Using lean management approach in improving clinical team leader handover process: nursing services

This report describes the result of the study using lean management approach in improving clinical team leader handover process in nursing services at Sultan Bin Abdulaziz Humanitarian City, the largest rehabilitation facility in the Middle East with 511-bed capacity and more than 20 nursing inpatient units. Clinical handover refers to the transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another pehealthcare system is a crson or professional group on a temporary or permanent basis. It is in fact a valuable and essential part of the care processes in the hospitals. However, clinical team leaders face a challenging role during handover due to prolonged process, causing extra nursing working hour beyond their 12-hour scheduled shift, resulting in additional burden and exhaustion. The aim of this project was to test the effectivity of the lean management approach in improving the duration of clinical handover by reducing the handover time frame to 50% through eliminating unnecessary steps towards a more efficient, sustainable and effective communication between clinical nursing team leaders. The project results demonstrated the effectiveness and efficiency of the team leader clinical handover process by decreasing the duration by 50%. One hundred per cent of nursing units that were involved in the project were able to start and end their team leader handover process by the average of the selection target of 20–30 min of handover duration.

Download Full-text

Has Lean improved organizational decision making?

International Journal of Health Care Quality Assurance ◽

10.1108/ijhcqa-09-2015-0118 ◽

2016 ◽

Vol 29 (5) ◽

pp. 536-549 ◽

Cited By ~ 4

Author(s):

Pascale Simons ◽

Jos Benders ◽

Jochen Bergs ◽

Wim Marneffe ◽

Dominique Vandijck

Keyword(s):

Decision Making ◽

Design Methodology ◽

Lean Management ◽

Structured Interviews ◽

Organizational Decision Making ◽

Content Type ◽

Organizational Contexts ◽

Sustainable Improvement ◽

Care Processes ◽

Practical Implications

Purpose – Sustainable improvement is likely to be hampered by ambiguous objectives and uncertain cause-effect relations in care processes (the organization’s decision-making context). Lean management can improve implementation results because it decreases ambiguity and uncertainties. But does it succeed? Many quality improvement (QI) initiatives are appropriate improvement strategies in organizational contexts characterized by low ambiguity and uncertainty. However, most care settings do not fit this context. The purpose of this paper is to investigate whether a Lean-inspired change program changed the organization’s decision-making context, making it more amenable for QI initiatives. Design/methodology/approach – In 2014, 12 professionals from a Dutch radiotherapy institute were interviewed regarding their perceptions of a Lean program in their organization and the perceived ambiguous objectives and uncertain cause-effect relations in their clinical processes. A survey (25 questions), addressing the same concepts, was conducted among the interviewees in 2011 and 2014. The structured interviews were analyzed using a deductive approach. Quantitative data were analyzed using appropriate statistics. Findings – Interviewees experienced improved shared visions and the number of uncertain cause-effect relations decreased. Overall, more positive (99) than negative Lean effects (18) were expressed. The surveys revealed enhanced process predictability and standardization, and improved shared visions. Practical implications – Lean implementation has shown to lead to greater transparency and increased shared visions. Originality/value – Lean management decreased ambiguous objectives and reduced uncertainties in clinical process cause-effect relations. Therefore, decision making benefitted from Lean increasing QI’s sustainability.

Download Full-text

Nurses’ perceptions of bedside clinical handover in a medical-surgical unit: An interpretive descriptive study

Proceedings of Singapore Healthcare ◽

10.1177/2010105816678423 ◽

2016 ◽

Vol 26 (3) ◽

pp. 150-157 ◽

Cited By ~ 3

Author(s):

Shahidah Binte Roslan ◽

Mei Ling Lim

Keyword(s):

