Implementation of lean six sigma to tessen waiting times in public emergency care networks: a case study

Emergency Care Networks (ECNs) are integrated healthcare systems comprised of emergency departments (EDs). ECNs are called to be the primary response of healthcare authorities to deal with the expected uptick in the future demands for emergency care during the current Covid-19 pandemic. Lean Six Sig...

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Autores:
Ortiz Barrios, Miguel Angel
Coba Blanco, Dayana Milena
Salomon, Valerio
Jiménez, Genett
Tipo de recurso:
http://purl.org/coar/resource_type/c_816b
Fecha de publicación:
2021
Institución:
Corporación Universidad de la Costa
Repositorio:
REDICUC - Repositorio CUC
Idioma:
eng
OAI Identifier:
oai:repositorio.cuc.edu.co:11323/8982
Acceso en línea:
https://hdl.handle.net/11323/8982
https://repositorio.cuc.edu.co/
Palabra clave:
Covid-19
Emergency Care Networks (ECNs)
Healthcare
Lean Six Sigma (LSS)
Waiting times (WT)
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openAccess
License
CC0 1.0 Universal
id RCUC2_4fce9baf71df5026214e626b329ab1de
oai_identifier_str oai:repositorio.cuc.edu.co:11323/8982
network_acronym_str RCUC2
network_name_str REDICUC - Repositorio CUC
repository_id_str
dc.title.spa.fl_str_mv Implementation of lean six sigma to tessen waiting times in public emergency care networks: a case study
title Implementation of lean six sigma to tessen waiting times in public emergency care networks: a case study
spellingShingle Implementation of lean six sigma to tessen waiting times in public emergency care networks: a case study
Covid-19
Emergency Care Networks (ECNs)
Healthcare
Lean Six Sigma (LSS)
Waiting times (WT)
title_short Implementation of lean six sigma to tessen waiting times in public emergency care networks: a case study
title_full Implementation of lean six sigma to tessen waiting times in public emergency care networks: a case study
title_fullStr Implementation of lean six sigma to tessen waiting times in public emergency care networks: a case study
title_full_unstemmed Implementation of lean six sigma to tessen waiting times in public emergency care networks: a case study
title_sort Implementation of lean six sigma to tessen waiting times in public emergency care networks: a case study
dc.creator.fl_str_mv Ortiz Barrios, Miguel Angel
Coba Blanco, Dayana Milena
Salomon, Valerio
Jiménez, Genett
dc.contributor.author.spa.fl_str_mv Ortiz Barrios, Miguel Angel
Coba Blanco, Dayana Milena
Salomon, Valerio
Jiménez, Genett
dc.subject.spa.fl_str_mv Covid-19
Emergency Care Networks (ECNs)
Healthcare
Lean Six Sigma (LSS)
Waiting times (WT)
topic Covid-19
Emergency Care Networks (ECNs)
Healthcare
Lean Six Sigma (LSS)
Waiting times (WT)
description Emergency Care Networks (ECNs) are integrated healthcare systems comprised of emergency departments (EDs). ECNs are called to be the primary response of healthcare authorities to deal with the expected uptick in the future demands for emergency care during the current Covid-19 pandemic. Lean Six Sigma (LSS) has been proposed to address this challenge since it allows managers to detect factors contributing to the extended waiting times (WT) throughout the patient journey. The suggested framework follows the DMAIC cycle that was initiated with the project charter definition; in the meantime, a SIPOC diagram was drawn to analyze the emergency care process and pinpoint critical process variables. Following this, a nested Gage R&R study was undertaken to study the measurement system performance; subsequently, a normal-based capability analysis was carried out to determine how well the ECN process satisfies the specifications. The next step was to identify the potential causes separating the ECN nodes from the desired target. Afterwards, improvement strategies were devised to lessen the average WT. After suitable data collection, a before-and-after analysis was performed to verify the effectiveness of the implemented strategies. Ultimately, a control plan containing an I-MR control chart was designed to maintain the improvements achieved with the LSS implementation. The results revealed that the average WT of the showcased node passed from 190.02 min to 103.1 min whereas the long-term sigma level increased from −0.06 to 0.11. The proposed framework was validated through a case study including the involvement of a medium-sized hospital from the public sector. © 2021, Springer Nature Switzerland AG.
