Improving performance of the hospitalization process by applying the principles of Lean Thinking

2021 ◽  
Vol 33 (7) ◽  
pp. 253-271
Author(s):  
Antonella Fiorillo ◽  
Alfonso Sorrentino ◽  
Arianna Scala ◽  
Vincenzo Abbate ◽  
Giovanni Dell'aversana Orabona
Keyword(s):  
Patient Management ◽  
Performance Indicator ◽  
Length Of Hospital Stay ◽  
Lean Thinking ◽  
Content Type ◽  
Value Stream ◽  
Ishikawa Diagram ◽  
Lean Tools ◽  
Value Stream Map

PurposeThe goal was to improve the quality of the hospitalization process and the management of patients, allowing the reduction of costs and the minimization of the preoperative Length of Hospital Stay (LOS).Design/methodology/approachThe methodology used to improve the quality of the hospitalization process and patient management was Lean Thinking. Therefore, the Lean tools (Value stream map and Ishikawa diagram) were used to identify waste and inefficiencies, improving the process with the implementation of corrective actions. The data was collected through personal observations, patient interviews, brainstorming and from printed medical records of 151 patients undergoing oral cancer surgery in the period from 2006 to 2018.FindingsThe authors identified, through Value Stream Map, waste and inefficiencies during preoperative activities, consequently influencing preoperative LOS, considered the best performance indicator. The main causes were identified through the Ishikawa diagram, allowing reflection on possible solutions. The main corrective action was the introduction of the pre-hospitalization service. A comparative statistical analysis showed the significance of the solutions implemented. The average preoperative LOS decreased from 4.90 to 3.80 days (−22.40%) with a p-value of 0.001.Originality/valueThe methodology allowed to highlight the improvement of the patient hospitalization process with the introduction of the pre-hospitalization service. Therefore, by adopting the culture of continuous improvement, the flow of hospitalization was redrawn. The benefits of the solutions implemented are addressed to the patient in terms of lower LOS and greater service satisfaction and to the hospital for lower patient management costs and improved process quality. This article will be useful for those who need examples on how to apply Lean tools in healthcare.

scholarly journals Introducing a strategic perspective in lean thinking applications through system dynamics modelling: the dynamic Value Stream Map

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Guido Noto ◽  
Federico Cosenz
Keyword(s):  
System Dynamics ◽  
Management Practices ◽  
System Structure ◽  
Illustrative Case ◽  
Management Tools ◽  
Lean Thinking ◽  
Content Type ◽  
Value Stream ◽  
Strategic Perspective ◽  
Value Stream Map

PurposeLean Thinking is an operation management discipline which aims to identify, map and analyse the activities forming a process to detect “value waste” and outline the most effective flow of activities to execute in sequence. Process mapping is often developed in lean projects through the use of the Value Stream Map (VSM). Like many other management tools, the VSM adopts a static and non-systemic perspective in the representation of an organizational process. This may result in the implementation of Lean projects inconsistent with the overall organizational long-term strategy, thus leading to dysfunctional performance. In order to overcome this limit, the paper suggests combining VSM with System Dynamics (SD) modelling.Design/methodology/approachThe paper is based on a review of the literature on VSM. This review is matched with an analysis of SD modelling principles aimed at explaining the practical and theoretical contribution of this approach to operation and strategic management practices. An illustrative case study is then provided to explore the practical implications of the proposed approach.FindingsOur results show that SD modelling provides robust methodological support to VSM and Lean Thinking due to its inner characteristics, namely: simulation, systemic view, explicit link between system structure and behaviour and effective visual representation.Originality/valueThis research proposes a novel approach to design VSMs aimed at fostering a strategic perspective in Lean Thinking applications. Such an approach connects two fields of research and practice – i.e. VSM and SD modelling – which have traditionally been kept separated or, at least, partially combined for specific organizational sub-systems, thereby neglecting a broader strategic view of the entire process system.

