Continuous Improvement Methodology Research Articles

An Overview of Lean Six Sigma management applications in research animals facilities

Lean Six Sigma (LSS) is recognized as a continuous improvement methodology that enhances operational processes by reducing waste, variability, and costs, while increasing the quality of products and services. Originating in the industrial and manufacturing sectors, it has been implemented in healthcare over the past three decades to improve operational performance, costs and excellence. In animal research facilities, LSS was first reported at Seattle Children’s Hospital, where tools and methods were applied in administrative and research support services. The objective of this study was to characterize the current knowledge regarding the application of LSS tools in animal research facilities, identifying the benefits and limitations of these practices. A database search identified 227 publications, of which 11 were selected. The results showed that LSS has notable applicability and should be incorporated associated with initiatives for cultural and organizational change despite limitations as resistance to implementation and difficulty in sustainment the gains.

Reduction of Setup Times in a Metal Fabrication Company Using a Lean-Sigma Approach

Manufacturing companies face demand fluctuations and must deliver the required quantity of parts to their customers within the required time; however, companies face different challenges in fulfilling them. One is technological advances, which make it impossible for them to compete with other countries, such as China, due to financial issues. Therefore, manufacturing companies use continuous improvement methodologies to achieve better performance in their processes. Six Sigma and Lean Manufacturing are some of the best-known approaches. This article briefly presents the application of a lean sigma approach oriented to solving problems. This research proposes a methodology based on Lean Sigma that contrasts what different authors currently do: continuous improvement projects that take up to 12 months to produce results and do not solve a problem. This implementation is conducted in a process that manufactures metal parts and fails to deliver them on time to its customers. Using tools such as the Single Minute Exchange of Die (SMED) in a production line, on-time deliveries were increased from 89 % to 96 %; at the same time, the model change times were reduced by approximately 60 %, which is required for the implementation of this methodology for only four weeks, unlike the traditional six-sigma approach that can take up to 12 months to improve the process.

Using Engineering Methods (Kaizen and Micromovements Science) to Improve and Provide Evidence Regarding Microsurgical Hand Skills

ObjectiveMicrosurgical interventions involve the interaction of numerous variables, making objective analysis of skill proficiency challenging. This difficulty is even more pronounced in low-resource contexts. Continuous improvement methodologies such as Kaizen-PDCA and Micro-Movements Science can address this issue. This study aimed to demonstrate the advantages of designing and implementing microsurgical training programs using these methodologies. MethodsFollowing an extensive literature review of Kaizen-PDCA and Micro-Movements Science and under the guidance of experienced neurosurgeons and engineers, a microvascular bypass training program was developed using the human placenta. Subsequently, the training program was used to analyze and describe the process of a trainee neurosurgeon in Argentina with no prior experience in microvascular anastomosis, as the operator gained proficiency. ResultsThe trainee required 12 attempts to achieve the program goals. The longest procedural time was during the first attempt (1 h 49 min 05 s with two mistakes), while the shortest time was during the fourth attempt (53 min 29 s with three mistakes). After 12 attempts, the trainee made no mistakes, and the procedural time was reduced to 57 min 37 s. The final learning curve demonstrated a regular pattern and reached a plateau after seven attempts. ConclusionsThe training program and methodology effectively assessed, facilitated, and demonstrated the acquisition of microsurgical skills. Kaizen-PDCA and Micro-Movements Science enabled the effective use of expert experience, detailed evaluation of microsurgical procedures, and integration into a continuous improvement cycle. The program structure could also be valuable for teaching, evaluating, and enhancing similar surgical procedures.

Relevant factors to implement continuous improvement in administrative services of public universities: an action research study

The research presented in this article focuses on enhancing the quality of administrative services in a higher education institution, addressing the scarcity of concrete examples of continuous improvement in public services. The study investigates the applicability and effectiveness of continuous improvement methodologies in a public service context, emphasising the distinct challenges faced by public institutions, such as a culture of silos, in implementing process improvements. The article employs an action research methodology, which involves researchers collaborating with university administrative personnel to identify improvement opportunities, implement solutions, and measure the impact of these initiatives on service quality. The impact of continuous improvement initiatives on the quality of administrative services offered by the university is assessed through participant perceptions, service user feedback, and the improvement of main processes within the university departments. The research identifies several barriers and facilitators to continuous improvement within the university’s administrative services, including organisational culture, employee involvement and commitment, communication, goal clarity, and resource availability. The study provides insight into how these factors influence the success of continuous improvement efforts. Based on the findings, the study offers recommendations for deploying continuous improvement workshops at the university. These recommendations aim to address the identified barriers, leverage facilitators, and enhance the overall quality of administrative services. The article contributes to understanding continuous improvement in public service contexts and provides practical guidance for implementing such initiatives in higher education institutions.

