Applicazione dello strumento Lean A3 al percorso di presa in carico di pazienti anziani con frattura del femore: il caso studio di un ospedale pugliese

Journal title MECOSAN
Author/s Angelo Rosa, Giuliano Marolla, Francesco Zammori
Publishing Year 2019 Issue 2018/106
Language Italian Pages 27 P. 37-63 File size 845 KB
DOI 10.3280/MESA2018-106003
DOI is like a bar code for intellectual property: to have more infomation click here

Below, you can see the article first page

If you want to buy this article in PDF format, you can do it, following the instructions to buy download credits

Article preview

FrancoAngeli is member of Publishers International Linking Association, Inc (PILA), a not-for-profit association which run the CrossRef service enabling links to and from online scholarly content.

Despite numerous articles reporting the application of Lean in the health sector, the methodologies to implementing the paradigm in hospitals are described in few articles. Most of the research focuses more on the results of the Lean approach than on the approach itself. Embarking on continuous improvement by navigating without compass and without guidelines can be frustrating and in the best case could lead to silver bullet solution, spending resources without generating the "culture of change" or increasing the ability to "project management". The purpose of this paper is to describe the case study of a Puglia hospital in which a Lean project was activated to the clinical pathway of patients over sixty-five with fracture of the femur. The originality is to detail the framework to support Lean implementation and offer a guideline to practitioners. The project was implemented through the Report A3, involving a hospital team work and an external consultant. The results show a reduction in the rate of the patients who cannot undergo surgery in 48 hours and the spreading of continuous improvement culture in the organization.

Keywords: Lean, Case Study, Report A3, Continuous Improvement, Organization, Healthcare