publishDate 2021
dc.date.issued.none.fl_str_mv 2021
dc.date.accessioned.none.fl_str_mv 2022-01-19T20:32:34Z
dc.date.available.none.fl_str_mv 2022-01-19T20:32:34Z
dc.date.embargoEnd.none.fl_str_mv 2022
dc.type.spa.fl_str_mv Pre-Publicación
dc.type.coar.spa.fl_str_mv http://purl.org/coar/resource_type/c_816b
dc.type.content.spa.fl_str_mv Text
dc.type.driver.spa.fl_str_mv info:eu-repo/semantics/preprint
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dc.type.version.spa.fl_str_mv info:eu-repo/semantics/acceptedVersion
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dc.identifier.uri.spa.fl_str_mv https://hdl.handle.net/11323/8982
dc.identifier.doi.spa.fl_str_mv DOI:10.1007/978-3-030-90966-6_7
dc.identifier.instname.spa.fl_str_mv Corporación Universidad de la Costa
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dc.identifier.repourl.spa.fl_str_mv https://repositorio.cuc.edu.co/
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identifier_str_mv DOI:10.1007/978-3-030-90966-6_7
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language eng
dc.relation.references.spa.fl_str_mv 1 Manns, B.J., Wasylak, T. Clinical networks: Enablers of health system change (Open Access) (2019) CMAJ, 191 (47), pp. E1299-E1305. Cited 4 times. https://www.cmaj.ca/content/cmaj/191/47/E1299.full.pdf doi: 10.1503/cmaj.190313
2 Brown, B.B., Patel, C., McInnes, E., Mays, N., Young, J., Haines, M. The effectiveness of clinical networks in improving quality of care and patient outcomes: A systematic review of quantitative and qualitative studies (Open Access) (2016) BMC Health Services Research, 16 (1), art. no. 360. Cited 50 times. http://www.biomedcentral.com/bmchealthservres/ doi: 10.1186/s12913-016-1615-z
3 Al Owad, A., Karim, M.A., Ma, L. Integrated Lean Six Sigma approach for patient flow improvement in hospital emergency department (2013) Advanced Materials Research, 834-836, pp. 1893-1902. Cited 12 times. ISBN: 978-303785916-2 doi: 10.4028/www.scientific.net/AMR.834-836.1893
4 Sklar, D.P., Handel, D.A., Hoekstra, J., Baren, J.M., Zink, B., Hedges, J.R. The future of emergency medicine: An evolutionary perspective (Open Access) (2010) Academic Medicine, 85 (3), pp. 490-495. Cited 19 times. http://www.lww.com/product/?1040-2446 doi: 10.1097/ACM.0b013e3181ccb628
5 Ortíz-Barrios, M., McClean, S., Jiménez-Delgado, G., Martínez-Sierra, D.E. Integrating lean six sigma and discrete-event simulation for shortening the appointment lead-time in gynecobstetrics departments: A case study (Open Access) (2020) Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics), 12199 LNCS, pp. 378-389. https://www-springer-com.ezproxy.cuc.edu.co/series/558 ISBN: 978-303049906-8 doi: 10.1007/978-3-030-49907-5_27
6 Ortiz-Barrios, M., Alfaro-Saiz, J.-J. An integrated approach for designing in-time and economically sustainable emergency care networks: A case study in the public sector (Open Access) (2020) PLoS ONE, 15 (6 June), art. no. e0234984. Cited 2 times. https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0234984&type=printable doi: 10.1371/journal.pone.0234984
7 Azevedo, J., Sá, J.C., Ferreira, L.P., Santos, G., Cruz, F.M., Jimenez, G., Silva, F.J.G. Improvement of production line in the automotive industry through lean philosophy (2019) Procedia Manufacturing, 41, pp. 1023-1030. Cited 13 times. http://www.journals.elsevier.com.ezproxy.cuc.edu.co/procedia-manufacturing
8 Abu-Laban, R.B., Drebit, S., Svendson, B., Chan, N., Ho, K., Khazei, A., Lindstrom, R.R., (...), Christenson, J. Process and findings informing the development of a provincial emergency medicine network (2019) Healthcare Management Forum, 32 (5), pp. 253-258. http://hmf.sagepub.com.ezproxy.cuc.edu.co/content/by/year doi: 10.1177/0840470419844276
