analysis of the process underwent by the hospitals in search for a lean management model.

Reference Materials

The present study allowed to connect the existing studies, which usually showed lean healthcare implementation divided in parts either focusing on a given technique or emphasizing positive resultsbut it did not give an overall view of the whole process. The in-depth analysis of the LP implementation process allowed the identification of some determinant factors for the success of lean healthcare, and helped building a conceptual basis for this process.

The studied cases presented certain similarities with the consulted literature, which considers that kaizen and VSM should be the first lean techniques implemented Carter et al. However, the empirical evidence in the present study is in contrast with Radnor et al. In the studied cases, LP implementation was linked to strategic planning, and aligned with operational goals and the development of continuous improvement culture. The present study may help hospitals and managers that wish to implement LP, helping them to develop lean culture and improve patient care quality, decrease costs, and increase process efficiency.

The present study may also help the managers of the studied applying lean in healthcare a collection of international case studies to understand how LP implementation occurred in their hospitals, and make future improvements from the lessons learned in their trajectories. Another contribution of the present study applying lean in healthcare a collection of international case studies the presentation of 10 guidelines lessons learned for lean healthcare implementation.

Based on these guidelines, further studies may be performed to elaborate a methodology of LP implementation in hospital operations. The present study presented limitations, one of them being that the resources necessary to LP implementation were not identified. It is therefore suggested that the most important resources to lean method implementation must be identified from a resource-based viewpoint, in order to identify which resources must be developed and improved. This may also be extended to the hospital supply chain, which affects directly the success of LP implementation and must be studied.

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