Acute Care ◽

Quality Care ◽

Night Shift ◽

Acute Care Hospital ◽

Care Hospital ◽

Clinical Handover ◽

Inpatient Settings ◽

Handover Process ◽

Group Interviews ◽

Nurses Perceptions

Background: Clinical handover is the transfer of relevant and important information and responsibility for patient care from one healthcare provider to another. An effective clinical handover is determined by the transition of critical information and the continuity of quality care for the patient. In the inpatient settings, bedside clinical handover mainly occurs during shift changes (morning to afternoon shift, afternoon to night shift and night to morning shift). Bedside clinical handover can take place in a cohort room of up to six patients or a single-bedded room with only one patient. Various nurses in the nursing hierarchy are involved in the handover, each contributing to ensure patients’ safety and continuity of quality care. Aim: To explore nurses’ perceptions of bedside clinical handover in an inpatient acute-care ward in Singapore. Methodology: An interpretive, descriptive, qualitative study was conducted using focus group interviews with semi-structured questions. The interviews were conducted with 20 nurses from an acute-care hospital in Singapore. The interviews were audiotaped and transcribed verbatim. Data collected were analyzed using thematic analysis. Results: Nurses described that bedside clinical handover could potentially compromise patient’s confidentiality and that the patient and/or their family members and the environment were sources of constant interruptions and distractions. Bedside clinical handover also acted as a platform for communication amongst nurses and between nurses and patients. Conclusion: This study provided an insight into nurses’ perceptions of bedside clinical handover and offered a foundation for nurses to improve the handover process.

Download Full-text

Evaluating the national multisite implementation of dialectical behaviour therapy in a community setting: A mixed methods approach

10.21203/rs.2.14353/v2 ◽

2019 ◽

Author(s):

Daniel Flynn ◽

Mary Joyce ◽

Conall Gillespie ◽

Mary Kells ◽

Michaela Swales ◽

...

Keyword(s):

Mixed Methods ◽

National Level ◽

Team Leader ◽

Barriers And Facilitators ◽

Future Research ◽

Evidence Based ◽

Community Settings ◽

Team Leaders ◽

Implementation Framework ◽

Mixed Methods Approach

Abstract Background The implementation of evidence-based interventions for borderline personality disorder in community settings is important given that individuals with this diagnosis are often extensive users of both inpatient and outpatient mental health services. Although work in this area is limited, previous studies have identified facilitators and barriers to successful DBT implementation. This study seeks to expand on previous work by evaluating a coordinated implementation of DBT in community settings at a national level. The Consolidated Framework for Implementation Research (CFIR) [1] provided structural guidance for this national level coordinated implementation.Methods A mixed methods approach was utilised to explore the national multi-site implementation of DBT from the perspective of team leaders and therapists who participated in the coordinated training and subsequent implementation of DBT. Qualitative interviews with DBT team leaders ( n = 8) explored their experiences of implementing DBT in their local service and was analysed using content analysis. Quantitative surveys from DBT therapists ( n = 74) examined their experience of multiple aspects of the implementation process including orienting the system, and preparations and support for implementation. Frequencies of responses were calculated. Written qualitative feedback was analysed using content analysis.Results Five themes were identified from the interview data: team formation, implementation preparation, client selection, service level challenges and team leader role. Participants identified team size and support for the team leader as key points for consideration in DBT implementation. Key challenges encountered were the lack of system support to facilitate phone coaching and a lack of allocated time to focus on DBT. Implementation facilitators included having dedicated team members and support from management.Conclusions The barriers and facilitators identified in this study are broadly similar to those reported in previous research. Barriers and facilitators were identified across several domains of the CFIR and are consistent with a recently published DBT implementation Framework [2]. Future research should pay particular attention to the domain of characteristics of individuals involved in DBT implementation. The results highlight the importance of a mandated service plan for the coordinated implementation of an evidence-based treatment in a public health service.

