Assessing performance and value-creation capabilities in Lean healthcare: insights from a case study

ABSTRACT

Lean thinking is increasingly being applied worldwide. Yet its actual impact is still a puzzle, particularly when a ‘full-implementation approach’—which entails the adoption of a strategic approach to Lean dissemination on policy deployment procedures—is used. Focusing on the healthcare sector, this paper presents and tests a comprehensive measurement framework for Lean interventions. The paper explains how Lean testing can help decision-makers to solve managerial issues related to Lean initiatives.     

Exploring the utility of current performance measures for changing roles and practices of ambulance paramedics

This article explores the relationship between the changing roles of ambulance paramedics, the causes of increasing call outs in the UK and in other countries and the need for improvements in process and outcome measures to reflect these changes. It also reflects on the application of ‘Lean’ techniques to the modernization of ambulance services, although with some scepticism. Moreover, it is contended that changing roles have moved far in advance of existing performance measures, contributing to misunderstandings between healthcare professionals and service users.     

Understanding before implementing: the context of Lean in public healthcare organizations

A three-year study of Lean implementation in public healthcare organizations in Québec identified poor understanding of the organizational context as a contributing factor to unsustainable Lean implementation. This paper presents a holistic perspective of the unique context of public healthcare organizations and discusses its implications with regards to Lean implementation.     

Implementing Lean Six Sigma in healthcare: issues from Italy

Lean Six Sigma is a method for strategic process improvement that aims to improve operational uniformity and quality, and reduce variations and waste. Lean thinking and Six Sigma have traditionally been applied to manufacturing. This paper examines ways of using Lean Six Sigma in healthcare organizations. The authors discuss the implications of their research for practitioners (managers and physicians) and present an agenda for future research.     

Guaranteeing Healthcare: What Does the Care Guarantee Do?

Abstract: According to the Swedish Health and Medical Services Act, healthcare is to be provided to the population according to need and on equal terms. It must also be accessible – a part of healthcare that has been criticized. In an effort to improve accessibility, the Swedish Association of Local Authorities and Regions and the government have both agreed to introduce a national care guarantee with effect from 01‐11‐2005. On 01‐07‐2010, the guarantee was incorporated into the Health and Medical Services Act. This paper considers, using the ideas of Foucault (discursive formation), Butler and Callon (performativity), how the idea of a care guarantee came to be influential during the formulation of Sweden's healthcare policies and on the management of services in hospitals. The concept of performativity is used to illustrate how the care guarantee becomes binding on the county council, as a promise to the patient.     

商业健康保险推行社区健康保障服务模式可行性探讨

本文从分析社区医疗保障现状、其面对的主要问题及其主要原因出发,认为社区医疗体系的发展需要商业健康保险介入,并有针对性地分析了商业健康保险介入社区医疗体系发展的意义、保障模式选择、多方面作用和多角度可行性,详细阐述了商业健康保险介入社区医疗领域的主要思路。     

Lean consumption

During the past 20 years, the real price of most consumer goods has fallen worldwide, the variety of goods and the range of sales channels offering them have continued to grow, and product quality has steadily improved. So why is consumption often so frustrating? It doesn't have to be--and shouldn't be--the authors say. They argue that it's time to apply lean thinking to the processes of consumption--to give consumers the full value they want from goods and services with the greatest efficiency and the least pain. Companies may think they save time and money by off-loading work to the consumer but, in fact, the opposite is true. By streamlining their systems for providing goods and services, and by making it easier for customers to buy and use those products and services, a growing number of companies are actually lowering costs while saving everyone time. In the process, these businesses are learning more about their customers, strengthening consumer loyalty, and attracting new customers who are defecting from less user-friendly competitors. The challenge lies with the retailers, service providers, manufacturers, and suppliers that are not used to looking at total cost from the standpoint of the consumer and even less accustomed to working with customers to optimize the consumption process. Lean consumption requires a fundamental shift in the way companies think about the relationship between provision and consumption, and the role their customers play in these processes. It also requires consumers to change the nature of their relationships with the companies they patronize. Lean production has clearly triumphed over similar obstacles in recent years to become the dominant global manufacturing model. Lean consumption, its logical companion, can't be far behind.     

