Improving Care Continuity in Oncology Settings: A Lean Management Approach to Minimize Discharges Without Follow-Up Appointments.

OBJECTIVE: This study aimed to reduce the number of patients discharged without scheduled follow-up appointments by implementing lean management principles. METHODS: Conducted at the Sultan Qaboos Comprehensive Cancer Center in Muscat, Oman, the research utilized a one-group pretest-posttest quasi-experimental design to evaluate the impact of lean management interventions on the rate of patient discharges without follow-up appointments. Strategies such as the Kaizen principle, Gemba Walks, cross-functional collaboration, standard work procedures, and waste reduction were employed to enhance operational efficiency. RESULTS: Spanning from Quarter 3 of 2022 to Quarter 2 of 2023, the study demonstrated a significant decrease in the percentage of patients discharged without planned follow-up appointments. The rate dropped from 9% in September 2022 to 0% in March 2023, with statistically significant differences observed (X2= 65.05, p value=<.0001). CONCLUSION: By effectively implementing lean management principles, this research successfully enhanced care continuity for oncology patients after being discharged.

The clinical trial activation process: a case study of an Italian public hospital.

BACKGROUND/AIMS: In order to make the centers more attractive to trial sponsors, in recent years, some research institutions around the world have pursued projects to reorganize the pathway of trial activation, developing new organizational models to improve the activation process and reduce its times. This study aims at analyzing and reorganizing the start-up phase of trials conducted at the Research and Innovation Department (DAIRI) of the Public Hospital of Alessandria (Italy). METHODS: A project was carried out to reorganize the trial authorization process at DAIRI by involving the three facilities responsible for this pathway: clinical trial center (CTC), ethics committee secretariat (ESC), and administrative coordination (AC). Lean Thinking methodology was used with the A3 report tool, and the analysis was carried out by monitoring specific key performance indicators, derived from variables representing highlights of the trials' activation pathway. The project involved phases of analysis, implementation of identified countermeasures, and monitoring of timelines in eight 4-month periods. The overall mean and median values of studies activation times were calculated as well as the average times for each facility involved in the process. RESULTS: In this study, 298 studies both sponsored by research associations and industry with both observational and interventional study design were monitored. The mean trial activation time was reduced from 218 days before the project to 56 days in the last period monitored. From the first to the last monitoring period, each facility involved achieved at least a halving of the average time required to carry out its activities in the clinical trials' activation pathway (CTC: 55 days vs 23, ECS: 25 days vs 8, AC 29 days vs 10). Average activation time for studies with agreement remains longer than those without agreement (100 days vs. 46). CONCLUSIONS: The reorganization project emphasized the importance of having clinical and administrative staff specifically trained on the trial activation process. This reorganization led to the development of a standard operating procedure and a tool to monitor the time (KPIs of the process) that can also be implemented in other clinical centers.

Improving Efficiency in Hospital Pharmacy Services: An Integrated Strategy Using the OCTAGON-P Framework and Lean 5S Management Practices.

