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A topical collection in International Journal of Environmental Research and Public Health (ISSN 1660-4601).

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Editors

Prof. Dr. Giovanni Improta

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Collection Editor

Department of Public Health, University of Naples Federico II, 80134 Naples, Italy
Interests: bioengineering; public health; healthcare decision making; machine learning and data mining for healthcare; modeling and analysis of biomedical data; health technology assessment; quality improvement in healthcare; lean six sigma; biomedical signal processing and analysis
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Prof. Dr. Massimo Martorelli

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Department of Industrial Engineering, Fraunhofer JL IDEAS-University of Naples Federico II, P.le Tecchio 80, 80125 Naples, Italy
Interests: design for additive manufacturing; reverse engineering; design methods; creative design; mechanical analysis; modeling and simulation; biomechanics; scaffold design
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Dr. Alfonso Maria Ponsiglione

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Collection Editor

Department of Electrical Engineering and Information Technology (DIETI), University of Naples Federico II, Naples, Italy
Interests: biomedical engineering; bioengineering; nanomedicine; magnetic resonance imaging; contrast agents; microfluidics; biomaterials; nanoparticles; biomedical data analysis; biomedical signal processing; heart rate variability; fetal heart rate variability; electronic fetal monitoring; lean six sigma in healthcare
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Prof. Dr. Antonio Gloria

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Institute of Polymers, Composites and Biomaterials, National Research Council of Italy, Naples, Italy
Interests: design for additive manufacturing; reverse engineering; design methods; creative design; mechanical analysis; modeling and simulation; biomechanics; scaffold design
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Topical Collection Information

Dear Colleagues,

Lean Six Sigma is a methodology which combines principles and tools of Six Sigma and Lean production in order to avoid wastes. The objective is to optimize the utilization of resources, work areas, production process and, at the same time, to assure high quality in production and in process management. This methodology comes from the manufacturing sector. In fact, Lean thinking has been used to describe the Toyota Production System, while Six Sigma has been developed in 1987 by the Motorola Corporation to improve products quality. Lean Six Sigma is capable of combining the statistical analysis power of Six Sigma with the tools and principles used to eliminate wastes and reduce lead times, which is typical of Lean system.

In the last few years, Lean Six Sigma has been also implemented in the health care sector to reduce wastes and to measure process inefficiency in order to reduce it via corrective actions. Unfortunately, not all the healthcare sector implements Lean Six Sigma. For this reason, it is important to keep the research active. Indeed, implementing Lean Six Sigma in the whole health care sector and keeping all personnel involved in this process focused on performance and patient satisfaction (Performance and Patient Centric) could represent a great opportunity to lean towards operational excellence.

The objective of this Topical Collection is to attract ideas regarding the application of Lean Six Sigma tools in healthcare. Especially appreciated are original research articles which could contribute to providing guidelines, tools, and techniques in order to improve healthcare processes for political leaders. Review articles which summarize the state of the art and recent advances in these topics are also welcome.

Potential topics include but are not limited to the following:

Reducing hospital costs
Reducing the amount of hospital-acquired infections
Reducing patient waiting time
Introducing new clinical procedures in order to reduce the amount of length of hospital stays
Comparing drugs
Improving quality of care provided

Dr. Giovanni Improta
Prof. Dr. Massimo Martorelli
Dr. Alfonso Maria Ponsiglione
Prof. Dr. Antonio Gloria
Collection Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the collection website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

lean
Six Sigma
Lean Six Sigma
DMAIC
healthcare quality improvement
process re-engineering
public health
patients’ satisfaction

Published Papers (4 papers)

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2021

22 pages, 4102 KiB

Open AccessArticle

Externalities of Lean Implementation in Medical Laboratories. Process Optimization vs. Adaptation and Flexibility for the Future

by Simona Andreea Apostu, Valentina Vasile and Cristina Veres

Int. J. Environ. Res. Public Health 2021, 18(23), 12309; https://doi.org/10.3390/ijerph182312309 - 23 Nov 2021

Cited by 12 | Viewed by 4198

Abstract

Important in testing services in medical laboratories is the creation of a flexible balance between quality-response time and minimizing the cost of the service. Beyond the different Lean methods implemented so far in the medical sector, each company can adapt the model according to its needs, each company has its own specifics and organizational culture, and Lean implementation will have a unique approach. Therefore, this paper aims to identify the concerns of specialists and laboratory medical services sector initiatives in optimizing medical services by implementing the Lean Six Sigma method in its various variants: a comparative analysis of the implemented models, with emphasis on measuring externalities and delimiting trends in reforming/modernizing the method, a comprehensive approach to the impact of this method implementation, and an analysis of available databases in order to underline the deficit and information asymmetry. The results highlighted that in the case of clinical laboratories, the Lean Six Sigma method is conducive to a reduction of cases of diagnostic errors and saves time but also faces challenges and employees’ resistance in implementation. Full article