Lean, mean, fighting machine

2020 ◽  
Vol 37 (1) ◽  
pp. 33-34
Keyword(s):  
Competitive Advantage ◽  
Design Methodology ◽  
Reading Time ◽  
Lean Thinking ◽  
Content Type ◽  
Value Stream ◽  
Pertinent Information ◽  
Value Stream Map ◽  
Practical Implications ◽  
Help Model

Purpose This paper aims to review the latest management developments across the globe and pinpoint practical implications from cutting-edge research and case studies. Design/methodology/approach This briefing is prepared by an independent writer who adds their own impartial comments and places the articles in context. Findings The principle of Lean Thinking can boost the competitive advantage of an organization through removing waste that doesn’t benefit the customer. The Dynamic Value Stream Map can help model this process in order to implement Lean Thinking more efficiently and effectively. Originality/value The briefing saves busy executives, strategists and researchers hours of reading time by selecting only the very best, most pertinent information and presenting it in a condensed and easy-to-digest format.

scholarly journals Lean Healthcare Tools for Processes Evaluation: An Integrative Review

2021 ◽  
Vol 18 (14) ◽  
pp. 7389
Author(s):  
Letícia Bianchini de Barros ◽  
Letícia de Camargo Bassi ◽  
Laura Passos Caldas ◽  
Alice Sarantopoulos ◽  
Eliete Boaventura Bargas Zeferino ◽  
...  
Keyword(s):  
Health Services ◽  
Continuous Improvement ◽  
Lean Six Sigma ◽  
Value Stream ◽  
Ishikawa Diagram ◽  
Health Area ◽  
Lean Healthcare ◽  
Lean Tools ◽  
And Control ◽  
Value Stream Map

Several health services have used lean healthcare to seek continuous improvement of their processes. Therefore, it is important to investigate the evidence available in the literature about the most used lean tools in the health area to review processes and the main results achieved by the researchers. As an integrative literature review methodology was used, it was conducted in five databases, using the descriptor “quality improvement” and the keyword “Lean Healthcare”. A total of 33 complete articles were selected for analysis. The most recurrent tools were: define, measure, analyze, improve and control (DMAIC); value stream map (VSM); suppliers, inputs, process, outputs, customers analysis (SIPOC), Ishikawa Diagram and 5S. Through the analysis of waste, different interventions were implemented and the main results achieved were reduction in times (processing, waiting, cycle and total), costs, workload and increase in the number of calls. The findings enabled the identification of the main lean tools used in the health area to achieve better results. In particular, we highlight recent studies that have explored the lean six sigma healthcare approach. The results, in addition to contributing to the literature, will also assist managers in choosing the best tool to achieve continuous improvement in hospitals and other health services.

scholarly journals Lean Thinking to Foster the Transition from Traditional Logistics to the Physical Internet

2020 ◽  
Vol 12 (15) ◽  
pp. 6053
Author(s):  
Vanessa Rodríguez Cornejo ◽  
Ángel Cervera Paz ◽  
Luis López Molina ◽  
Víctor Pérez-Fernández
Keyword(s):  
Supply Chain ◽  
Waiting Times ◽  
Value Stream Mapping ◽  
Lean Thinking ◽  
Value Stream ◽  
A Value ◽  
Physical Internet ◽  
The Right ◽  
The Relationship ◽  
Value Stream Map

This paper studies the relationship between Lean paradigms and the Physical Internet (PI). Lean thinking is a philosophy that allows one to obtain the right amount of the right items in the right place at the right time; it seeks to minimize waste and is flexible to change. In fact, applying Lean not only helps to reduce costs, but it also adds value and improves results across the supply chain. By using a value stream map, we can map the process from the supply chain to the customer, while trying not to add value activities. Such activities include excessive production, overstorage, waiting times poorly adjusted to needs, defects and rejects that require reprocessing, and, finally, unnecessary transport and movements. Storage, waiting times, and unnecessary transport and movements are at the core of the PI. A value stream map can also help to identify empty transport and unnecessary CO2 emissions. This study analyzes value stream mapping as a tool that can enable the objectives of the different Alliance for Logistics Innovation through Collaboration (ALICE) roadmaps for logistics innovation to be achieved, and can also allow PI principles to be reached on the established dates.

