Lean Six Sigma in Healthcare
TL;DR: This article outlines a methodology and presents examples to illustrate how principles of Lean Thinking and Six Sigma can be combined to provide an effective framework for producing systematic innovation efforts in healthcare.
Abstract: Healthcare, as with any other service operation, requires systematic innovation efforts to remain competitive, cost efficient, and up-to-date. This article outlines a methodology and presents examples to illustrate how principles of Lean Thinking and Six Sigma can be combined to provide an effective framework for producing systematic innovation efforts in healthcare. Controlling healthcare cost increases, improving quality, and providing better healthcare are some of the benefits of this approach.
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TL;DR: Though there seems to exist an agreement about the potential of lean healthcare, it remains a challenge for academics and practitioners to evaluate lean healthcare under a more critical perspective.
Abstract: Purpose – The aim of this paper is to provide a review of the existing literature on lean healthcare. It seeks to describe how this concept has being applied and to assess how trends and methods of approach in lean healthcare have evolved over the years.Design/methodology/approach – The paper surveys the applications of lean healthcare in the current literature and classifies over 90 works according to a taxonomy suggested.Findings – Though there seems to exist an agreement about the potential of lean healthcare, it remains a challenge for academics and practitioners to evaluate lean healthcare under a more critical perspective.Practical implications – This work is helpful not only for healthcare practitioners and for researchers in private and public organisations, but also for journal editors and reviewers because it offers ready access to an up to date comprehensive review.Originality/value – Since lean started being applied in healthcare, no effort to provide a complete resource surveying the existing...
577 citations
TL;DR: Even though Lean results appear to be promising, findings so far do not allow to draw a final word on its positive impacts or challenges when introduced in the healthcare sector.
405 citations
TL;DR: In this article, the authors performed an analysis of literature review of lean production (LP) research articles published from 1988 to 2011 in selected 24 operations research journals and provided a taxonomical and integrated review of articles, puts up perspective into the conceptualisation and various critical parameters for research.
Abstract: The purpose of this paper is to perform the analysis of literature review of lean production (LP). The analysis involved studying 546 research articles published from 1988 to 2011 in selected 24 operations research journals. The articles are classified by: time distribution of articles, research methodology, research stream, authorship patterns, sector-wise focus, popular elements in lean literature, focus of the articles on lean waste, and implementation status and performance measurement of various existing frameworks/models. Then, the suggestions for the future scope of research possibilities and development are identified. The study provides a taxonomical and integrated review of articles, puts up perspective into the conceptualisation and various critical parameters for research. The findings include: increase in empirical approach research articles, need of applying lean principles in the field of product development and enterprise level areas, need of more interregional research collaborations, nee...
378 citations
Cites result from "Lean Six Sigma in Healthcare"
...Similar kind of results is reported in service sector after implementation of lean principles (De Koning et al. 2006; Piercy and Rich 2009)....
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TL;DR: There is only limited scientific evidence that streaming of patients into different tracks, performing laboratory analysis in the emergency department or having nurses to request certain x-rays results in shorter waiting time and length of stay.
Abstract: Background: Overcrowding in emergency departments is a worldwide problem. A systematic literature review was undertaken to scientifically explore which interventions improve patient flow in emergency departments. Methods: A systematic literature search for flow processes in emergency departments was followed by assessment of relevance and methodological quality of each individual study fulfilling the inclusion criteria. Studies were excluded if they did not present data on waiting time, length of stay, patients leaving the emergency department without being seen or other flow parameters based on a nonselected material of patients. Only studies with a control group, either in a randomized controlled trial or in an observational study with historical controls, were included. For each intervention, the level of scientific evidence was rated according to the GRADE system, launched by a WHO-supported working group. Results: The interventions were grouped into streaming, fast track, team triage, point-of-care testing (performing laboratory analysis in the emergency department), and nurse-requested x-ray. Thirty-three studies, including over 800,000 patients in total, were included. Scientific evidence on the effect of fast track on waiting time, length of stay, and left without being seen was moderately strong. The effect of team triage on left without being seen was relatively strong, but the evidence for all other interventions was limited or insufficient. Conclusions: Introducing fast track for patients with less severe symptoms results in shorter waiting time, shorter length of stay, and fewer patients leaving without being seen. Team triage, with a physician in the team, will probably result in shorter waiting time and shorter length of stay and most likely in fewer patients leaving without being seen. There is only limited scientific evidence that streaming of patients into different tracks, performing laboratory analysis in the emergency department or having nurses to request certain x-rays results in shorter waiting time and length of stay.