9 Christenson, J. A network to improve emergency patient care by facilitating practitioners to effectively support practitioners (2014) Healthcare Management Forum, 27 (3), pp. 132-135. Cited 6 times. http://hmf.sagepub.com.ezproxy.cuc.edu.co/content/by/year doi: 10.1016/j.hcmf.2014.05.004
10 Ahmed, A., Page, J., Olsen, J. Enhancing Six Sigma methodology using simulation techniques: Literature review and implications for future research (2020) International Journal of Lean Six Sigma, 11 (1), pp. 211-232. Cited 5 times. http://www.emeraldinsight.com/journal/ijlss doi: 10.1108/IJLSS-03-2018-0033
11 Defeo, J., Moret, D. (2019) Lean Six Sigma, Lean & Six Sigma: A Definitive Guide Juran Institute https://www.juran.com/blog/guide-to-lean-and-lean-six-sigma/
12 Jimenez, G., Santos, G., Sá, J.C., Ricardo, S., Pulido, J., Pizarro, A., Hernández, H. Improvement of productivity and quality in the value chain through lean manufacturing - A case study (2019) Procedia Manufacturing, 41, pp. 882-889. Cited 14 times. http://www.journals.elsevier.com.ezproxy.cuc.edu.co/procedia-manufacturing
13 Kuo, A.M.-H., Borycki, E., Kushniruk, A., Lee, T.-S. A healthcare lean six sigma system for postanesthesia care unit workflow improvement (2011) Quality Management in Health Care, 20 (1), pp. 4-14. Cited 32 times. doi: 10.1097/QMH.0b013e3182033791
14 Dickson, E.W., Anguelov, Z., Vetterick, D., Eller, A., Singh, S. Use of Lean in the Emergency Department: A Case Series of 4 Hospitals (2009) Annals of Emergency Medicine, 54 (4), pp. 504-510. Cited 160 times. doi: 10.1016/j.annemergmed.2009.03.024
15 Johnson, P.M., Patterson, C.J., O'Connell, M.P. Lean methodology: An evidence-based practice approach for healthcare improvement (2013) Nurse Practitioner, 38 (12), pp. 1-7. Cited 9 times. doi: 10.1097/01.NPR.0000437576.14143.b9
16 Vermeulen, M.J., Stukel, T.A., Guttmann, A., Rowe, B.H., Zwarenstein, M., Golden, B., Nigam, A., (...), Schull, M.J. Evaluation of an emergency department lean process improvement program to reduce length of stay (Open Access) (2014) Annals of Emergency Medicine, 64 (5), pp. 427-438. Cited 49 times. http://www.elsevier.com.ezproxy.cuc.edu.co/inca/publications/store/6/2/3/2/7/8/index.htt doi: 10.1016/j.annemergmed.2014.06.007
17 Richardson, D.M., Rupp, V.A., Long, K.R., Urquhart, M.C., Ricart, E., Newcomb, L.R., Myers, P.J., (...), Kane, B.G. Using lean methodology to decrease wasted RN time in seeking supplies in emergency departments (2014) Journal of Nursing Administration, 44 (11), pp. 606-611. Cited 6 times. http://journals.lww.com/jonajournal doi: 10.1097/NNA.0000000000000133
18 Improta, G., Cesarelli, M., Montuori, P., Santillo, L.C., Triassi, M. Reducing the risk of healthcare-associated infections through Lean Six Sigma: The case of the medicine areas at the Federico II University Hospital in Naples (Italy) (Open Access) (2018) Journal of Evaluation in Clinical Practice, 24 (2), pp. 338-346. Cited 41 times. http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-2753 doi: 10.1111/jep.12844
19 Terra, J.D.R., Berssaneti, F.T.: Application of lean healthcare in hospital services: a review of the literature (2007 to 2017). Production 28 (2018). https://doi-org.ezproxy.cuc.edu.co/10.1590/0103-6513.201 80009
20 Suman, G., Prajapati, D.R. Statistical analysis of the researches carried out on Lean and Six Sigma applications in healthcare industry (2018) International Journal of Quality Engineering and Technology, 7 (1), pp. 1-38. Cited 7 times. http://www.inderscience.com/ijqet doi: 10.1504/IJQET.2018.094667