Background Hospital pharmacy departments have a critical role in the healthcare system, as they aim to provide excellent patient services while also ensuring cost-effectiveness. Lean methodologies are well-known for improving efficiency and quality in various industries, but their impact on healthcare, particularly in hospital pharmacy settings, has not been thoroughly investigated. Aim This quality improvement (QI) study aimed to assess the impact of implementing the sort, set in order, shine, standardize, and sustain (5S) methodology using the innovative orientation, coordination, training, awareness, governance, observation, normalization, and promotion (OCTAGON-P) framework on the operations of Mediclinic Parkview Hospital (MPAR) Pharmacy in Dubai, UAE. Methods The QI project spanned a period of six weeks, from December 18th, 2023, to January 28th, 2024. Throughout this period, a new novel OCTAGON-P framework's eight crucial elements were methodically integrated. Simultaneously, an extensive preparation process encompassing the five stages of the 5S method was carried out. Results The findings indicated a notable enhancement in organization, orderliness, cleanliness, medication storage, and workspace standardization. The significant improvement of 217% in terms of organization highlighted the effectiveness of resource arrangement. The orderliness of the workspace saw an increase of 800%, indicating a transformation in the systematic organization. Additionally, cleanliness improved by 138%, demonstrating a significant advancement in maintaining a spotless environment. The standardization of processes experienced a boost of 300%, reflecting a solidified approach to consistent operational methods. These refinements resulted in an overall improvement of 90% from the initial baseline of 20% on the 5S checklist scores. Efficiency gains were observed, with outpatient medication retrieval times reduced by 50%, inpatient times by 40%, emergency prescription serving by 16.7%, and pediatric prescription serving by 11%. The inpatient medication return process saw a 67% improvement. Patient counseling time increased by 23.3%, indicating a more patient-centered approach. Prescription verification and medication expiry checks increased by 50% and 200%, respectively, enhancing the quality of care. Inventory management efficiency improved by 36%, and medication label printing time decreased by 70% with the additional label printers. Installing extra medication label printers was done through the OCTAGON-P framework, specifically in the "orientation" and "coordination" phases. These two initial phases focused on leadership's 5S orientation, management support, and securing additional resources. Therefore, the OCTAGON-P framework provided a structured approach that promoted continuous improvement and sustained lean practices. Conclusion This research study presented the remarkable effectiveness of the OCTAGON-P framework in structurally implementing the 5S methodology into hospital pharmacy operations. The findings underscored the potential of lean 5S to enhance and optimize operational efficiency and overall quality within the critical environment of hospital pharmacy settings. Consequently, these improvements can conclusively result in the provision of superior and enhanced patient care, which is truly fundamental and central to the mission and objectives of any healthcare institution.

Contribution of proactive management of healthcare risks to the reduction of adverse events in a maternity hospital.

BACKGROUND: The risks of the childbirth assistance process are still very high, both for mothers and babies. According to the WHO, birth-related asphyxia accounts for 23% of all 3.3 million annual neonatal deaths and an even larger number of survivors with disabilities. On the other hand, maternal mortality is still a global challenge, affecting 17 mothers per 100 000 births in the USA. This is associated with the use of outdated technologies and a lack of well-defined processes in monitoring labour and early recognition of maternal clinical deterioration. METHOD: This study used Lean methodology to map the care flow for pregnant women in a Brazilian maternity hospital (Hospital Israelita Albert Einstein) in order to identify the risks within this process and a set of actions to minimise them. The work team consisted of 29 individuals, including local medical and nursing leaders, as well as healthcare professionals. The What-if tool was used to categorise the levels of risks, and the proportion of severe and catastrophic adverse events was evaluated before and after the implementation of changes. RESULTS: After the implementation of the actions, 100% of the extreme risks (28 risks) and 8% of the high risks (4 risks) were eliminated. This led to a reduction in the interval between severe/catastrophic events from 126 to 284 days, even with an increase in the average monthly number of visits from 367 to 449. Consequently, the weighted value of events decreased from 7.91 to 3.29 per 1000 patients treated, resulting in an annual cost savings of R$693 646.80 (US$139 000.00). DISCUSSION: The construction of a process based on Lean methodology was essential for mapping the involved risks and implementing a set of actions to minimise them. The participation of the healthcare team and leadership seemed to be important in choosing the measures to be adopted and their applicability. The results found can be attributed to both the established changes and the safety culture brought about by this constructive process.

Research on the construction of information-based nursing quality control system based on deep learning model under the lean perspective.