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13 pages, 1113 KiB

Open AccessArticle

Six Sigma in Health Literature, What Matters?

by Ana-Beatriz Hernández-Lara, Maria-Victoria Sánchez-Rebull and Angels Niñerola

Int. J. Environ. Res. Public Health 2021, 18(16), 8795; https://doi.org/10.3390/ijerph18168795 - 20 Aug 2021

Cited by 9 | Viewed by 4172

Abstract

Six Sigma has been widely used in the health field for process or quality improvement, constituting a quite profusely investigated topic. This paper aims at exploring why some studies have more academic and societal impact, attracting more attention from academics and health professionals. Academic and societal impact was addressed using traditional academic metrics and alternative metrics, often known as altmetrics. We conducted a systematic search following the PRISMA statement through three well-known databases, and identified 212 papers published during 1998–2019. We conducted zero-inflated negative binomial regressions to explore the influence of bibliometric and content determinants on traditional academic and alternative metrics. We observe that the factors influencing alternative metrics are more varied and difficult to apprehend than those explaining traditional impact metrics. We also conclude that, independently of how the impact is measured, the paper’s content, rather than bibliometric characteristics, better explains its impact. In the specific case of research on Six Sigma applied to health, the papers with more impact address process improvement focusing on time and waste reduction. This study sheds light on the aspects that better explain publications’ impact in the field of Six Sigma application in health, either from an academic or a societal point of view. Full article

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21 pages, 3885 KiB

Open AccessReview

Lean Healthcare Tools for Processes Evaluation: An Integrative Review

by Letícia Bianchini de Barros, Letícia de Camargo Bassi, Laura Passos Caldas, Alice Sarantopoulos, Eliete Boaventura Bargas Zeferino, Vinicius Minatogawa and Renata Cristina Gasparino

Int. J. Environ. Res. Public Health 2021, 18(14), 7389; https://doi.org/10.3390/ijerph18147389 - 10 Jul 2021

Cited by 41 | Viewed by 10793

Abstract

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. Full article

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13 pages, 1109 KiB

Open AccessArticle

Lean Six Sigma Approach for Reducing Length of Hospital Stay for Patients with Femur Fracture in a University Hospital

by Arianna Scala, Alfonso Maria Ponsiglione, Ilaria Loperto, Antonio Della Vecchia, Anna Borrelli, Giuseppe Russo, Maria Triassi and Giovanni Improta

Int. J. Environ. Res. Public Health 2021, 18(6), 2843; https://doi.org/10.3390/ijerph18062843 - 11 Mar 2021

Cited by 92 | Viewed by 7197

Abstract

Surgical intervention within 48 h of hospital admission is the gold standard procedure for the management of elderly patients with femur fractures, since the increase in preoperative waiting time is correlated with the onset of complications and longer overall length of stay (LOS) in the hospital. However, national evidence demonstrates that there is still the need to provide timely intervention for this type of patient, especially in some regions of central southern Italy. Here we discuss the introduction of a diagnostic–therapeutic assistance pathway (DTAP) to reduce the preoperative LOS for patients undergoing femur fracture surgery in a university hospital. A Lean Six Sigma methodology, based on the DMAIC cycle (Define, Measure, Analyze, Improve, Control), is implemented to evaluate the effectiveness of the DTAP. Data were retrospectively collected and analyzed from two groups of patients before and after the implementation of DTAP over a period of 10 years. The statistics of the process measured before the DTAP showed an average preoperative LOS of 5.6 days (standard deviation of 3.2), thus confirming the need for corrective actions to reduce the LOS in compliance with the national guidelines. The influence of demographic and anamnestic variables on the LOS was evaluated, and the impact of the DTAP was measured and discussed, demonstrating the effectiveness of the improvement actions implemented over the years and leading to a significant reduction in the preoperative LOS, which decreased to an average of 3.5 days (standard deviation of 3.60). The obtained reduction of 39% in the average LOS proved to be in good agreement with previously developed DTAPs for femur fracture available in the literature. Full article

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Lean Six Sigma in Healthcare (Closed)

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2021

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