Improving the performance of a Malaysian pharmaceutical warehouse supply chain by integrating value stream mapping and discrete event simulation

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Ahmed Abideen ◽  
Fazeeda Binti Mohamad
Keyword(s):  
Supply Chain ◽  
Lead Time ◽  
Discrete Event ◽  
Integrated Approach ◽  
Value Stream Mapping ◽  
Content Type ◽  
Value Stream ◽  
Future State ◽  
The Future ◽  
Value Stream Map

Purpose Lean implementation is vastly incorporated in core manufacturing processes; however, its applicability in the supply chain and service industry is still in its infancy. To acquire performance excellence and thrive in the global competitive market, many firms are adopting newer methodologies. But, there is a stringent need for production simulation systems to analyze supply chains both inbound and outbound. The era of face validation is slowly disappearing. Lean tools and procedures that provide future state assumptions need advanced tools and techniques to measure, quantify, analyze and validate them. The purpose of this study is to enable dynamic quantification and visualization of the future state of a warehouse supply chain value stream map using discrete event simulation (DES) technique. Design/methodology/approach This study aimed to apply an integrated approach of the value stream mapping (VSM) and DES in a Malaysian pharmaceutical production warehouse. The main focus is diverted towards reducing the warehouse supply chain lead time by initially constructing a supply chain value stream map (both present state and future state) and integrating its data in a DES modelling and simulation software to dynamically visualize the changes in future state value stream map. Findings The DES simulation was able to mimic the future state lead time reductions successfully, which assists in better decision-making. Improvements were seen related to total lead time, process time, value and non-value-added percentage. Warehouse performance metrics such as receiving, put away and storage rates were substantially improved along with pallet processing time, worker and forklift throughput usage percentage. Detailed findings are clearly stated at the end of this paper. Research limitations/implications This study is limited to the warehouse environment and further additional process models and functional upgrades in the DES software systems are very much needed to directly visualize and quantify all the possible Lean assumptions such as radio frequency image identification/Andon (Jidoka), 5S, Kanban, Just-In-Time and Heijunka. However, DES has a leading edge in extracting dynamic characteristics out of a static VSM timeline and capture details on discrete events precisely by picturizing facility modification and lead time related to it. Practical implications This paper includes all the fundamental pharmaceutical warehouse supply chain processes and the simulations of the future state VSM in a real-life context by successfully reducing supply chain lead time and allowing managers in inculcating near-optimal decision-making, controlling and coordinating warehouse supply chain activities as a whole. Social implications This integrated approach of DES and VSM can involve managers and top management to support the adoption of anticipated changes. This study also has the potential to engage practitioners, researchers and decision-makers in the warehouse industry. Originality/value This study involves a powerful DES software package that can mimic the real situation as a virtual simulation and all the data and model building are based on a real warehouse scenario in the pharmaceutical industry.

scholarly journals A lean thinking and simulation-based approach for the improvement of routing operations

2016 ◽  
Vol 116 (5) ◽  
pp. 903-925 ◽  
Author(s):  
Bernardo Villarreal ◽  
Jose Arturo Garza-Reyes ◽  
Vikas Kumar
Keyword(s):  
Vehicle Routing ◽  
Value Stream Mapping ◽  
Lean Thinking ◽  
Vehicle Performance ◽  
Content Type ◽  
Value Stream ◽  
Novel Approach ◽  
Simulation Based ◽  
Operations Performance ◽  
Number Of Customers