OBJECTIVE: In order to improve nursing quality management and protect patient medical safety, it is necessary to change the default mode and completely integrate information technology and nursing quality control utilising lean management. METHODS: A database was created, the nurse quality control scoring standard was entered into the computer and after the inspection, and various inspection reports were entered into the computer to precisely and promptly preserve data. The computer was then utilised to precisely assess the intensity and quality of nursing work, compute, count, and analyse the stored data, output the quality of nursing work in each department as a report, and adopt lean management for the gathered issues. RESULTS: To reach the objective of raising nursing quality, data analysis makes it simple to identify flaws and consistently strengthen the weak points. In order to create an information-based nursing quality control system with a simple and effective method as well as results that are scientific and objective, lean management is brought into the construction process.

Optimization of the STARlet workflow for semi-automatic SARS-CoV-2 screening of swabs and deep respiratory materials using the RealAccurate Quadruplex SARS-CoV-2 PCR kit and Allplex SARS-CoV-2 PCR kit.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic triggered the implementation of large-scale screenings in the health care and in the general population. Consequently, medical laboratories have to apply lean laboratory management to design workflows that are able to process large batches within short turnaround times while maintaining flexibility to use different SARS-CoV-2 reverse transcription polymerase chain reactions (RT-PCRs) and to be able to process a variety of clinical samples. We validated two SARS-CoV-2 PCR assays on the STARlet workflow: Allplex SARS-CoV-2 PCR kit and RealAccurate Quadruplex SARS-CoV-2 PCR kit. Furthermore, we optimized and validated the STARlet workflow for semi-automatic screening for SARS-CoV-2 in upper respiratory swabs and deep respiratory materials (sputa, bronchoalveolar lavage, and aspirate). Strikingly, guanidine-containing lysis buffers allow for easy processing and can enhance sensitivity of SARS-COV-2 screening since sampling in these buffers may preserve viral transcripts as evident by the higher copy numbers of the SARS-CoV-2 N gene. Moreover, using the principles of lean laboratory management, several bottlenecks that are typical for medical laboratories were addressed. We show that lean laboratory management resulted in significant reduction of the turnaround times of the SARS-CoV-2 PCR in our laboratory. This report thus describes a useful framework for laboratories to implement similar semi-automated workflows.IMPORTANCEThe SARS-CoV-2 pandemic triggered the implementation of large-scale screenings in the health care and in the general population. Consequently, medical laboratories had to adapt and evolve workflows that are able to process large batches within short turnaround times while maintaining flexibility to use different assays and to be able to process a variety of clinical samples. We describe how the need for increased outputs and greater flexibility was addressed with respect to clinical samples and assays (Allplex SARS-CoV-2 PCR and RealAccurate Quadruplex SARS-CoV-2 PCR). Strikingly, we found that upper respiratory swabs collected in guanidine-containing lysis buffers both improved the ease of processing as well as enhanced the sensitivity of the SARS-CoV-2 screening. This report thus describes a useful framework for laboratories to implement and optimize similar semi-automated workflows.

Unveiling the Impact of Lean Leadership on Continuous Improvement Maturity: A Scoping Review.

Purpose: Lean Management (LM) is a process improvement approach with growing interest from healthcare organizations. Obtaining a culture of continuous improvement is a primary objective of LM, and a culture of continuous improvement indicates a mature LM approach, and here leadership plays a central role. However, a comprehensive overview of leadership activities influencing LM maturity is lacking. This study aims to identify leadership activities associated with continuous improvement and, thus, LM, maturity. Methods: Following the PRISMA guidelines, a scoping literature review of peer-reviewed articles was conducted in twenty healthcare management journals. The search provided 466 articles published up until 2023. During the selection process, 23 studies were included in the review. The leadership activities related to continuous improvement maturity were identified using the grounded theory approach and data coding. Results: The analysis highlighted a total of 58 leadership activities distributed across nine themes of LM leadership. Next, analysing leadership activities concerning the different maturity levels revealed three maturity stages: beginner, intermediate, and expert. Based on the findings, we propose a framework that guides suitable leadership activities at the various stages of LM maturity. The framework provides leaders in healthcare with a practical overview of actions to facilitate the growth of the LM approach, and the related propositions offer academics a theoretical basis for future studies. Conclusion: This review presents the first comprehensive overview of LM leadership activities in relation to continuous improvement and LM maturity. To enhance LM maturity, leaders are encouraged to consider their leadership style, (clinical) stakeholder involvement, alignment with the organizational strategy, and their role in promoting employee autonomy.