21 Patri, R., Suresh, M. Factors influencing lean implementation in healthcare organizations: An ISM approach (2018) International Journal of Healthcare Management, 11 (1), pp. 25-37. Cited 41 times. http://www-tandfonline-com.ezproxy.cuc.edu.co/loi/yjhm20#.VwH1lk1f1Qs doi: 10.1080/20479700.2017.1300380
22 Gabriel, G.T., Campos, A.T., Magacho, A.L., Segismondi, L.C., Vilela, F.F., de Queiroz, J.A., Montevechi, J.A.B. Lean thinking by integrating with discrete event simulation and design of experiments: An emergency department expansion (Open Access) (2020) PeerJ Computer Science, 6, art. no. e284. Cited 4 times. https://peerj.com/articles/cs-284.pdf doi: 10.7717/PEERJ-CS.284
23 Pegoraro, F., Alves Portela Santos, E., de Freitas Rocha Loures, E. A support framework for decision making in emergency department management (2020) Computers and Industrial Engineering, 146, art. no. 106477. Cited 2 times. https://www-journals-elsevier-com.ezproxy.cuc.edu.co/computers-and-industrial-engineering doi: 10.1016/j.cie.2020.106477
24 Ortiz-Barrios, M., Alfaro-Saiz, J.-J. A Hybrid Fuzzy Multi-Criteria Decision-Making Model to Evaluate the Overall Performance of Public Emergency Departments: A Case Study (Open Access) (2020) International Journal of Information Technology and Decision Making, 19 (6), pp. 1485-1548. Cited 3 times. http://www.worldscinet.com/ijitdm/ijitdm.shtml doi: 10.1142/S0219622020500364
25 Scala, A., Ponsiglione, A.M., Loperto, I., Della Vecchia, A., Borrelli, A., Russo, G., Triassi, M., (...), Improta, G. Lean six sigma approach for reducing length of hospital stay for patients with femur fracture in a university hospital (Open Access) (2021) International Journal of Environmental Research and Public Health, 18 (6), art. no. 2843, pp. 1-13. Cited 16 times. https://www.mdpi.com/1660-4601/18/6/2843/pdf doi: 10.3390/ijerph18062843
26 Nuñez-Perez, N., Ortíz-Barrios, M., McClean, S., Salas-Navarro, K., Jimenez-Delgado, G., Castillo-Zea, A.: Discrete-event simulation to reduce waiting time in accident and emergency departments: a case study in a district general clinic. In: Ochoa, S.F., Singh, P., Bravo, J. (eds.) UCAmI 2017. LNCS, vol. 10586, pp. 352–363. Springer, Cham (2017). https://doi-org.ezproxy.cuc.edu.co/10. 1007/978-3-319-67585-5_37
27 Jones, B., McClean, S., Stanford, D. Modelling mortality and discharge of hospitalized stroke patients using a phase-type recovery model (Open Access) (2019) Health Care Management Science, 22 (4), pp. 570-588. Cited 3 times. www.springer.com/journal/10729 doi: 10.1007/s10729-018-9446-6
28 Ortiz Barrios, M., Felizzola Jiménez, H. Reduction of average lead time in outpatient service of obstetrics through six sigma methodology (2015) Amihealth 2015. LNCS, Vol. 9456, pp. 293-302. Cited 2 times. Bravo, J., Hervás, R., Villarreal, V. (eds.), pp., Springer, Cham https://doi-org.ezproxy.cuc.edu.co/10.1007/978-3-319-26508-7_29
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spelling Ortiz Barrios, Miguel AngelCoba Blanco, Dayana MilenaSalomon, ValerioJiménez, Genett2022-01-19T20:32:34Z2022-01-19T20:32:34Z20212022https://hdl.handle.net/11323/8982DOI:10.1007/978-3-030-90966-6_7Corporación Universidad de la CostaREDICUC - Repositorio CUChttps://repositorio.cuc.edu.co/Emergency Care Networks (ECNs) are integrated healthcare systems comprised of emergency departments (EDs). ECNs are called to be the primary response of healthcare authorities to deal with the expected uptick in the future demands for emergency