  1. Ahlstrom P. (2004). Lean service operations: Translating Lean production principles to service operations. International Journal of Services, Technology and Management, 5(5-6): 545-564. DOI: 10.1504/IJSTM.2004.006284
  2. Aldarrab A. (2006). Application of Lean Six Sigma for patients presenting with ST-elevation myocardial infarction: the Hamilton health sciences experience. Healthcare Quarterly, 9(1): 56-61.
  3. Bowen D. E., Youngdahl W. E. (1998). Lean service: in defense of a production-line approach. International Journal of Service Industry Management, 9(3): 207-225. DOI: 10.1108/09564239810223510
  4. Bush R.W. (2007). Reducing waste in US health care systems. JAMA: The Journal of the American Medical Association, 297(8): 871-874.
  5. Coelho S.M., Pinto C.F., Calado R.D., Silva, M.B. (2013). Process Improvement in a Cancer Outpatient Chemotherapy Unit using Lean Healthcare. IFAC Proceedings Volumes, 46(24): 241-246. DOI: 10.3182/20130911-3-BR-3021.00047
  6. Collar R.M., Shuman A.G., Feiner S., McGonegal A.K., Heidel N., Duck M., McLean S.A., Billi J.E., Healy D.W., Bradford C.R. (2012). Lean management in academic surgery. Journal of the American College of Surgeons, 214(6): 928-936.
  7. Collden C., Gremyr I., Hellstrom A., Sporraeus D. (2017). A value-based taxonomy of improvement approaches in healthcare. Journal of Health Organization and Management, 31(4): 445-458. DOI: 10.1108/JHOM-08-2016-0162
  8. Curatolo N., Lamouri S., Huet J.C., Rieutord A. (2014). A critical analysis of Lean approach struc turing in hospitals. Business Process Management Journal, 20(3): 433-454. DOI: 10.1108/BPMJ-04-2013-0051
  9. D’Andreamatteo A., Ianni L. Sargiacomo M., Lega F. (2015). Lean in healthcare: A comprehensive review. Health Policy, 119(9): 1197-1209.
  10. De Souza L.B., Pidd M. (2011). Exploring the barriers to Lean health care implementation, Public Money Manage, 31(1): 59-66. DOI: 10.1080/09540962.2011.545548
  11. Furman C., Caplan R. (2007). Applying the Toyota Production System: using a patient safety alert system to reduce error, Joint Commission Journal on Quality and Patient Safety, 33: 376-86.
  12. Goldstein F., Strasser D., Woodard J., Roberts V.J. (1997). Functional outcome of cognitively impaired hip fracture patients on a geriatric rehabilitation unit. J Am Geriatc Soc, 45(1): 35-42.
  13. Graban M., (2008). Lean Hospitals: Improving Quality, Patient Safety, and Employee Satisfaction. New York, NY: CRC Press.
  14. Guercini J., Bianciardi C., Mezzatesta V., Bellandi L. (2016). Lean Healthcare: il caso dell’AOU Senese. Storia di una strategia vincente. Milano: FrancoAngeli.
  15. Gupta S., Sharma M., Sunder M.V. (2016). Lean services: a systematic review. International Journal of Productivity and Performance Management, 65(8): 1025-1056. DOI: 10.1108/IJPPM-02-2015-0032
  16. Institute of Medicine (2012). Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. Washington, DC: The National Academies Press.
  17. Joosten T., Bongers I., Janssen R. (2009). Application of Lean thinking to health care: issues and observations. International Journal for Quality in Health Care, 21(5): 341-347.
  18. Kanis J.A. on behalf of the World Health Organization Scientific Group (2007). Assessment of osteoporosis at the primary health-care level. Technical Report. World Health Organization Collaborating Centre for Metabolic Bone Diseases. UK Printed by the University of Sheffield, 8-40. -- Testo disponibile al sito: http://www.sheffield.ac.uk/FRAX/pdfs/WHO_Technical_Report.pdf.
  19. Keene G.S., Parker M.J., Pryor G.A. (1993). Mortality and morbidity after hip fractures. British Medical Journal, 307: 1248-1250.
  20. Khan S.K., Kalra S., Khanna A., Thiruvengada M.M., Parker M.J. (2010). Timing of surgery for hip fractures: a systematic review of 52 published studies involving 291,413 patients, Injury, 40(7): 692-697.
  21. Krafcik J.F. (1988). Triumph of the Lean Production System. Sloan Management Review, 30(1): 41-52.
  22. Laubjerg Daugaard C., Jorgensen H.L., Riis T., Lauritzen J.B., Duus B.R., Van der Mark S. (2012). Is mortality after hip fracture associated with surgical delay or admission during weekends and public holidays? A retrospective study of 38,020 patients’. Acta Orthopaedica, 83(6): 609-613. DOI: 10.3109/17453674.2012.747926
  23. Leung F., Lau T.W., Kwan K., Chow S.P., Kung A.W. (2010). Does timing of surgery matter in fragility hip fractures?’, Osteoporos Int., 21(Suppl 4): 529-34.
  24. Martin S.C., Greenhouse P.K., Kowinsky A.M., McElbeny R.L., Petras C.R., Sharbaugh D.T. (2009).