Building lean improvement sckills at scale: an evaluation of a massive open online course in the English NHS.

BACKGROUND: Internationally, healthcare systems face challenges from population demographics and rising care costs. Systematic methods of quality improvement (QI) are considered key to delivering needed transformation and change. Large-scale training in QI skills is required.Massive open online courses (MOOCs) are an inexpensive strategy for QI training across large regions and countries. The Lean Fundamentals MOOC was developed in the English NHS to train health and care staff in Lean QI methods. It supported participants to learn and apply process improvement skills through a free-to-access, practical, learning-in-action approach. METHODS: Lean Fundamentals' cost-effectiveness and its impact on participants' knowledge and confidence to apply Lean to improve processes were assessed. Using the Kirkpatrick framework, participant reaction, knowledge and confidence change, results and overall return-on-investment (ROI) were evaluated. Quantitative data were collected via pre and postcourse surveys to analyse participants' knowledge and confidence change using the Wilcoxon signed rank test. Qualitative learning platform and postcourse survey data demonstrated participants' results from application. RESULTS: Over 18 months, Lean Fundamentals attracted 6617 enrolments and supported 3462 active participants. 97.6% (n=829) of participants completing the postcourse survey indicated Lean Fundamentals met their expectations and 97.2% (n=823) indicated they would recommend it. Self-reported changes in knowledge and confidence to apply Lean showed significant differences (p<0.001). Learning was applied to operational healthcare priorities (such as post-COVID recovery of services) and participants shared 511 project improvement reports. CONCLUSION: Lean Fundamentals helped large numbers of participants to develop Lean process improvement skills-avoiding costs associated with commercial Lean training in the range £1.7 m to £3.4 m and generating ROI of between £11 and £23 per every pound spent on delivery. This demonstrates that massive online is an effective and efficient method for building improvement knowledge and skills at scale.

What are barriers and facilitators in sustaining lean management in healthcare? A qualitative literature review.

BACKGROUND: Lean management (LM) is a continuous improvement methodology originating from manufacturing and is widely adopted in healthcare to improve processes. LM shows promising results in healthcare and research on the topic is increasing. However, it can be difficult to sustain LM over time, and an overview of facilitators or barriers that influence the sustainment of LM in a healthcare context is unavailable. METHODS: Prior to search, five inclusion and exclusion criteria were defined to establish suitability of identified articles for our research question. This study was based on 24 selected peer-reviewed studies that reported on the sustainment of LM in healthcare organisations, published in the last five years. Following the Preferred Reporting Items for Systemtic Reviews and Meta-Analyses (PRISMA) guidelines, all articles were scanned, retrieved for full-text and analysed thematically. RESULTS: Following thematic analysis, we identified four overarching themes: Mobilising Employees, Guiding Change Efforts, Methods, and Local Context. Key facilitators for supporting LM are fostering an improvement culture and learning culture, providing professional development opportunities, assigning more responsibilities to employees in decision making processes and appointing change agents to act as local LM leaders. Key barriers for sustaining LM include overburdening employees with responsibilities, omitting staff involvement during LM implementation, lack of patient engagement, lack of resources to engage with LM, a lack of leadership commitment and follow-up on projects, and a lack of knowledge of LM among leaders. CONCLUSION: Overall, studies emphasise the importance of actively involving and engaging the workforce to embed LM into organisational culture. Reflecting on the origins of LM, healthcare organisations can find inspiration in the virtue of respecting people in their journey to sustain and cultivate an improvement culture. LM provides potential to change healthcare for the better and could help healthcare organisations to cope with increasing external pressures.

A lean approach to robotic process automation in banking.

