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Topical Collection "Lean Six Sigma in Healthcare"

Editors

Dr. Giovanni Improta
E-Mail Website
Collection Editor
1. Department of Public Health, University Hospital of Naples “Federico II”, 80131 Naples, Italy
2. Interdepartmental Center for Research in Healthcare Management and Innovation in Healthcare (CIRMIS), University of Naples “Federico II”, 80131 Naples, Italy
Interests: public health; health technology assessment; Lean Six Sigma; bioengineering; healthcare decision making; biomedical signal processing and analysis; quality improvement in healthcare; modeling and analysis of biomedical data; machine learning and data mining for healthcare
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Massimo Martorelli
E-Mail Website
Collection Editor
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
Special Issues, Collections and Topics in MDPI journals
Dr. Alfonso Maria Ponsiglione
E-Mail Website
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
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Antonio Gloria
E-Mail Website
Collection Editor

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 semimonthly 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 (6 papers)

2022

Jump to: 2021

Article
Machine Learning and Lean Six Sigma to Assess How COVID-19 Has Changed the Patient Management of the Complex Operative Unit of Neurology and Stroke Unit: A Single Center Study
Int. J. Environ. Res. Public Health 2022, 19(9), 5215; https://doi.org/10.3390/ijerph19095215 - 26 Apr 2022
Viewed by 525
Abstract
Background: In health, it is important to promote the effectiveness, efficiency and adequacy of the services provided; these concepts become even more important in the era of the COVID-19 pandemic, where efforts to manage the disease have absorbed all hospital resources. The COVID-19 [...] Read more.
Background: In health, it is important to promote the effectiveness, efficiency and adequacy of the services provided; these concepts become even more important in the era of the COVID-19 pandemic, where efforts to manage the disease have absorbed all hospital resources. The COVID-19 emergency led to a profound restructuring—in a very short time—of the Italian hospital system. Some factors that impose higher costs on hospitals are inappropriate hospitalization and length of stay (LOS). The length of stay (LOS) is a very useful parameter for the management of services within the hospital and is an index evaluated for the management of costs. Methods: This study analyzed how COVID-19 changed the activity of the Complex Operative Unit (COU) of the Neurology and Stroke Unit of the San Giovanni di Dio e Ruggi d’Aragona University Hospital of Salerno (Italy). The methodology used in this study was Lean Six Sigma. Problem solving in Lean Six Sigma is the DMAIC roadmap, characterized by five operational phases. To add even more value to the processing, a single clinical case, represented by stroke patients, was investigated to verify the specific impact of the pandemic. Results: The results obtained show a reduction in LOS for stroke patients and an increase in the value of the diagnosis related group relative weight. Conclusions: This work has shown how, thanks to the implementation of protocols for the management of the COU of the Neurology and Stroke Unit, the work of doctors has improved, and this is evident from the values of the parameters taken into consideration. Full article
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2021

Jump to: 2022

Article
Externalities of Lean Implementation in Medical Laboratories. Process Optimization vs. Adaptation and Flexibility for the Future
Int. J. Environ. Res. Public Health 2021, 18(23), 12309; https://doi.org/10.3390/ijerph182312309 - 23 Nov 2021
Cited by 1 | Viewed by 635
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 [...] Read more.
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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Article
A Health Technology Assessment in Maxillofacial Cancer Surgery by Using the Six Sigma Methodology
Int. J. Environ. Res. Public Health 2021, 18(18), 9846; https://doi.org/10.3390/ijerph18189846 - 18 Sep 2021
Cited by 1 | Viewed by 841
Abstract
Squamous cell carcinoma represents the most common cancer affecting the oral cavity. At the University of Naples “Federico II”, two different antibiotic protocols were used in patients undergoing oral mucosa cancer surgery from 2006 to 2018. From 2011, there was a shift; the [...] Read more.
Squamous cell carcinoma represents the most common cancer affecting the oral cavity. At the University of Naples “Federico II”, two different antibiotic protocols were used in patients undergoing oral mucosa cancer surgery from 2006 to 2018. From 2011, there was a shift; the combination of Cefazolin plus Clindamycin as a postoperative prophylactic protocol was chosen. In this paper, a health technology assessment (HTA) is performed by using the Six Sigma and DMAIC (Define, Measure, Analyse, Improve, Control) cycle in order to compare the performance of the antibiotic protocols according to the length of hospital stay (LOS). The data (13 variables) of two groups were collected and analysed; overall, 136 patients were involved. The American Society of Anaesthesiologist score, use of lymphadenectomy or tracheotomy and the presence of infections influenced LOS significantly (p-value < 0.05) in both groups. Then, the groups were compared: the overall difference between LOS of the groups was not statistically significant, but some insights were provided by comparing the LOS of the groups according to each variable. In conclusion, in light of the insights provided by this study regarding the comparison of two antibiotic protocols, the utilization of DMAIC cycle and Six Sigma tools to perform HTA studies could be considered in future research. Full article
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Article
Six Sigma in Health Literature, What Matters?
Int. J. Environ. Res. Public Health 2021, 18(16), 8795; https://doi.org/10.3390/ijerph18168795 - 20 Aug 2021
Viewed by 934
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. [...] Read more.
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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Review
Lean Healthcare Tools for Processes Evaluation: An Integrative Review
Int. J. Environ. Res. Public Health 2021, 18(14), 7389; https://doi.org/10.3390/ijerph18147389 - 10 Jul 2021
Cited by 3 | Viewed by 1799
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 [...] Read more.
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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Article
Lean Six Sigma Approach for Reducing Length of Hospital Stay for Patients with Femur Fracture in a University Hospital
Int. J. Environ. Res. Public Health 2021, 18(6), 2843; https://doi.org/10.3390/ijerph18062843 - 11 Mar 2021
Cited by 54 | Viewed by 1726
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) [...] Read more.
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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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Title: Implementing Fast Track Surgery in Hip and Knee Arthroplasty Using the Lean Six Sigma Methodology

Authors: Imma Latessa 1 and Antonella Fiorillo 2, Ilaria Picone 2, Carlo Ricciardi 2,*, Giovanni Balato 1,
Maria Triassi 1, Giovanni Improta 1

Affiliations:

  1. Department of Public Health, University Hospital of Naples “Federico II”, Naples, Italy.
  2. Department of Advanced Biomedical Sciences, University Hospital of Naples “Federico II”, Naples, Italy.
  3. Centro Interdipartimentale Di Ricerca In Management Sanitario E Innovazione In Sanità (CIRMIS)—Università degli Studi di Napoli "Federico II"

 

Title: Lean Six Sigma approach to reduce LOS through a diagnostic-therapeutic-assistance path at San Giovanni di Dio e Ruggi d'Aragona University Hospital

Authors: Arianna Scala 1,*, Alfonso Maria Ponsiglione 2, Antonio Della Vecchia 3, Anna Borrelli 3, Michele Sparano 3, Maria Triassi 1,4, Giovanni Improta 1,4

Affiliations:

  1. Department of Public Health, University Hospital of Naples “Federico II”, Naples, Italy.
  2. Department of Electrical Engineering and Information Technology, University Hospital of Naples “Federico II”, Naples, Italy.
  3. “San Giovanni di Dio e Ruggi d’Aragona”, University Hospital of Salerno, Salerno, Italy.
  4. Centro Interdipartimentale Di Ricerca In Management E Innovazione In Sanità (CIRMIS) - Università degli Studi di Napoli "Federico II"
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