Technological innovations and optimized work methods in subsea maintenance and production

Subsea maintenance and production represent critical aspects of offshore operations, vital for sustaining energy production and ensuring operational efficiency. However, these endeavors face numerous challenges, including the complexities of deepwater environments, harsh weather conditions, and the high costs associated with traditional maintenance methods. To address these challenges, this paper explores the integration of technological innovations and optimized work methods in subsea operations. Technological innovations play a pivotal role in revolutionizing subsea maintenance and production. Remote monitoring and control systems enable real-time data collection and decision-making, enhancing operational visibility and efficiency. Autonomous underwater vehicles (AUVs) offer the capability to conduct inspections and repairs in remote and hazardous environments, reducing human intervention and associated risks. Robotics and automation further streamline maintenance tasks, improving accuracy and reducing downtime. Advanced materials and coatings enhance equipment durability and corrosion resistance, prolonging asset lifecycles and reducing maintenance requirements. In parallel, optimized work methods offer strategic approaches to enhance subsea operations' effectiveness. Predictive maintenance strategies leverage data analytics and machine learning to anticipate equipment failures, enabling proactive interventions and minimizing downtime. Condition-based monitoring facilitates real-time assessment of asset health, enabling timely maintenance interventions and cost savings. Integrated asset management systems provide holistic insights into asset performance and facilitate informed decision-making. Lean operations and continuous improvement methodologies further optimize workflows, driving operational excellence and cost efficiency. Through case studies and industry examples, this paper highlights the successful implementation of technological innovations and optimized work methods in subsea maintenance and production. Furthermore, it explores future trends, regulatory considerations, and the importance of industry collaborations in shaping the future of subsea operations. Ultimately, the integration of these approaches offers a pathway towards enhanced operational efficiency, reduced costs, and sustainable subsea operations. Keywords: Technological Innovations, Optimized Work Methods, Subsea Maintenance and Production.

A Roadmap for Digitally Transforming the Operations of Labour-Intensive Organisations

In this paper, a roadmap for the incremental digital transformation of operations in labour-intensive organisations is presented. The roadmap utilises a developed reference architecture that takes into account the various areas of value creation in these organisations. It focuses on achieving practical and value-adding levels of digital transformation incrementally in all aspects of a labour-intensive organisation, not just the labour processes. The reference architecture is developed based on a brief analysis and comparison of labour in different manufacturing systems, supported by observational case studies conducted by the first author. The roadmap approach is then implemented in three phases: evaluating the current environment in phase 1, implementing lower-level or test bed methods of digital transformation in phase 2, and ultimately reaching high levels of digital transformation in phase 3. The roadmap also utilises a continuous improvement methodology, in which the roadmap is restarted after each implementation to identify additional opportunities for digital innovation at the operational level.

Desarrollo y validación de estándares para unidades de calidad de centros sanitarios

ObjectiveIn Spain, the Quality Units advise health centres, services and professionals on the methodology of continuous improvement of the quality of care. A system based on good practice standards could provide these units with a tool to improve their results and value their work. The objective was to develop, agree on and validate standards, to properly guide and orient the functions, results and continuous improvement of the Quality Units in health centers. Material and methodsA qualitative–quantitative, prospective and cross-sectional study was carried out, applying the Metaplan method, the e-Delphi technique and a simulation study. The participants were coordinators of these units, belonging to 14 Spanish Autonomous Communities and distributed in four experts’ panels. They agreed on the standards to be used and evaluated the different types of validity. ResultsThe 204 standards proposed by the scientific committee were reduced to 157 with Metaplan, to 110 with e-Delphi, and to 96 with the committee's final review (87.3% consensus, content validity). The construct validity showed a Cronbach's alpha >0.7 (P<.001); the validity of content was reaffirmed in the simulation workshop (80% “understood” each other, P<.001; and there was “documentary evidence” in 84%, P<.001); face validity was accepted (75% “related to quality dimensions”, P<.001); and the validity of the criteria was verified with a sensitivity of 84.2%, a specificity of 98.3%, and a kappa index of 0.84. ConclusionsValid standards have been developed for Quality Units in health centers.