250 citations
TL;DR: It is demonstrated that there are significant gaps in the SS/L health care quality improvement literature and very weak evidence thatSS/L improve health carequality.
Abstract: Background Popular quality improvement tools such as Six Sigma and Lean Systems (SS/L) claim to provide health care managers the opportunity to improve health care quality on the basis of sound methodology and data. However, it is unclear whether these 2 quality improvement tools actually improve health care quality. Methods The authors conducted a comprehensive literature review to assess the empirical evidence relating SS/L to improved clinical outcomes, processes of care, and financial performance of health care organizations. Results The authors identified 177 articles on SS/L published in the last 10 years. However, only 34 of them reported any outcomes of the SS/L projects studied, and less than one-third of these articles included statistical analyses to test for significant changes in outcomes. Conclusions This review demonstrates that there are significant gaps in the SS/L health care quality improvement literature and very weak evidence that SS/L improve health care quality.
249 citations
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Posted Content•
TL;DR: In this paper, the authors discuss and promote Karl Marx's influential method of studying technology as the result of interrelated social processes, emphasizing the mutual interaction between technology and the economy, and conclude that scientific progress is heavily influenced by technological considerations that are, in turn, shaped by industry and economics.
Abstract: Explores how technological innovation has shaped and been shaped by science, industry, and economics in the twentieth century. Technological change and specific technologies have impacted productivity, the learning process, technology transfer and technology policies. Starting with a summary of historical literature on technical progress, the book goes on to discuss and promote Karl Marx's influential method of studying technology as the result of interrelated social processes -- especially emphasizing the mutual interaction between technology and the economy. Analysis of current empirical studies shows the need for an enlarged framework for understanding the relation between the economy and technical change. Technological interdependence in the American economy is analyzed, and later expanded to encompass international business. High-tech industries are discussed as particularly reliant upon scientific research. The commercial aircraft industry from 1925-75 is also examined, as an exemplary instance in which technological innovation and government support and regulation allowed for economic success. The book concludes that scientific progress is heavily influenced by technological considerations that are, in turn, shaped by industry and economics. Thus, decisions made in the private and public sectors should affect both supply and demand, favoring the creative, mutually advantageous connection between science and technology. (CJC)
3,181 citations
Book•
01 Jan 2007
TL;DR: Womack, Jones, and Roos as discussed by the authors published The Machine that changed the world in 1990, and applied the principles of lean production to the automotive industry, including product development, supplier management, sales, service and production.
Abstract: When James Womack, Daniel Jones, and Daniel Roos wrote THE MACHINE THAT CHANGED THE WORLD in 1990, Japanese automakers, and Toyota in particular, were making a strong showing by applying the principles of lean production. However, the full power of lean principles was unproven, and they had not been applied outside of the auto industry. Today, the power of lean production has been conclusively proved by Toyota's unparalleled success, and the concepts have been widely applied in many industries. Based on MIT's pioneering global study of industrial competition, THE MACHINE THAT CHANGED THE WORLD offers a groundbreaking analysis of the entire lean business system, including product development, supplier management, sales, service, and production - an analysis even more relevant today as GM and Ford struggle to survive and a wide range of British abd American companies embrace lean production. A new Foreword by the authors brings the story up to date and details how their predictions were right. As a result, this reissue of a classic is as insightful and instructive today as when it was first published.
2,257 citations
"Lean Six Sigma in Healthcare" refers background in this paper
...Lean Thinking The proliferation of Lean Thinking was facilitated by the publication of Womack, Jones, and Roos (1990)....
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TL;DR: This new edition of Toyota Production System: An Integrated Approach to Just-In-Time updates the classic with new material on e-kanban, mini-profit centers, computer-based information systems, and innovative solutions to common obstacles in TPS implementation.