Automation is a concept that has been previously introduced in organizations as a means to improve their processes. However, Robotic Process Automation (RPA) is an emerging method to automate processes with software, which the industry calls robots. These robots perform repetitive and low-complexity tasks previously performed by humans in front of a computer which as is known is the most commonly used feature in a company nowadays. Using the Design Science Research methodology to build up this article, it is argued that RPA is being used idly compared to its full potential which would entail using process improvement techniques before applying the automation itself. Thus, this article proposes a new approach to RPA through the use of Lean techniques. This article assesses two market leaders in RPA. It suggests a framework of activities for organizations that are investing in RPA and that want to take advantage of the capabilities currently offered by this technology. The majority of the demonstration proposal was carried out in a Portuguese private bank in three processes. Depending on the different cases, it had an overall positive evaluation in the field or simulations. Comparing RPA and Lean RPA projects in the number of resources (time, FTE) needed to carry out business processes, the latter approach presented values that were significantly lower and, consequently, satisfactory.

Lean management of nursing human resources during COVID-19 pandemic.

AIM: To find a rapid, scientific, rational and accurate method of allocating nursing human resources during the COVID-19 pandemic. DESIGN: A longitudinal prospective study. METHODS: Lean management tool is used to implement four-level scheduling of nursing human resources, which is departmental level, district level, hospital level and city level, according to the daily reporting data of the whole hospital, such as Lianfan scheduling data, Dingding sensitive data and Hospital Information System daily report data. RESULTS: Fifty batches of nursing manpower, 294 nurses and 3813 working days were deployed during the pandemic, and the nursing human resources allocation mathematical models of the hospital and all departments were constructed. Since COVID-19 occurred, the infection rate of nurses with novel coronavirus and the mortality rate of critical patients have been keeping 0%, and the cure rate of common patients has been 100%. CONCLUSION: The use of lean management tool to allocate nursing human resources plays a positive role in ensuring zero infection of nurses, improving the cure rate of common patients and reducing the mortality rate of critically ill patients with COVID-19.

[Research on Management Efficiency of Hospital Low-value Consumables in Nursing Unit under Lean Management Mode].

Aiming at the management efficiency problems in the traditional medical low-value consumables management mode of the nursing unit, based on the perspective of supply chain management, this study uses lean management method to construct the lean management mode of low-value consumables with a whole cycle and whole process information monitoring, and analyzes the application effect of this mode. The results show that after the application of lean management mode, the low-value consumables of the nursing unit can achieve "consumables in use=priced consumables + un-priced consumables", the settlement cost is significantly reduced and its stability is high, and the efficiency of "supply-inventor-distribution" link is significantly enhanced. This model effectively improves the management efficiency of low-value consumables in the hospital, and also provides a reference for other hospitals to improve the management level of low-value consumables.

Rationalisation of laboratory tests ordering and consumption at Armed Forces Hospital, Jazan.

Laboratory testing is one of the major and important component of medical diagnosis. However, unrationalised laboratory test ordering may lead to misdiagnosis of diseases which would delay treatment of the patients. It would also lead to wasting the laboratory resources that adversely impact the hospital budget. The aim of this project was to rationalise laboratory tests ordering and ensure effective utilisation of resources at Armed Forces Hospital Jizan (AFHJ). This study included two major steps: (1) the development and implementation of quality improvement interventions to reduce the unnecessary and abuse of laboratory testing in the AFHJ and (2) evaluation of the effectiveness of these interventions. In order to determine the possible causes of the problem, fishbone diagram was used to structure a brainstorming session. Pareto analysis was used to prioritise the causes so that the emphasis can be laid on most significant one. After interventions implementation, the data analysed and found that there was significant differences between 2019 and 2021 of total patients percentage and distribution that was revealed by box plot, who had a request of Hemoglobin A1c (HbA1c) (p=0.002), Thyroid Stimulating Hormone (TSH) (p=0.002), Free Thyroine (FT4) (p=0.002), Free Triiodothyronine (FT3) (p=0.001), Follicle-Stimulating Hormone (FSH) (p=0.002), Luteinizing Hormone (LH) (p=0.002) and Prolactin (PRL) (p=0.001). We achieved a 33% reduction in total laboratory tests cost and the total laboratory budget decreased from 6 000 000 SR in 2019 to about 4 000 000 Saudi Riyals (SR) in 2021. A change in laboratory resource consumption requires changes in physicians awareness. A modification of the electronic ordering system applied more restrictions to the ordering physicians. Extending these measures to the entire hospital might lead to significant reduction in the healthcare costs.