Download Full-text

A LEAN MANAGEMENT APPROACH FOR THE ROMANIAN TEXTILE AND CLOTHING INDUSTRY

Business Excellence and Management ◽

10.24818/beman/2019.9.2-03 ◽

2019 ◽

Vol 9 (2) ◽

pp. 21-31

Author(s):

Adriana DIMA ◽

◽

Ruxandra DINULESCU ◽

Keyword(s):

Lean Manufacturing ◽

Textile Industry ◽

Systematic Approach ◽

Continuous Process ◽

Value Added ◽

Process Industry ◽

Clothing Industry ◽

Management Approach ◽

Lean Management ◽

Reducing Costs

Lean management represents a systematic approach used for identifying and eliminating waste and non-value added activities from different industries, including the textile industry. Even if the lean manufacturing concept has shown important results in continuous process industry, the textile industry represents a good area for implementing this methodology targeting as a main objective the action of eliminating waste, thus reducing costs and therefore, increasing productivity. Being a customer oriented process, the system has the ability to eliminate a significant part of waste from the Romanian textile industry. As a result, this is an incipient study aimed to present the benefits of implementing Lean Management in the Romanian textile industry, through its improvement tools, as well as presenting a theoretical economic impact for a textile company. Also, taking into consideration that Lean Management is not yet applied in the Romanian textile field, the study will present a part of the areas which would need the Lean implementation, as well as further actions to be taken in order to improve productivity in textile industry.

Download Full-text

Lean management in health care: a review of reviews of socio-technical components for effective impact

Journal of Health Organization and Management ◽

10.1108/jhom-06-2020-0241 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Marta Marsilio ◽

Martina Pisarra

Keyword(s):

Health Care ◽

Implementation Process ◽

Management Approach ◽

Lean Management ◽

Impact Measurement ◽

Content Type ◽

Four Dimensions ◽

Support Organization ◽

Review Of Reviews

PurposeThe aims of the implementation of lean management in health care are to improve quality of care, to eliminate waste and to increase efficiency. The purpose of this study is to contribute to the advancement of knowledge by investigating which main socio-technical factors are considered to be effective for the implementation and management of lean initiatives.Design/methodology/approachA systematic review of literature reviews on lean management in health care was conducted. The components of the socio-technical system are identified by moving from the socio-technical drivers that support organization-wide quality improvement practices and the lean implementation process in health care. The impacts of lean management are classified using the internal processes, patient, learning and financial dimensions.FindingsThe 28 reviews retrieved confirm the current and increasing interest in lean management. While more than 60% of them call for a system-wide approach, system-wide implementations have rarely been observed, and, instead, adoption in isolated units or departments, or the use of single techniques and tools, prevails. The most commonly investigated socio-technical components are organizational structure, techniques and tools and organizational culture and strategic management. Significant impacts are reported for all the four dimensions. Nonetheless, the review reveals that there is still a lack of evidence on the sustainability of lean results and a need for a standardized impact measurement system.Originality/valueThis work stands out as the first review of reviews of how the socio-technical components of the lean management approach obtain positive impacts within the patient, internal processes, learning and financial dimensions.

Download Full-text

Evaluation of a structured preceptorship programme

British Journal of Community Nursing ◽

10.12968/bjcn.2019.24.11.554 ◽

2019 ◽

Vol 24 (11) ◽

pp. 554-557

Author(s):

Guy Tucker ◽

Joanne Atkinson ◽

Janet Kelly ◽

Lynette Parkin ◽

Alison McKenzie ◽

...

Keyword(s):

Nursing Education ◽

Large Scale ◽

Staff Nurses ◽

Clinical Team ◽

Team Leaders ◽

Large Scale Study ◽

Service Initiative ◽

District Nurses ◽

Experienced Nurse

Preceptorship is a period in which newly qualified staff nurses receive support from an experienced nurse to smooth their transition into the service. District nurses (DNs) from the authors’ trust informally expressed the need for a better transition between the completion of district nursing education and entry into the workforce. Hence, a structured preceptorship programme was developed and delivered. This article describes this service initiative and its evaluation by preceptors (n=14) and preceptees (newly qualified DNs; n=13). Both groups valued having a structured preceptorship programme. Preceptees agreed that having a named preceptor was very important, and preceptors felt that the role which they played was rewarding. Both groups felt that the role of the DN was a specialist role and that the preceptorship programme helped to support newly qualified staff make the transition into qualified DNs, clinical team leaders and, ultimately, caseload holders. A large-scale study of DN practice is required to develop a national consensus on the structure and content of preceptorship programmes for district nursing.

