Hospitals have been living hard times lately, since healthcare costs have increased due to more sophisticated technologies and treatments, beside the issue of ageing population. The challenge is to provide efficient logistics management, in order to decrease costs through the application of best practices and reach high levels of users’ satisfaction. Hospitals spend between 30% and 45% of their budgets on logistics and the pressure to reduce costs is very high. However, the field of hospital logistics offers important room for improvement, as documented by the substantial literature both in theory and in real cases where innovative practices have been successfully applied worldwide in recent years. First, this work describes the Italian healthcare system (SSN) and the principles on which it is based: universality, equality, equity; it then focuses on the recent reform that has changed the organization, the law 23/2015. Moreover, the main consequences of the economic crisis are outlined, which have led to cuts in healthcare costs with a reduction in staff and beds, and a drastic decline in the level of service provided. The thesis provides a thorough analysis of the literature about healthcare logistics management, which is the core of this project: specifically, 68 articles and a number of websites, reports and book chapters were analysed in order to identify these innovative practices and to know their level of implementation worldwide. The study focuses largely on the so-called 'lean philosophy', a concept that originated in the manufacturing for process improvement and which has been recently been associated several times with logistics management. This philosophy is having great success in the field of hospital logistics, as reported by several case studies: pioneers are the United States, followed by several European countries. Main examples are reported and fully described. The last part of the ‘literature review’ chapter concerns other innovative practices outside the lean philosophy, such as self-guided vehicles for drugs transportation directly to hospital wards, which allow a significant saving of human resources and an important reduction of errors. From the evidence obtained, a questionnaire was developed to assess healthcare facilities and find out to what extent they are implementing best practices in logistics management. It was decided to focus the study on the hospitals that according to the reform have the connotation of ASST, specifically AO and IRCCS. Out of the 34 hospitals, 13 filled the questionnaire. These hospitals were interviewed on inventory management, information systems, process optimization and continuous improvement. The 44 questions in the questionnaire refer to specific technologies described in the state of the art, in particular the Just In Time principle for the supply of medicines to hospitals, information systems integrated with suppliers in order to speed up practices and avoid errors, radio frequencies and bar coding for inventory management, process standardization, among others. Each question is associated with a score from 1 to 5, depending on the degree of familiarity with the specific logistical trend. Each hospital, classified according to its size, obtains a score for each section and an overall score, which are then analyzed. Through graphs and tables, it is possible to evaluate at which level the hospitals in region Lombardy implement the above mentioned logistic management trends. Results indicate that hospitals are successfully applying most of the logistical trends found in the state of the art; nevertheless, they need to improve in some areas, for example the introduction of high-end technologies, the improvement of relations with suppliers and the achievement of international certifications, among others. This study adds value to the literature focused on improving logistics processes in healthcare institutions. Furthermore, the developed questionnaire may be applied for future researches with bigger samples, both in Italy and abroad, giving the possibility to weigh up different hospitals in different regions and countries.
Gli ospedali hanno vissuto momenti difficili ultimamente, dato l’aumento dei costi sanitari per la necessità di tecnologie e trattamenti più sofisticati, oltre al problema dell'invecchiamento della popolazione. La sfida è quella di fornire una gestione efficiente dei processi logistici, al fine di ridurre i costi attraverso l'applicazione di pratiche innovative e raggiungere alti livelli di soddisfazione degli utenti. Gli ospedali spendono tra 30% e 45% del budget nella logistica e la pressione per la riduzione dei costi è molto elevata. Tuttavia il campo della logistica ospedaliera offre importanti margini di miglioramento, come documentato dalla consistente letteratura sia a livello teorico sia di casi reali in cui sono state applicate con successo pratiche innovative a livello mondiale negli ultimi anni. In primo luogo, questo lavoro descrive il sistema sanitario Italiano (SSN) e i principi su cui è fondato: universalità, uguaglianza, equità; si focalizza successivamente sulla recente riforma che ne ha modificato l’organizzazione, la legge 23/2015. Allo stesso modo si analizzano le principali conseguenze della crisi economica, che hanno portato tagli alle spese sanitarie, dunque diminuzione del personale e dei posti letto, e un drastico calo del livello di servizio fornito. La tesi fornisce un'analisi esaustiva della letteratura in relazione alla gestione della logistica ospedaliera, che rappresenta l’argomento principale di questo progetto: nello specifico, sono stati analizzati 68 articoli e un certo numero di siti web, report e capitoli di libri, al fine di identificare queste pratiche innovative e conoscere il loro livello di implementazione nel mondo. Lo studio si focalizza in gran parte sulla cosiddetta ‘filosofia lean’, un concetto che ha origine nell’industria manifatturiera per il miglioramento dei processi e che recentemente è stato più volte associato alla gestione della logistica. Questa filosofia sta avendo molto successo nel campo della logistica ospedaliera, come riportato da diversi casi di studio: i pionieri sono gli Stati Uniti, seguiti poi da diversi paesi Europei. I principali esempi sono riportati ed esaustivamente descritti. L’ultima parte del capitolo riferito alla revisione della letteratura riguarda altre pratiche innovative al di fuori della filosofia lean, ad esempio i veicoli autoguidati per il trasporto di farmaci direttamente ai reparti ospedalieri, che permettono un notevole risparmio di risorse umane e