Impact of Team Creativity and Continuous Improvement on Time-To-Market in Retail Industry

This study investigates the relationship between team creativity and continuous improvement practices on the time-to-market performance within the dynamic context of the retail industry. Through a comprehensive analysis of data collected from retail organizations, this research reveals the significant positive impact of fostering team creativity and implementing continuous improvement initiatives on reducing time-to-market for products and services. The findings underscore the strategic significance of nurturing a creative and innovative team culture while concurrently embracing continuous improvement methodologies to enhance the speed and efficiency of bringing retail offerings to market. This study contributes valuable insights for retail practitioners and decision-makers aiming to optimize their time-to-market strategies in an ever-evolving industry landscape.

What are barriers and facilitators in sustaining lean management in healthcare? A qualitative literature review

BackgroundLean management (LM) is a continuous improvement methodology originating from manufacturing and is widely adopted in healthcare to improve processes. LM shows promising results in healthcare and research on the topic is increasing. However, it can be difficult to sustain LM over time, and an overview of facilitators or barriers that influence the sustainment of LM in a healthcare context is unavailable.MethodsPrior to search, five inclusion and exclusion criteria were defined to establish suitability of identified articles for our research question. This study was based on 24 selected peer-reviewed studies that reported on the sustainment of LM in healthcare organisations, published in the last five years. Following the Preferred Reporting Items for Systemtic Reviews and Meta-Analyses (PRISMA) guidelines, all articles were scanned, retrieved for full-text and analysed thematically.ResultsFollowing thematic analysis, we identified four overarching themes: Mobilising Employees, Guiding Change Efforts, Methods, and Local Context. Key facilitators for supporting LM are fostering an improvement culture and learning culture, providing professional development opportunities, assigning more responsibilities to employees in decision making processes and appointing change agents to act as local LM leaders. Key barriers for sustaining LM include overburdening employees with responsibilities, omitting staff involvement during LM implementation, lack of patient engagement, lack of resources to engage with LM, a lack of leadership commitment and follow-up on projects, and a lack of knowledge of LM among leaders.ConclusionOverall, studies emphasise the importance of actively involving and engaging the workforce to embed LM into organisational culture. Reflecting on the origins of LM, healthcare organisations can find inspiration in the virtue of respecting people in their journey to sustain and cultivate an improvement culture. LM provides potential to change healthcare for the better and could help healthcare organisations to cope with increasing external pressures.

Nutrition Management: Use of New Methodologies in the Development of Competencies for Dietetic Practice

In the field of nutrition management, new methodologies are currently being used for the knowledge of dietetics, which allows nutritionists to prepare for optimal performance, facing the reality of populations with dietary needs. The general objective was to determine the influence of the use of new methodologies in the development of competencies for dietetic practice in clients of a Peruvian company in the area of nutrition. A hypothetical deductive method with a quantitative approach, non-experimental design, cross-sectional scope, and explanatory level was followed. The study sample consisted of 260 nutritionist clients. The technique used was the survey and the instrument was a questionnaire. In general, it is concluded that there is a significant influence between the use of new methodologies and the development of competencies for dietetic practice in nutrition clients since the Chi-square contrast statistic obtained a value of 146.539 and a high level of significance of 0.000 &lt; 0.05. The goodness of fit of the models was also identified with a high significance level of 0.001 &lt; 0.05, a Nagelkerke’s pseudo-R2 with a significant value of 0.625, and parameter estimation with a Wald value of 44.357 and a significance level of 0.000 &lt; 0.05. Finally, it is concluded that by managing new methodologies through processes, with agile and continuous improvement methodologies, competencies for the dietetic practice of clients in the area of nutrition are developed.

Controlling Hypertension through Education and Coaching in Kidney Disease (CHECK-D): protocol of a cluster randomised controlled trial

IntroductionChronic kidney disease (CKD) affects 30 million Americans. Early management focused on blood pressure (BP) control decreases cardiovascular morbidity and mortality. Less than 40% of patients with CKD achieve recommended...

A Robust Statistical Methodology for Measuring Enterprise Agility

In an era characterized by rapid technological advancements, economic fluctuations, and global competition, adaptability and resilience have become critical success factors for businesses navigating uncertainty and complexity. This article explores the role of enterprise agility in today’s business landscape at Latam branch of Tata Consultancy Services, where organizations face complex and diverse operations. We aim to examine how companies can become more agile in the face of emerging challenges and seize opportunities swiftly to drive growth and deliver value. Since 2014, the division has embarked on an agile transformation journey to drive growth, deliver value, foster innovation, and build resilience in an increasingly dynamic environment. We scrutinize an approach to measuring and enhancing enterprise agility, employing statistical analysis and continuous improvement methodologies to tackle real-world challenges while offering valuable insights and recommendations for organizations aiming to implement similar systems. The results of an agile transformation in a certain company’s Latam branch serve as a compelling case study, demonstrating how the implementation of targeted measures and continuous improvement can significantly bolster enterprise agility. Methodologically, our work applies a novel sequence of parametric statistical tests which, to the best of our knowledge, have not been used in the industry to validate the results of business agility metrics. In future work, we aim to create a new workflow considering non-parametric tests to address data with other statistical distributions. We conclude our work by proposing a sequence of steps for organizations to implement business agility metrics.

