Research
Influence of Leadership Factors and Lean and Modern Management Styles on Quality-of-Care Performance of Hospitals in the USA
Hospital efficiency relates to organizational factors and leadership style. This study investigated several factors, as one interdependent construct, with the potential to influence hospital performance in terms of quality-of-care. National database and survey information on modern management, lean management, organizational traits and leadership was compared. A positive correlation was found between hospital performance and hospital type. Two negative correlations were found: one relating to the root cause of problems in the context of modern management style, and one relating to managerial responsibility in the context of lean (process) management style. No correlations were found with organizational factors or leadership. This study clarifies the relevance of several factors to hospital performance and highlights areas for further research on management systems, covering acute vs critical care and transformational vs transactional leadership, in order to identify drivers of performance in US hospitals.
Lean Process Mapping Techniques: Improving the Care Process for Patients with Oesophageal Cancer
Objective. This paper tests the hypothesis that the value-stream mapping (VSM) method, based on Lean thinking, could help streamline the care process for patients with oesophageal cancer. Design. Case study. Setting and participants. One of the largest tertiary referral centres for oesophageal cancer in The Netherlands. Interventions. We applied and evaluated the principles and tools of Lean thinking, especially VSM processes, to improve the process of delivering care to patients referred for oesophageal cancer. Results. Evaluation at the start of the project revealed that the care pathway was unsystematic and might introduce medical errors. Application of VSM principles in the Lean context improved the process by cutting the number of individual steps needed to begin treatment from 128 to 103 and minimized variability by applying standardization. The implementation of Lean techniques improved the delivery of clinical care to our patients with oesophageal cancer by reducing the time it took to start treatment by 3.5 weeks. Conclusions. Our results suggest that the VSM method, based on Lean thinking, can help to better arrange the care processes for these patients. We believe that these principles can be applied to much of the care administered in this setting and to other areas of health-care delivery.
A Focus on Throughput: Lean Improvement of Nurse Scheduling in the Operating Theatre
The utilization of operating theatres and efficiency of nurse scheduling has an impact on patient outcomes, hospital finances and clinical effectiveness. To date, research has tended to focus on the output rather than on the process of nurse scheduling. We report on use of the Lean mapping tool, Makigami, in operating room (OR) nurse scheduling. This study was conducted at a large surgical department in the Netherlands. A multidisciplinary team of nine health-care professionals used Makigami, includingfive steps: (1) mapping the current state of OR nurse scheduling, (2) setting the ideal state and the first target condition, (3) performing a fishbone analysis, (4) conducting actions and (5) mapping the revised process of OR nurse scheduling. The current OR nurse scheduling process showed 44 transfers, 42 documents and 64 types of waste, which collectively led to 35 errors in 7 days. The first target condition was to guarantee quality of care:the right employees, at the right time, in the right place without errors. The revised process, as a result of the action plans that emerged through the fishbone analysis, led to an outcome of two errors in 7 days with a reduction in waste of 41%. The use of Makigami led to an optimized OR nurse scheduling process: the right OR nurses, with the right qualifications, were scheduled for the right surgical procedures. A focus on process led to a reduction in transfers and errors, which indicate a higher quality of care.