una notevole diminuzione degli errori. Dalle evidenze ottenute è stato sviluppato un questionario per valutare le strutture sanitarie e scoprire in che misura stanno implementando le migliori pratiche di gestione della logistica. Si è deciso di focalizzare lo studio sugli ospedali che secondo la riforma hanno la connotazione di ASST, nello specifico AO e IRCCS. Dal totale di 34 strutture ospedaliere, 13 hanno completato il questionario: gli ospedali sono stati intervistati in merito a gestione dell'inventario, sistemi informativi, ottimizzazione dei processi e miglioramento continuo. Le 44 domande del questionario si riferiscono a specifiche tecnologie descritte nello stato dell’arte, in particolare il principio Just In Time per le forniture di farmaci agli ospedali, sistemi informativi integrati con i fornitori al fine di velocizzare le pratiche e evitare errori, radio frequenze e bar coding per la gestione dell’inventario, standardizzazione dei processi, tra gli altri. Ad ogni domanda è associato un punteggio da 1 a 5, in funzione del grado di familiarità con la specifica tendenza logistica. Ciascun ospedale, classificato rispetto alla sua dimensione, ottiene un punteggio per ogni sezione e un punteggio globale, che vengono opportunamente analizzati. Attraverso grafici e tabelle, si può valutare a che livello gli ospedali della regione Lombardia implementano le suddette tendenze di gestione della logistica. I risultati indicano che gli ospedali stanno applicando con successo la maggior parte delle tendenze logistiche trovate nello stato dell'arte; ciononostante, devono migliorare in alcuni settori, per esempio l'introduzione di tecnologie di alta gamma, il miglioramento dei rapporti con i fornitori e il conseguimento di certificazioni internazionali, tra gli altri. Questo studio aggiunge valore alla letteratura focalizzata sul miglioramento dei processi logistici nelle istituzioni sanitarie. Inoltre, il questionario sviluppato può essere utilizzato per ricerche future con campioni più grandi, sia in Italia che all’estero, dando la possibilità di valutare diversi ospedali in diverse regioni e paesi.
Improving healthcare logistics : best practices and new trends from the hospitals of Lombardy region
CAPELLI, DAVIDE
2017/2018
Abstract
Hospitals have been living hard times lately, since healthcare costs have increased due to more sophisticated technologies and treatments, beside the issue of ageing population. The challenge is to provide efficient logistics management, in order to decrease costs through the application of best practices and reach high levels of users’ satisfaction. Hospitals spend between 30% and 45% of their budgets on logistics and the pressure to reduce costs is very high. However, the field of hospital logistics offers important room for improvement, as documented by the substantial literature both in theory and in real cases where innovative practices have been successfully applied worldwide in recent years. First, this work describes the Italian healthcare system (SSN) and the principles on which it is based: universality, equality, equity; it then focuses on the recent reform that has changed the organization, the law 23/2015. Moreover, the main consequences of the economic crisis are outlined, which have led to cuts in healthcare costs with a reduction in staff and beds, and a drastic decline in the level of service provided. The thesis provides a thorough analysis of the literature about healthcare logistics management, which is the core of this project: specifically, 68 articles and a number of websites, reports and book chapters were analysed in order to identify these innovative practices and to know their level of implementation worldwide. The study focuses largely on the so-called 'lean philosophy', a concept that originated in the manufacturing for process improvement and which has been recently been associated several times with logistics management. This philosophy is having great success in the field of hospital logistics, as reported by several case studies: pioneers are the United States, followed by several European countries. Main examples are reported and fully described. The last part of the ‘literature review’ chapter concerns other innovative practices outside the lean philosophy, such as self-guided vehicles for drugs transportation directly to hospital wards, which allow a significant saving of human resources and an important reduction of errors. From the evidence obtained, a questionnaire was developed to assess healthcare facilities and find out to what extent they are implementing best practices in logistics management. It was decided to focus the study on the hospitals that according to the reform have the connotation of ASST, specifically AO and IRCCS. Out of the 34 hospitals, 13 filled the questionnaire. These hospitals were interviewed on inventory management, information systems, process optimization and continuous improvement. The 44 questions in the questionnaire refer to specific technologies described in the state of the art, in particular the Just In Time principle for the supply of medicines to hospitals, information systems integrated with suppliers in order to speed up practices and avoid errors, radio frequencies and bar coding for inventory management, process standardization, among others. Each question is associated with a score from 1 to 5, depending on the degree of familiarity with the specific logistical trend. Each hospital, classified according to its size, obtains a score for each section and an overall score, which are then analyzed. Through graphs and tables, it is possible to evaluate at which level the hospitals in region Lombardy implement the above mentioned logistic management trends. Results indicate that hospitals are successfully applying most of the logistical trends found in the state of the art; nevertheless, they need to improve in some areas, for example the introduction of high-end technologies, the improvement of relations with suppliers and the achievement of international certifications, among others. This study adds value to the literature focused on improving logistics processes in healthcare institutions. Furthermore, the developed questionnaire may be applied for future researches with bigger samples, both in Italy and abroad, giving the possibility to weigh up different hospitals in different regions and countries.| File | Dimensione | Formato | |
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Master thesis Davide Capelli.pdf
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https://hdl.handle.net/10589/144623