care during the current Covid-19 pandemic. Lean Six Sigma (LSS) has been proposed to address this challenge since it allows managers to detect factors contributing to the extended waiting times (WT) throughout the patient journey. The suggested framework follows the DMAIC cycle that was initiated with the project charter definition; in the meantime, a SIPOC diagram was drawn to analyze the emergency care process and pinpoint critical process variables. Following this, a nested Gage R&R study was undertaken to study the measurement system performance; subsequently, a normal-based capability analysis was carried out to determine how well the ECN process satisfies the specifications. The next step was to identify the potential causes separating the ECN nodes from the desired target. Afterwards, improvement strategies were devised to lessen the average WT. After suitable data collection, a before-and-after analysis was performed to verify the effectiveness of the implemented strategies. Ultimately, a control plan containing an I-MR control chart was designed to maintain the improvements achieved with the LSS implementation. The results revealed that the average WT of the showcased node passed from 190.02 min to 103.1 min whereas the long-term sigma level increased from −0.06 to 0.11. The proposed framework was validated through a case study including the involvement of a medium-sized hospital from the public sector. © 2021, Springer Nature Switzerland AG.Ortiz Barrios, Miguel Angel-will be generated-orcid-0000-0001-6890-7547-600Coba Blanco, Dayana Milena-will be generated-orcid-0000-0002-0395-8172-600Salomon, Valerio-will be generated-orcid-0000-0002-5619-5076-600Jiménez, Genettapplication/pdfengCorporación Universidad de la CostaCC0 1.0 Universalhttp://creativecommons.org/publicdomain/zero/1.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Lecture Notes in Computer Sciencehttps://www.researchgate.net/publication/356393780_Implementation_of_Lean_Six_Sigma_to_Lessen_Waiting_Times_in_Public_Emergency_Care_Networks_A_Case_StudyCovid-19Emergency Care Networks (ECNs)HealthcareLean Six Sigma (LSS)Waiting times (WT)Implementation of lean six sigma to tessen waiting times in public emergency care networks: a case studyPre-Publicaciónhttp://purl.org/coar/resource_type/c_816bTextinfo:eu-repo/semantics/preprinthttp://purl.org/redcol/resource_type/ARTOTRinfo:eu-repo/semantics/acceptedVersion1 Manns, B.J., Wasylak, T. Clinical networks: Enablers of health system change (Open Access) (2019) CMAJ, 191 (47), pp. E1299-E1305. Cited 4 times. https://www.cmaj.ca/content/cmaj/191/47/E1299.full.pdf doi: 10.1503/cmaj.1903132 Brown, B.B., Patel, C., McInnes, E., Mays, N., Young, J., Haines, M. The effectiveness of clinical networks in improving quality of care and patient outcomes: A systematic review of quantitative and qualitative studies (Open Access) (2016) BMC Health Services Research, 16 (1), art. no. 360. Cited 50 times. http://www.biomedcentral.com/bmchealthservres/ doi: 10.1186/s12913-016-1615-z3 Al Owad, A., Karim, M.A., Ma, L. Integrated Lean Six Sigma approach for patient flow improvement in hospital emergency department (2013) Advanced Materials Research, 834-836, pp. 1893-1902. Cited 12 times. ISBN: 978-303785916-2 doi: 10.4028/www.scientific.net/AMR.834-836.18934 Sklar, D.P., Handel, D.A., Hoekstra, J., Baren, J.M., Zink, B., Hedges, J.R. The future of emergency medicine: An evolutionary perspective (Open Access) (2010) Academic Medicine, 85 (3), pp. 490-495. Cited 19 times. http://www.lww.com/product/?1040-2446 doi: 10.1097/ACM.0b013e3181ccb6285 Ortíz-Barrios, M., McClean, S., Jiménez-Delgado, G., Martínez-Sierra, D.E. Integrating lean six sigma and discrete-event simulation for shortening the appointment lead-time in gynecobstetrics departments: A case study (Open Access) (2020) Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics), 12199 LNCS, pp. 378-389. https://www-springer-com.ezproxy.cuc.edu.co/series/558 ISBN: 978-303049906-8 doi: 10.1007/978-3-030-49907-5_276 Ortiz-Barrios, M., Alfaro-Saiz, J.