Download Full-text

Healthcare Engineering: A Lean Management Approach

Journal of Healthcare Engineering ◽

10.1155/2020/8875902 ◽

2020 ◽

Vol 2020 ◽

pp. 1-17

Author(s):

Abdallah A. Abdallah

Keyword(s):

Cycle Time ◽

Service Sector ◽

Success Factors ◽

Healthcare Services ◽

Dominant Factor ◽

Management Approach ◽

Lean Management ◽

Operational Cost ◽

Implementation Framework ◽

Lean Implementation

This work tries to answer the following question: can healthcare be engineered using lean management tools? Lean is known to achieve successful results when implemented in the manufacturing sector. Typical results are operational cost reduction, cycle time reduction, and higher customer satisfaction. The service sector, however, has seen mixed results. For the last two decades, educators and healthcare professionals are trying to implement lean tools in healthcare. Some reported success and many did not, for variety of reasons. In this paper, we search the literature and reveal the special nature of healthcare services, success factors, and barriers facing implementation of lean in healthcare. We then conduct a survey of 18 elite Jordanian hospitals to study the case holistically. Statistical analysis of the survey results confirmed some of what the literature revealed; organizational leadership seems to be the most dominant factor, followed by knowledge of employees about lean, training, and patient satisfaction (customer focus). Another important finding, not captured by the literature, is that lean implementation success depends on educating physicians about continuous improvement and lean and ensuring they are part of the improvement team. Based on the revealed enablers and obstacles, we created a full lean implementation framework. This framework was then used along with selected engineering tools to implement lean in a major hospital successfully. Implementation results showed 60% of reduction in cycle time, 80% reduction in operational cost, and many other benefits.

Download Full-text

Clinical supervision in a high secure hospital: a service evaluation

British Journal of Mental Health Nursing ◽

10.12968/bjmh.2019.0025 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1-10

Author(s):

Stephanie Lewis ◽

Jaide Mead ◽

Ian Treasaden

Keyword(s):

Clinical Supervision ◽

Nursing Staff ◽

Service Evaluation ◽

Nursing Workforce ◽

Clinical Team ◽

Team Leaders ◽

Forensic Care

Few environments demand a higher level of emotional competences than forensic care settings, and the importance of clinical supervision to mitigate against the risks of such an environment cannot be underestimated. This paper explores the efficacy of clinical supervision provided to nursing staff within a high secure hospital using the Manchester Clinical Supervision Scale. Results indicated that the nursing workforce were overall very satisfied with their clinical supervision, specifically clinical team leaders are most likely to be very satisfied. Results also showed the significance of time: clinical supervision is more effective when it lasts between 30–60 minutes, but correspondingly, time is one of the key barriers to accessing clinical supervision.

Download Full-text

The sustainability of Medical Morning Handover Reporting: adherence in a regional hospital

Australian Health Review ◽

10.1071/ah09820 ◽

2010 ◽

Vol 34 (3) ◽

pp. 325 ◽

Cited By ~ 1

Author(s):

Terry J. Hannan ◽

Stanley Bart ◽

Colin Sharp ◽

Mathew J. Fassett ◽

Robert G. Fassett

Keyword(s):