Purpose – The improvement of routing operations performance has been of great concern for organisations. This has led to the development of alternative lean-based methods, however the literature research on the applications of lean thinking in the transportation sector is still considered rather limited. The purpose of this paper is to present a lean thinking and simulation-based approach to improve the efficiency of warehousing and routing operations. Design/methodology/approach – The paper reviews the existing literature in the area of lean transportation and then presents and applies a novel approach to improve the vehicle routing operations of a Mexican firm. The proposed approach suggests the classification of wastes into those relevant to transport operations, their identification through a transportation value stream mapping study, and the use of the transportation overall vehicle effectiveness (TOVE) index for the measure of the overall performance of the transport operations. Findings – The results obtained from the case study indicate that the proposed approach is an effective alternative for the improvement of vehicle routing operations as the number of routes decreased from 30 to 22 and the distance travelled by 32 per cent. Similarly, the average number of clients served by each route increased by 23 per cent as well as the TOVE index increased from 6.9 to 19.3 per cent. The TOVE component measures of vehicle performance and operating availability efficiencies also increased significantly while quality issues, in the form of number of customers not served per route, were reduced from six to zero. Originality/value – The improvement of routing operations performance has been traditionally addressed through operations research and mathematical modelling approaches. This paper presents an alternative and novel lean thinking and simulation-based approach to improve the efficiency of routing operations.

Does the threshold matter? The impact of the monitoring activity on non-performing loans

2019 ◽  
Vol 45 (2) ◽  
pp. 190-221 ◽  
Author(s):  
Domenico Piatti ◽  
Peter Cincinelli
Keyword(s):  
Early Warning ◽  
Performance Indicator ◽  
Positive Impact ◽  
Control Strategies ◽  
Threshold Value ◽  
Threshold Level ◽  
Content Type ◽  
The Impact ◽  
Monitoring Activity

PurposeThe purpose of this paper is to investigate whether the quality of the credit process is sensitive to reaching a particular threshold level of non-performing loans (NPLs) and, more importantly, whether higher NPLs ratios could make the monitoring activity ineffective.Design/methodology/approachThe empirical design is composed of two steps: in the first step, the authors introduce a monitoring performance indicator (MPI) of the credit process by combining the non-parametric technique Data Envelopment Analysis with some financial ratios adopted as input and output variables. As second step, the authors apply a threshold panel regression model to a sample of 298 Italian banks, over the time period 2006–2014, and the authors investigate whether the quality of the credit process is sensitive to reaching a particular threshold level of NPLs.FindingsThis paper finds that, first, when the NPLs ratio remains below the threshold value estimated endogenously, an increase in the quality of monitoring has a positive impact on the NPLs ratio. Second, if the NPLs ratio exceeds the estimated threshold, the relationship between the NPLs ratio and quality of monitoring assumes a positive value and is statistically significant.Research limitations/implicationsDue to the lack of data, the investigation of NPLs in the Italian industry across loan types combined with the monitoring effort by banks management was not possible. The authors plan to investigate this topic in future studies.Practical implicationsThe identification of the threshold has a double operational valence. The first regards the Supervisory Authority, the threshold approach could be used as an early warning in order to introduce active control strategies based on the additional information requested or by on-site inspections. The second implication is highlighted in relation to the individual banks, the monitoring of credit control quality, if objective and comparable, could facilitate the emergence of best practices among banks.Social implicationsA high NPLs ratio requires greater loan provisions, which reduces capital resources available for lending, and dents bank profitability. Moreover, structural weaknesses on banks’ balance sheets still persist particularly in relation to the inadequate internal governance structures. This means that bank management must able to recognise in advance early warning signals by providing prudent measurement together with an in-depth valuation of loans portfolio.Originality/valueThe originality of the paper is twofold: the authors introduce a new proxy of credit monitoring, called MPI; the authors provide an empirical proof of the Diamond’s (1991) economic intuition: for riskier borrowers, the monitoring activity is an inappropriate instrument depending on the bad reputational quality of borrowers.