  25. Rapid improvement event: an alternative approach to improving care delivery and the patient experience. Journal of Nursing Care Quality, 24(1): 17-24.
  26. Murphy M. (2003). Eliminating wasteful work in hospitals improves margin, quality and culture. Murphy Leadership Institute Research Briefing. -- Testo disponibile al sito: http://www.cs.odu.edu/~cpi/old/cpi-s2004/statag/murphy-wastefulwork.pdf.
  27. Ng D., Vail G., Thomas S., Schmidt N. (2010). Applying the Lean principles of the Toyota production system to reduce wait times in the emergency department. CJEM, 12(1): 50-57. DOI: 10.1017/S1481803500012021
  28. Nuzum R., McCarthy D., Gauthier A., Beck C. (2007). Denver Health: A High-Performance Public Health Care System. The Commonwealth Fund, 63. -- Testo disponibile al sito: http://www.commonwealthfund.org/publications/publicationsshow.htm?docid=509163.
  29. OECD (2002). Measuring Up: Improving Health System Performance in OECD Countries. Organisation for Economic Cooperation and Development Publications Service, Paris.
  30. OECD (2015). Fiscal Sustainability of Health Systems: Bridging Health and Finance Perspectives. Organisation for Economic Cooperation and Development Publications Service, Paris. – Testo disponibile al sito: https://www.oecd.org/gov/budgeting/Fiscal-Sustainability-of-Health-Systems-Policy-Brief-ENG.pdf.
  31. Piscitelli P., Iolascon G., Gimigliano F., Muratore M., Camboa P., Borgia O., Forcina B., Fitto F., Robaud V., Termini G., Rini G.B., Gianicolo E., Faino A., Rossini M., Adami S., Angeli A., Distante A., Gatto S., Gimigliano R., Guida G., SIOMMMS study group, CERSUM research group (2007). Incidence and costs of hip fractures compared to acute myocardial infarction in the Italian population: a 4-year survey. Osteoporos Int, 188(2): 211-219.
  32. Porter M., Lee T.H. (2013). The strategy that will fix health care: providers must lead the way in making value the overarching goal. Harvard Business Review, 91(10): 50-68. -- Testo disponibile al sito: https://hbr.org/2013/10/the-strategy-thatwill-fix-health-care.
  33. Agenas (2016). PNE Edizione 2016. -- Testo disponibile al sito: http://www.quotidianosanita.it/allegati/allegato1539624.pdf.
  34. Raab S.S., Andrew-Jaja C., Condel J.L., Dabbs D.J. (2006). Improving papanicolaou test quality and reducing medical errors by using Toyota production system methods. American Journal of Obstetrics and Gynecology, 194(1): 57-64.
  35. Radnor Z.J. (2010). Review of business process improvement methodologies in public services. Advanced Institute of Management. -- Testo disponibile al sito: https://www.researchgate.net/publication/266868980_Review_of_Business_Process_Improvement_Methodologies_in_Public_Services.
  36. Rosa A. (2017). Lean Organization in Sanità:esperienze e modelli di applicazione da nord a sud. GueriniNext.
  37. Souza L.B.D. (2009). Trends and approaches in Lean healthcare. Leadership in Health Services, 22(2): 121-139. DOI: 10.1108/17511870910953788
  38. Torchia M., Calabro A.; Morner M. (2015). Public-Private Partnerships in the Health Care Sector: A systematic review of the literature. Public Management Review, 17(2): 236-261. DOI: 10.1080/14719037.2013.792380
  39. van Lent W.A.M., Goedbloed N., van Harten W.H. (2009). Improving the efficiency of a chemotherapy day unit: applying a business approach to oncology. European Journal of Cancer, 45(8): 800-806.
  40. Womack J.P., Jones D.T (1996). Lean Thinking: Banish Waste and Create Wealth in Your Corporation. New York: Simon and Schuster. Womack J.P., Byrne A.P., Fiume J.O., Kaplan G.S., Toussaint J.T. (2005). Going Lean in Health Care. Innovation Series 2005. -- Testo disponibile al sito: https://www.entnet.org/sites/default/files/GoingLeaninHealthCareWhitePaper-3.pdf.
  41. Womack J.P., Jones, D.T. and Roos D. (1990). The Machine That Changed. New York, NY: The World, Rawson Associates.
  42. Yousri T.A., Khan Z., Chakrabarti D., Fernandez R., Wahab K. (2011). Lean thinking: Can it improve the outcome of fracture neck of femur patients in a district general hospital?, Injury, 42(11): 1234-1237.

  • Lean Six Sigma to reduce the acute myocardial infarction mortality rate: a single center study Angelo Rosa, Teresa Angela Trunfio, Giuliano Marolla, Antonietta Costantino, Davide Nardella, Olivia McDermott, in The TQM Journal /2023 pp.25
    DOI: 10.1108/TQM-03-2022-0082

Angelo Rosa, Giuliano Marolla, Francesco Zammori, Applicazione dello strumento Lean A3 al percorso di presa in carico di pazienti anziani con frattura del femore: il caso studio di un ospedale pugliese in "MECOSAN" 106/2018, pp 37-63, DOI: 10.3280/MESA2018-106003