Quality Of Care ◽

Health Information ◽

Continuity Of Care ◽

Information Technologies ◽

Time Frame ◽

Hospital Environment ◽

Strict Adherence ◽

Clinical Handover ◽

Medical Diagnoses

Background.The Medical Morning Handover Report is a form of clinical handover and is considered to be an essential mechanism for continuity of care and adverse event minimisation within a hospital environment. It is considered a significant Quality of Care activity recommended in Australian Medical Association clinical handover guidelines. The sustainability of such activities has not been reported. Aim.We aimed to assess the sustainability of Medical Morning Handover Reporting (MMHR) in the Department of Medicine at the Launceston General Hospital since its implementation in 2001. Methods.We conducted a quality improvement survey amongst the medical staff (pre-graduate and post graduate medical faculties) to assess its sustainability since implementation in 2001. Results.There were 30 respondents of whom 19 attended MMHR daily, four attended weekly, and only five attended less than weekly. Attendance rates at MMHR were maintained from 2001 to 2009 based on comparisons with previously conducted surveys. Conclusions.This study shows MMHR is sustainable and has evolved in format to incorporate advances in Health Information Technology. We believe adherence is dependent on providing leadership and structure to MMHR. What is known about the topic?Since the mid 2000s, the MMHR has emerged as a significant quality intervention activity in our Department of Medicine, with particular emphasis on the first 12–24 h of a patient's encounter with the hospital with conditions that are considered to be medical diagnoses. When considered relevant follow up feedback on previous admissions is covered by the meeting. What does this paper add?This paper attempts to add measurable end points for the quality of the MMHR meeting, the importance of measuring sustainability and introduce the concepts relating to the use of health information technologies as significant decision support and peer review tools within the meeting. What are the implications for practitioners?This study has several implications for clinicians in hospitals: (1) the Report is an essential component of ongoing quality of care handover to maintain the continuity of care and to apply the necessary variations in care uncovered during the handover process. (2) Strict adherence to the meeting time frame improves the MMHR efficiency. (3) Consultant staff attendance has a strong positive influence on the care and educational benefits of the meeting. (4) The integrated use of e-technologies appears to have a strong positive effect on decision making and education during MMHR.

Download Full-text

Evaluating the national multisite implementation of dialectical behaviour therapy in a community setting: A mixed methods approach

10.21203/rs.2.14353/v3 ◽

2020 ◽

Author(s):

Daniel Flynn ◽

Mary Joyce ◽

Conall Gillespie ◽

Mary Kells ◽

Michaela Swales ◽

...

Keyword(s):

Content Analysis ◽

Mixed Methods ◽

National Level ◽

Team Leader ◽

Barriers And Facilitators ◽

Evidence Based ◽

Community Settings ◽

Team Leaders ◽

Implementation Framework ◽

Mixed Methods Approach

Abstract Background: The implementation of evidence-based interventions for borderline personality disorder in community settings is important given that individuals with this diagnosis are often extensive users of both inpatient and outpatient mental health services. Although work in this area is limited, previous studies have identified facilitators and barriers to successful DBT implementation. This study seeks to expand on previous work by evaluating a coordinated implementation of DBT in community settings at a national level. The Consolidated Framework for Implementation Research (CFIR) [1] provided structural guidance for this national level coordinated implementation. Methods: A mixed methods approach was utilised to explore the national multi-site implementation of DBT from the perspective of team leaders and therapists who participated in the coordinated training and subsequent implementation of DBT. Qualitative interviews with DBT team leaders (n = 8) explored their experiences of implementing DBT in their local service and was analysed using content analysis. Quantitative surveys from DBT therapists (n = 74) examined their experience of multiple aspects of the implementation process including orienting the system, and preparations and support for implementation. Frequencies of responses were calculated. Written qualitative feedback was analysed using content analysis. Results: Five themes were identified from the interview data: team formation, implementation preparation, client selection, service level challenges and team leader role. Participants identified team size and support for the team leader as key points for consideration in DBT implementation. Key challenges encountered were the lack of system support to facilitate phone coaching and a lack of allocated time to focus on DBT. Implementation facilitators included having dedicated team members and support from management. Conclusions: The barriers and facilitators identified in this study are broadly similar to those reported in previous research. Barriers and facilitators were identified across several domains of the CFIR and are consistent with a recently published DBT implementation Framework [2]. Future research should pay particular attention to the domain of characteristics of individuals involved in DBT implementation. The results highlight the importance of a mandated service plan for the coordinated implementation of an evidence-based treatment in a public health service.Trial Registration: ClinicalTrials.gov ID: NCT03180541; Registered June 7th 2017 ‘retrospectively registered’

Download Full-text