Managing industrial operations by lean thinking using value stream mapping and six sigma in manufacturing unit

2019 ◽  
Vol 58 (6) ◽  
pp. 1118-1148 ◽  
Author(s):  
Jagdeep Singh ◽  
Harwinder Singh ◽  
Amandeep Singh ◽  
Jashanpreet Singh
Keyword(s):  
Six Sigma ◽  
Lean Manufacturing ◽  
Lead Time ◽  
Manufacturing Industry ◽  
Value Stream Mapping ◽  
Lean Thinking ◽  
Content Type ◽  
Value Stream ◽  
Future State ◽  
Industrial Operations

Purpose The purpose of this paper is to cover the significance of lean thinking using value stream mapping and six sigma methodology in managing industrial operations. Design/methodology/approach Lean manufacturing is an efficient approach for identifying and eliminating waste through a continuous improvement via flow of the product/service at the pull of customer in chase of exactness. This study has been carried out in a manufacturing unit of Northern India that was suffering from high production lead time and work in progress (WIP) inventory. Findings The current state and future state maps for the critical product have been prepared. On comparison of both current and future state maps, it was observed that lead time has been reduced by 14.88 percent, processing time by 14.71 percent and wastage of material movement by 37.97 percent. As proposed in model, the WIP inventories have been reduced by 17.76 percent and workforce by 17.64 percent. Further it would lead to the profit of Rs161,800 per annum. Six sigma projects have been carried out to reduce rejections of the critical product P-19 under study. The total length of the product was undersize of the critical product. Root cause analysis technique has been used through strategic DMAIC implementation. Results of investigation demonstrated net savings of rupees 145,560 annually. Originality/value The paper demonstrates the practical application of lean thinking, showing how it can bring real breakthroughs in saving cost in the manufacturing industry.

scholarly journals Efficiency through a Lean Healthcare Implementation in a Public Hospital

2019 ◽  
Author(s):  
Luisa Rosas-Hernandez ◽  
Diego Tlapa ◽  
Yolanda Baez-Lopez ◽  
Jorge Limon-Romero ◽  
Armando Perez-Sanchez
Keyword(s):  
Public Hospital ◽  
Waste Reduction ◽  
Value Stream ◽  
Medical Supplies ◽  
Lean Healthcare ◽  
Measure Analysis ◽  
Healthcare Process ◽  
Increasing Demand ◽  
Value Stream Map

Hospitals face challenges to improve efficiency in order to meet an increasing demand for high quality of care and low costs. Industry-based methods such as lean healthcare (LH) are implemented to improve healthcare systems. This study presents a LH implementation following the DMAIC approach (Define-Measure-Analysis-Improve-Control) in a Mexican public hospital, and contributes to the literature by analyzing the relation of waste reduction and sustainability. We focused on improving the medical supply chain from a temporary warehouse (TW) to the operating room (OR). Therefore, we analyzed the value stream including main surgical procedures and their related medical supplies, and identified different causes of inefficiency, which were evaluated and controlled. As a result, five types of waste were reduced through different tools including: value stream map, Kanban, 5’s, among others. Over-processing requests were reduced 15.3%; similarly, defective identification numbers were reduced up to 46.5%, redundant processing was improved by 94.8%, unnecessary inventories were reduced near to 2.8% of the TW inventory, and transportation waste was reduced up to 16.7%. As a consequence, the lead-time for the main supplies was reduced 33 days. Results indicate that LH and DMAIC are effective to reduce waste and highly conducive to improve healthcare process sustainability.

scholarly journals Applications of template A3 and value-stream mapping in process improvement: the case of building elevators installation

2021 ◽  
Vol 28 (1) ◽  
Author(s):  
Gino Flávio Vieira ◽  
James Manoel Guimarães Weiss
Keyword(s):  
Project Management ◽  
Process Improvement ◽  
Value Stream Mapping ◽  
Lean Thinking ◽  
Process Improvements ◽  
Value Stream ◽  
Project Management Institute ◽  
Significant Process

abstract: This article explores the application of lean thinking concepts in the analysis and obtaining of significant process improvements in building elevators installations. Based on a pilot installation, planned to analyze the installation processes of an elevator manufacturer, the authors compared two similar elevator installations. In one of them, they applied various lean thinking concepts and tools, with particular emphasis on template A3 and value stream mapping (VSM). This pilot installation planning was also developed based on the recommendations for efficient project management, structured by the Project Management Institute (PMI). The application of the template A3 and the value stream mapping to the installation of one of the elevators resulted in increased productivity, reduced installation times, and increased final quality of the product installed.

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