-J. An integrated approach for designing in-time and economically sustainable emergency care networks: A case study in the public sector (Open Access) (2020) PLoS ONE, 15 (6 June), art. no. e0234984. Cited 2 times. https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0234984&type=printable doi: 10.1371/journal.pone.02349847 Azevedo, J., Sá, J.C., Ferreira, L.P., Santos, G., Cruz, F.M., Jimenez, G., Silva, F.J.G. Improvement of production line in the automotive industry through lean philosophy (2019) Procedia Manufacturing, 41, pp. 1023-1030. Cited 13 times. http://www.journals.elsevier.com.ezproxy.cuc.edu.co/procedia-manufacturing8 Abu-Laban, R.B., Drebit, S., Svendson, B., Chan, N., Ho, K., Khazei, A., Lindstrom, R.R., (...), Christenson, J. Process and findings informing the development of a provincial emergency medicine network (2019) Healthcare Management Forum, 32 (5), pp. 253-258. http://hmf.sagepub.com.ezproxy.cuc.edu.co/content/by/year doi: 10.1177/08404704198442769 Christenson, J. A network to improve emergency patient care by facilitating practitioners to effectively support practitioners (2014) Healthcare Management Forum, 27 (3), pp. 132-135. Cited 6 times. http://hmf.sagepub.com.ezproxy.cuc.edu.co/content/by/year doi: 10.1016/j.hcmf.2014.05.00410 Ahmed, A., Page, J., Olsen, J. Enhancing Six Sigma methodology using simulation techniques: Literature review and implications for future research (2020) International Journal of Lean Six Sigma, 11 (1), pp. 211-232. Cited 5 times. http://www.emeraldinsight.com/journal/ijlss doi: 10.1108/IJLSS-03-2018-003311 Defeo, J., Moret, D. (2019) Lean Six Sigma, Lean & Six Sigma: A Definitive Guide Juran Institute https://www.juran.com/blog/guide-to-lean-and-lean-six-sigma/12 Jimenez, G., Santos, G., Sá, J.C., Ricardo, S., Pulido, J., Pizarro, A., Hernández, H. Improvement of productivity and quality in the value chain through lean manufacturing - A case study (2019) Procedia Manufacturing, 41, pp. 882-889. Cited 14 times. http://www.journals.elsevier.com.ezproxy.cuc.edu.co/procedia-manufacturing13 Kuo, A.M.-H., Borycki, E., Kushniruk, A., Lee, T.-S. A healthcare lean six sigma system for postanesthesia care unit workflow improvement (2011) Quality Management in Health Care, 20 (1), pp. 4-14. Cited 32 times. doi: 10.1097/QMH.0b013e318203379114 Dickson, E.W., Anguelov, Z., Vetterick, D., Eller, A., Singh, S. Use of Lean in the Emergency Department: A Case Series of 4 Hospitals (2009) Annals of Emergency Medicine, 54 (4), pp. 504-510. Cited 160 times. doi: 10.1016/j.annemergmed.2009.03.02415 Johnson, P.M., Patterson, C.J., O'Connell, M.P. Lean methodology: An evidence-based practice approach for healthcare improvement (2013) Nurse Practitioner, 38 (12), pp. 1-7. Cited 9 times. doi: 10.1097/01.NPR.0000437576.14143.b916 Vermeulen, M.J., Stukel, T.A., Guttmann, A., Rowe, B.H., Zwarenstein, M., Golden, B., Nigam, A., (...), Schull, M.J. Evaluation of an emergency department lean process improvement program to reduce length of stay (Open Access) (2014) Annals of Emergency Medicine, 64 (5), pp. 427-438. 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