The initiation, exploration, and development of hospital-based health technology assessment in China: 2005 ‒ 2022.

A hospital-based health technology assessment (HB-HTA) can provide the evidence needed to inform clinical decisions at the administrative level. With the implementation of a new round of medical and health care system reforms in China, such as the abolition of medical mark-ups, adoption of modern hospital management systems, reform of diagnosis related groups (DRGs) payment, and performance evaluations for public hospitals, medical institutions increasingly need HB-HTA. The development of HB-HTA in China can be divided into three phases: An initiation phase (2005-2014), a preliminary exploratory phase (2015-2017), and a rapid development phase (2018-present). HB-HTA has been used to manage medical consumables, medical devices, and medicines, but there are still problems and challenges in terms of concept recognition, the mode of development, and limited professionals and data. To promote and use HB-HTA in developing countries, we have identifies the development paths and recommendations for implementation based on a case study in China, which can be summarized as follows: enhancing the top-level design of HB-HTA, formulating HB-HTA guidelines, further promoting the main ideas of HB-HTA, concentrating on the training of evaluation personnel, establishing an HB-HTA network and paying attention to the flexibility of HB-HTA in the application process, and multi- stakeholder participation.

Quality and process improvement of the multidisciplinary Heart Team meeting using Lean Six Sigma.

INTRODUCTION: The Heart Team is a multidisciplinary meeting for shared decision-making in cardiology and cardiothoracic surgery. A quality improvement project to optimise the Heart Team was initiated after the merger of the cardiac centres of Amsterdam University Medical Centre. METHODS: Lean Six Sigma was applied with the purpose of improving efficiency and quality of care. Qualitative and quantitative analyses supported the multidisciplinary team during quality improvement sessions. Lean Six Sigma tools included process mapping, gemba walks, root cause analysis, line balancing, first time right, standardised work and poka-yoke. INTERVENTIONS: Seven areas of improvement were introduced. Key elements were the improvement of the patient referral process, introduction of a structured agenda, task division and balanced planning of patients, better exchange of information, improved availability of diagnostics and supportive tools and information technology. Work agreements were introduced to support a positive work culture and mutual respect. RESULTS: Lean Six Sigma designed an optimised Heart Team to improve efficiency by better resource utilisation, first time right decision-making, patient selection, complete and better access to information and elimination of waste. It leads to higher quality of decision-making by involving physicians in a more structured preparation, attendance of an imaging cardiologist, meeting duration within limits, installation of standard operating procedures, increased involvement of the referring cardiologists and a better engaged team. CONCLUSIONS: Heart Teams are essential to make evidence-based, patient-centred treatment plans for optimal patient outcomes. However, clinical practice and experience showed that it is challenging to have an efficient and effective discussion with complete patient information and to bring together healthcare professionals. The application of Lean Six Sigma resulted in an optimised Heart Team and created a best practice design for patient-centred, evidence-based decision-making. After implementation and process stability, a postintervention analysis could clarify long-term success and sustainability.

Implementation of Lean Management Tools Using an Example of Analysis of Prolonged Stays of Patients in a Multi-Specialist Hospital in Poland.