Abstract: The Toyota production System is a technology of comprehensive production management the Japanese invented a hundred years after opening up to the modern world. More than likely, another gigantic advance in production methods will not appear for some time to come.
1,674 citations
"Lean Six Sigma in Healthcare" refers background in this paper
...Lean Thinking emerged within the Japanese automobile industry after World War II (Ohno, 1988) but can be traced back to the early days of the Ford Motor Company (Ford & Crowther, 1926)....
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Posted Content•
TL;DR: In this article, Drucker argues that an entrepreneurial society is needed in which innovation and entrepreneurship are normal, steady, and continuous, and proposes seven successful sources for innovative opportunity: (1) unexpected success, failure, or outside event; (2) incongruity between what is and what "ought" to be within an industry or market; (3) innovation based on a process need (supplying the missing link); (4) changes in industry structure or market structure; (5) demographics or population changes; (6) new scientific and non-scientific knowledge
Abstract: The emergence of an entrepreneurial econmy in the 1970s was the most significant and hopeful event in recent U.S. social and economic history. For Drucker, innovation and entrepreneurship are not a "flash of genius," but purposive tasks that can be organized as systematic, rational work fostered by management. Entrepreneurship is treated not as personality or intuition but behavior, concept, and theory. Entrepreneurship is not high-risk; rather, few so-called entrepreneurs have the method for what they do. The practice of innovation, the practice of entrepreneurship, and entrepreneurial strategies compose innovation and entrepreneurship. Instead of pursuing "bright ideas," entrepreneurs should focus on the seven successful sources for innovative opportunity: (1) unexpected success, failure, or outside event; (2) incongruity between what is and what "ought" to be within an industry or market; (3) innovation based on a process need (supplying the missing link); (4) changes in industry structure or market structure; (5) demographics or population changes; (6) changes in perception, mood, and meaning; and (7) new scientific and non-scientific knowledge (requiring analysis of relevant factors, focus on strategic position, and entrepreneurial management). The practice of innovation is purposeful innovation resulting from analysis, system, and hard work. The principles of purposeful, systematic innovation are: (1) analyze opportunities, (2) be perceptive, (3) be simple and focused, (4) start small, and (5) aim at leadership. Principles of innovation are (1) innovation is work, (2) build on strengths, and (3) innovations have an effect in the economy and society. Entrepreneurs are not "risk-takers" but opportunity focused. The discipline called entrepreneurial management must develop a practical guide for innovation in (1) the existing business (policies to create a climate, practices, measures of innovative performance, and organizational practices), (2) the public-service institution (policies and need to innovate), and (3) the new venture (focus on market, financial foresight, early building of a top management team, role decisions by the founder, and outside advice). Entrepreneurship also requires four strategies, or practices and policies in the marketplace: (1) being "Fustest with the Mostest"; (2) "Hit Them Where They Ain't," or "entrepreneurial judo" (avoid the "not invented here" syndrome, don't "cream" a market, the fallacy of "quality," delusion of the "premium" price, and maximizing instead of optimizing; (3) finding an ecological niche (toll-gate, specialty skill, and specialty market strategies); and (4) changing utility, values, and economic characteristics (creating utility, pricing, adapting to customer's reality, and delivering true value to customer). In conclusion, Drucker argues that an entrepreneurial society is needed in which innovation and entrepreneurship are normal, steady, and continuous. What will not work is planning or over-reliance on high-technology. Social innovation is needed in the areas of redundant workers and abandoning outworn and obsolete social policies and institutions. Also needed are changes in tax and fiscal policies and government regulations, and individuals must undertake continuous learning and relearning. (TNM)
1,542 citations
"Lean Six Sigma in Healthcare" refers background in this paper
...The net result was a process for institutionalized systematic innovation that consistently delivers the intended end results (Drucker, 1985)....
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01 Jan 1986
TL;DR: In this paper, the authors discuss the entrepreneurial economy, innovation, and entrepreneurship in the context of the suggested readings index, and propose a set of suggested readings for each of them.
Abstract: Preface Introduction: The entrepreneurial economy The practice of innovation The practice of entrepreneurship Entrepreneurial strategies Conclusion: The entrepreneurial society Suggested readings Index.
1,351 citations