Performance effects of multiple control forms in a Lean organization: A quantitative case study in a systems fit approach

The primary objective of this paper is to research and test how control forms function and perform in a Lean organization. In the present quantitative case study, we provide statistical support that Lean is a set of multiple control forms (output, behavioral, and social controls) that complement each other to enhance performance, i.e., it is a control package. Therefore, performance is increased if the average level of control forms is increased, and performance is further increased if the control forms are balanced at the same level representing a complementary effect between them. Moreover, we provide a refinement to the statistical approach in testing systems fit models like ours by supplementing the Euclidian distance with the city-block distance. In this way, we are able to show that the control forms in Lean have a balanced complementary effect on performance, which is distinct from a solely additive effect or no effect. The refined understanding of complementary effect between control forms, the notion of balance, in a Lean organization can be utilized in understanding and testing more general control package theory in other contexts. Our data are archival data spanning multiple years in a dedicated Lean organization. This Scandinavian organization has around 2000 employees and produces small electronic components that are sold to business customers.     

Healthcare professionals’ perceptions of risk in the context of genetic testing for the prediction of chronic disease: a qualitative metasynthesis

Advances in genomic technologies and a growing trend towards stratified and preventive approaches to medicine mean that increasing numbers of individuals may have access to information about their genetic makeup, and their risk of developing diseases. This is likely to impact on healthcare professionals involved in the delivery of genetic tests, or in supporting patients who are affected by a disease with a genetic risk factor. It is therefore important to understand healthcare professionals’ perceptions about providing these services, and how they feel about communicating information about genetic risk to patients. This paper provides a systematic review and metasynthesis of qualitative research exploring healthcare professionals’ perceptions of genetic risk in the context of predictive genetic testing for chronic disease. Healthcare professionals expressed a range of reservations about the utility of predictive testing in this context. Professionals judged patients’ understanding of risk information to be limited and subject to bias and a range of sociocultural influences. Concerns about the psychosocial impact of genetic risk information were frequently cited, both in relation to individual patients and the wider impact on their families and communities. The need for provision of multidisciplinary support was described. The concept of responsibility was also an important theme. Healthcare professionals recognized the responsibility that accompanies risk knowledge, and that ultimately this responsibility lies with the patient, not the provider. Our analysis suggests that professionals’ evaluation of the utility of predictive genetic testing is influenced not only by resource deficits, but may also be interpreted as a response to challenging ethical and social issues associated with genetic risk, that are not well aligned with current medical practice.     

Using contractual incentives in district nursing in the English NHS: results from a qualitative study

Since 2008, health policy in England has been focusing increasingly on improving quality in healthcare services. To ensure quality improvements in community nursing, providers are required to meet several quality targets, including an incentive scheme known as Commissioning for Quality and Innovation (CQUIN). This paper reports on a study of how financial incentives are used in district nursing, an area of care which is particularly difficult to measure and monitor.     

Pillar or platform—a taxonomy for process improvement activities in public services

Research into Lean in public services and particularly implementation, needs to develop from reporting cases to provide a taxonomy for researchers and practitioners. The paper outlines two approaches to process improvement activities (PIAs)—’Pillar’ and ‘Platform’ and tests the validity of these approaches through two organizational case studies (96 PIAs are considered). The degree to which this taxonomy supports decision-making is explored and issues associated with implementation are discussed.     

FASB's ASU 2011-7 changes financial statement reporting requirements

FASB's new Accounting Standards Update 2011-07 will change how healthcare entities accumulate and report major portions of their financial statements, including patient revenues, net accounts receivables, and bad-debt expenses. Healthcare entities now must reclassify their provisions for bad debts associated with patient service revenue from an operating expense to a deduction from patient service revenue (net of contractual allowances and discounts). International Financial Reporting Standards do not require healthcare entities to comply with this new standard.     

New development: 4P recommendations for implementing change,from research in hospitals

How are hospital staff involved in process improvement initiatives such as Lean? What can we learn from Lean implementation experiences about the sustainability of such initiatives? The authors considered such questions in a study of workplace change in Australia and Canada. They found that Lean is more likely to be sustained when leaders adopted the 4P recommendations presented in this article.     

New development: Wang Anshi's Wanyanshu as the origins of modern public management?