Healthcare institutions in Poland constantly encounter challenges related both to the quality of provided services and to the pressures associated with treatment effectiveness and economic efficiency. The implemented solutions have a goal of improving the service quality of lowering the continuously increasing operational costs. The aim of this paper is to present the application of Lean Management (LM) tools in a Polish hospital, which allowed for the identification of prolonged stays as one of the main issues affecting the service costs and the deteriorating financial results of the hospital. The study was conducted in the neurology department and involved an analysis of data for the whole of 2019 and the first half of 2022. In addition, surveys were conducted among the medical staff to help identify the main causes of prolonged stays. Methods of data analysis and feasible solutions were developed in order to improve the economic efficiency of the unit. The analysis shows that the application of LM tools may contribute to improvement in the functioning of hospitals and that further studies should focus on the development of the method to evaluate efficiency of the implemented solutions intended at shortening the hospital stays of the patients.

Methodology focused on the selection of construction operations for the standardization of work with an emphasis on the occupational safety criterion.

This article indicates that work standardization is an effective tool for the improvement of occupational safety in any process performed by people. Work standardization has an impact on improving productivity, quality and engaging employees in improving current working methods. The article shows that in the construction industry there are problems concerning the selection of operations for work standardization due to the specificity of the operations performed there. As a result, work standardization is not a common methodology used in the construction industry, which may be one of the reasons for the greater number of accidents and near misses when compared to the manufacturing industry. The article presents the author's safety-complication-frequency (SCF) model for the selection of operations for work standardization, which is dedicated to the construction industry. The SCF model enables operations with the highest priority in terms of implementation for work standardization to be selected.

Achieving transformation to lean management systems in health care.

OBJECTIVE: To understand what factors and organizational dynamics enable Lean transformation of health care organizations. DATA SOURCES: Primary data were collected through two waves of interviews in 2016-2017 with leaders and staff at seven veterans affairs medical centers participating in Lean enterprise transformation. STUDY DESIGN: Using an observational study design, for each site we coded and rated seven potential enablers of transformation. The outcome measure was the extent of Lean transformation, constructed by coding and rating 11 markers of depth and spread of transformation. Using multivalue coincidence analysis (CNA), we identified enablers that distinguished among sites having different levels of transformation. We identified representative quotes for the enablers. DATA COLLECTION METHODS: We interviewed 121 executive leaders, middle managers, expert consultants, systems redesign staff, frontline supervisors, and staff. PRINCIPAL FINDINGS: Two sites achieved high Lean transformation, three medium, and two low. Together leadership support and capability development were sufficient for the three-level Lean transformation outcomes with 100% consistency and 100% coverage. High scores on both corresponded to high Lean transformation; medium on either one corresponded to medium transformation; and low on both corresponded to low transformation. Additionally, low scores in communication and availability of data and very low scores in alignment characterized low-transformation sites. Sites with high leadership support also had a high veteran engagement. CONCLUSIONS: This multisite study develops a novel measure of the extent of organization-wide Lean transformation and uses CNA to identify enablers linked to transformation. It provides insights into why and how some organizations are more successful at transformation than others. Findings support the applicability of the organization transformation model that guided the study and highlight the roles of executive leadership and capability development in the dynamics of transformation.

Research on Management Efficiency of Hospital Low-value Consumables in Nursing Unit under Lean Management Mode / 中国医疗器械杂志

Aiming at the management efficiency problems in the traditional medical low-value consumables management mode of the nursing unit, based on the perspective of supply chain management, this study uses lean management method to construct the lean management mode of low-value consumables with a whole cycle and whole process information monitoring, and analyzes the application effect of this mode. The results show that after the application of lean management mode, the low-value consumables of the nursing unit can achieve "consumables in use=priced consumables + un-priced consumables", the settlement cost is significantly reduced and its stability is high, and the efficiency of "supply-inventor-distribution" link is significantly enhanced. This model effectively improves the management efficiency of low-value consumables in the hospital, and also provides a reference for other hospitals to improve the management level of low-value consumables.