In the recent years, research in the field of healthcare operations management has provided evidence of how adopting a Lean approach can provide significant benefits including hospitals’ cost reduction and service level improvement. In fact, many examples of successful implementation of Lean approach above all in American healthcare institutions can be found in literature (Fillingham, 2007, Swensen, et al., 2009, Vest & Gamm, 2009, Barnas 2011, Swensen, et al., 2011, Toussaint 2011 and Graban 2012). In Italy, however, the adoption of the mentioned approach is not widespread yet as witnessed by the limited number of experiences that can be observed (Portioli Staudacher, 2008). If focus is placed on hospitals operating units, the research presented in this thesis reveals that a limited number of Neurosurgery Departments across different countries have implemented a Lean approach. Further, within Neurosurgery no prior case study has been specifically focused on the Patient Intake process. In response to this gap, this thesis aims to shed light on the main issues commonly embedded in Patient Intake process and to present the potential opportunities that adopting a Lean approach to the aforementioned process can provide. The analysis of successful experience at the UCLA Department of Neurosurgery Los Angeles (CA, USA), represents the first part of this thesis. The opportunity to spend a short-term period in the United States and experience first-hand the studied subject in its actual context have contributed toward the validity of this thesis. Experiences gained in the United States may also be valuable if viewed from another context. In this different environment, similar problems may be solved in different ways or remain unresolved challenges. New approaches from one place can be introduced to solve problems elsewhere, thereby making a comparison valuable. Healthcare institutions in Milan, Italy were chosen as the different context where a comparison with the United States may have value. In particular, Istituto Clinico Humanitas, Ospedale San Raffaele and Ospedale Maggiore Policlinico were object of this study. Possible solutions that could be implemented in Italy given the experienced problems that this study revealed will be presented and discussed towards in the second part of this thesis. The last section is focused on summarizing the key opinion statements of hospitals’ representatives involved in the final endorsement phase. For further details, the reader can see the appendix where the original validation letters have been attached as important feedbacks about the applicability and relevance of the proposed solutions. Conclusions and discussion regarding research areas that are found as interesting but outside the purpose of this report will end the thesis.
Negli ultimi anni, l’esperienza di ricerca nell’ambito della Gestione delle Operations in sanità ha mostrato i vantaggi che l’approccio Lean apporta agli ospedali in termini di riduzione dei costi e miglioramento del livello di servizio erogato. Molti esempi di successo, soprattutto nella sanità Americana, sono presenti in letteratura (Fillingham, 2007, Swensen, et al., 2009, Vest & Gamm, 2009, Barnas 2011, Swensen, et al., 2011, Toussaint 2011 and Graban 2012). In Italia, invece, sono poche le iniziative fino ad ora intraprese, il che’ fa dedurre la limitata diffusione di tale approccio (Portioli Staudacher, 2008). Ponendo l’attenzione sulle singole unità operative all’interno degli ospedali, ed in particolare sui Dipartimenti di Neurochirurgia, questa ricerca evidenzia una limitata implementazione dell’approccio Lean. Inoltre, si è riscontrato che nessun caso studio si sia ancora interessato del Flusso del Paziente in Ingresso al Dipartimento. Nel presente contesto si inserisce quindi questa tesi con l’obiettivo di mettere in luce i principali problemi che caratterizzano il suddetto flusso e come il Lean contribuisca ad affrontarli. L’opportunità di trascorrere un periodo negli Stati Uniti ed osservare l’esperienza del Dipartimento di Neurochirurgia, UCLA Health System, Los Angeles (CA) hanno inciso significativamente sulla validità di questo lavoro. La Lean Journey del Dipartimento di Neurochirurgia ne rappresenta la prima parte. In una seconda parte, viene presentata la ricerca condotta in Italia alla luce dell’esperienza maturata negli Stati Uniti, che ha permesso di analizzare il Flusso del Paziente in Ingresso e di valutare se e in quale misura potessero essere condivise le soluzioni implementate alla UCLA. Istituto Clinico Humanitas, Ospedale San Raffaele e Ospedale Maggiore Policlinico sono stati oggetto di questo studio. Infine vengono proposte una serie di soluzioni atte ad apportare un miglioramento del servizio e ridurne al contempo i costi. L’ultima parte del lavoro è dedicata a riportare le opinioni ricevute in seguito alla presentazione dei risultati e delle soluzioni proposte presso gli ospedali oggetto di studio. Il lettore potrà trovarne una sintesi al Capitolo 7. Per ulteriori approfondimenti, in appendice, sono disponibili gli originali delle lettere di validazione ricevute. L’analisi dei possibili sviluppi futuri infine conclude la trattazione.
Adopting a lean approach to patient intake in neurosurgery departments. A comparison between UCLA health system and hospitals in the Milan area
GHERARDI, GIULIA
2011/2012
Abstract
In the recent years, research in the field of healthcare operations management has provided evidence of how adopting a Lean approach can provide significant benefits including hospitals’ cost reduction and service level improvement. In fact, many examples of successful implementation of Lean approach above all in American healthcare institutions can be found in literature (Fillingham, 2007, Swensen, et al., 2009, Vest & Gamm, 2009, Barnas 2011, Swensen, et al., 2011, Toussaint 2011 and Graban 2012). In Italy, however, the adoption of the mentioned approach is not widespread yet as witnessed by the limited number of experiences that can be observed (Portioli Staudacher, 2008). If focus is placed on hospitals operating units, the research presented in this thesis reveals that a limited number of Neurosurgery Departments across different countries have implemented a Lean approach. Further, within Neurosurgery no prior case study has been specifically focused on the Patient Intake process. In response to this gap, this thesis aims to shed light on the main issues commonly embedded in Patient Intake process and to present the potential opportunities that adopting a Lean approach to the aforementioned process can provide. The analysis of successful experience at the UCLA Department of Neurosurgery Los Angeles (CA, USA), represents the first part of this thesis. The opportunity to spend a short-term period in the United States and experience first-hand the studied subject in its actual context have contributed toward the validity of this thesis. Experiences gained in the United States may also be valuable if viewed from another context. In this different environment, similar problems may be solved in different ways or remain unresolved challenges. New approaches from one place can be introduced to solve problems elsewhere, thereby making a comparison valuable. Healthcare institutions in Milan, Italy were chosen as the different context where a comparison with the United States may have value. In particular, Istituto Clinico Humanitas, Ospedale San Raffaele and Ospedale Maggiore Policlinico were object of this study. Possible solutions that could be implemented in Italy given the experienced problems that this study revealed will be presented and discussed towards in the second part of this thesis. The last section is focused on summarizing the key opinion statements of hospitals’ representatives involved in the final endorsement phase. For further details, the reader can see the appendix where the original validation letters have been attached as important feedbacks about the applicability and relevance of the proposed solutions. Conclusions and discussion regarding research areas that are found as interesting but outside the purpose of this report will end the thesis.| File | Dimensione | Formato | |
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https://hdl.handle.net/10589/70202