The drive for efficiencies across all areas of public spending in the UK has accelerated the need for improvements in service performance. This article considers how police performance might be improved through the adoption of a ‘Lean’ philosophy. This is seen as a potential driver for internal police improvements and is made in response to the government's call for reform and to address the challenges of a decrease in future police funding.     

Weak Links in the Chain: A Diagnosis of Health Policy in Poor Countries

Recent empirical and theoretical literature sheds light on thedisappointing experience with implementation of primary healthcare programs in developing countries. This article focuseson the evidence showing two weak links in the chain betweengovernment spending for services to improve health and actualimprovements in health status. First, institutional capacityis a vital ingredient in providing effective services. Whenthis capacity is inadequate, health spending, even on the rightservices, may lead to little actual provision of services. Second,the net effect of government health services depends on theseverity of market failures—the more severe the marketfailures, the greater the potential for government servicesto have an impact. Evidence suggests that market failures arethe least severe for relatively inexpensive curative services,which often absorb the bulk of primary health care budgets.A companion paper, available from the authors (seep. 219), offersa perspective on how government funds can best be used to improvehealth and well-being in developing countries. It gives an alternativeview of appropriate public health policy, one that focuses onmitigating the characteristic market failures of the sectorand tailoring public health activities to the government's abilityto deliver various services.      

金融信息服务领域运营工业化的探索

本文通过剖析中国银联在精益六西格玛方面的实践,指出六西格玛在金融信息服务领域工业化和信息化方面所起的关键作用。     

New development: The evolution of Welsh devolution

The reliance on consumer choice to drive improvements in public services is at the centre of policy debates in the UK and elsewhere. However, the discourse of consumerism occurs in the midst of a quagmire as to whether users of public services can legitimately be considered as customers, citizens or co-producers, while the existing evidence on how far they assume the role of public service consumers is largely ignored. This article discusses research on users' attitudes to choice in health, education and social services in the UK, the European Union and the USA. Provision of public services is rarely about acquiring products for pure consumption, but more about providers and users jointly addressing essential social and human needs. The author argues for an alternative conception of public service provision going beyond the limitations of consumerism, although some users are more likely to choose certain public services over others (for example schools rather than health services). However, the evidence presented disproves the view that users of public services will act as discerning consumers in the market-place.     

Keeping informed during times of economic downturn: the trusted amateur as a preferred source of financial information

Service providers need to understand financial capability from the perspective of the older client, in order to deliver services best suited for this age group. This article explores how older people perceive one dimension of their financial capability—their ability to stay financially informed. Older people were found to be accessing less traditional sources of financial information: they are either selfreliant for information, researching on the internet or using the media, or they tap into existing sources of social capital found within their social networks. Trusted public and voluntary sector service providers are preferred information resources over and above professionals in financial services. These findings suggest financial services need to build trust and/or form partnerships with other trusted voluntary or public sector services.     

Focusing on white space to improve patient throughput

When designing a new patient care process or modifying an existing one, healthcare leaders should: Set specific goals for frontline staff, Move beyond gathering and discussing data to acting on the data, Issue data reports frequently, Prepare to take advantage of success, Do not expect a silver bullet.     

Blockchain architecture: A design that helps CPA firms leverage the technology

Blockchain technology has garnered the interest of the accounting profession in recent years. However, when considering whether to adopt this technology, many business professionals have voiced a lack of a compelling use case as a major challenge. To utilize the technology effectively, first, we need to establish how organizations will connect to the blockchain that will also provide a compelling use-case for CPA firms. In this paper, we design a blockchain architecture for organizations that will facilitate effective connectivity to a blockchain while enabling auditors to leverage this technology to provide audit and assurance services. To design the architecture, we consider two broad questions: first, how do CPA firms gain access to reliable audit evidence and, second, how can client firms maintain confidentiality and security of their data given a decentralized and distributed immutable ledger (i.e., a blockchain). Consequently, the proposed architecture will help auditors gain access to reliable digital audit evidence while incentivizing client firms to adopt blockchain technology by substantially reducing the costs of replacing existing information systems. Given this architecture, auditors could also design continuous audit procedures for their respective clients without having to incur substantial investments in software integration. Further, the architecture can be expanded to include various use cases and supply chain participants, other CPA firms, customers, and regulators.