Mutual Adoption of Soft Systems Methodology, Co-Creation, Enterprise Architecture, and Balanced Scorecard for Continuous Assessment and Improvement of Programmes on Integrated Care for Multimorbid Patients

Mutual Adoption of Soft Systems Methodology, Co-Creation, Enterprise Architecture, and Balanced Scorecard for Continuous Assessment and Improvement of Programmes on Integrated Care for Multimorbid Patients

The Impact of Applying Quality Standards on the Internal Operations in the Public Sector in the Sultanate of Oman

Purpose: The aim of this study is to identify the impact of applying quality standards on the internal operations efficiency in public sector institutions in the Sultanate of Oman along with measuring the effectiveness and efficiency of operations after applying quality standards. Theoretical framework: This study focuses on the definition of quality and its history, quality standards, its types, rational behind their application, continuous improvement methodology which is Deming cycle (plan, Do, check, Act), and defining internal processes and their dimensions. Design/Methodology/Approach: To achieve the objective of this study , the questionnaire was used as a main tool for data collection. Questionnaires were distributed to a simple random sample of 115; 107, questionnaires were retrieved and (102) were suitable for analysis. The data was then analyzed using a variety of statistical techniques (arithmetic means and standard deviations, multiple linear regression analysis using the stepwise method, and Cronbach alpha for stability). Findings: The main findings in this study was identifies that prove there is a gap between quality standereds applications in planning of operations, readiness, and outputs. Research /Practical /Social Implications: This study is significant since it focuses on the influence of applying quality standards in terms of results and effect, specifically on processes and whether there is continuous process improvement. In social indicator it is impacting individuals satisfactions specially when speaking about the customers experience. Moreover, in enconmoical indocators it is indicates improvement of the institutional performance. Originality/ Value: This study is distinguished from previous studies in that it focuses on the impact of applying quality standards in terms of results and effect, specifically on processes. Moreover, this study specially build based on Oman experience.

Design of a guide tool based on continuous improvement methodologies applicable to SMEs in the dairy sector in Latin American y Caribbean countries

El objetivo de la investigación fue diseñar una herramienta guía basada en técnicas de mejora continua aplicable a pymes del sector lácteo en América Latina y el Caribe. A través de una revisión literaria de 753 pymes en 10 países de América Latina y el Caribe, se analizaron los principales factores que influyen en el desarrollo organizacional y productivo de pymes lácteas. Posteriormente, se diseñó una entrevista semiestructurada aplicada a seis pymes lácteas de Veracruz (México) y a seis pymes lácteas de Bogotá (Colombia). Los resultados mostraron deficiencias en aspectos como estructura y desarrollo organizacional, planeación de la producción y relación con proveedores y clientes. Por tanto, el diseño de la herramienta guía integra técnicas de mejora continua e indicadores que permitan a las pymes lácteas administrar y controlar sus procesos de manera clara, sencilla, y fomentar la evaluación de su desempeño.

405 Integrating a Learning Health System Framework Into a Large Academic Medical Center

OBJECTIVES/GOALS: The Learning Health System (LHS) framework at Columbia University Irving Medical Center (CUIMC) aims to optimize health system performance through enhancing the patient and care team experience, reducing inequities, costs and improving population health outcomes, through a collaborative, interdisciplinary and data driven approach. METHODS/STUDY POPULATION: In alignment with the Quintuple Aim, the LHS program at CUIMC is composed of five critical components: data integration (particularly using Epic EHR and real-time informatics data), utilization of evidence-based practices, a methodology for continuous improvement, and leadership commitment. Our methodology incorporates an iterative process improvement project cycle into an integrated infrastructure and governance of an academic medical center and its hospital partners to fulfill rapid project design and implementation. The LHS at CUIMC aims to bring a cultural shift through stakeholder engagement, symposia, training, accelerated pilot award opportunities, and building external partnership engagement. RESULTS/ANTICIPATED RESULTS: At CUIMC, our definition of a successful integration of a LHS framework is a cultural shift in thinking, method, and continuous improvement. The LHS program has developed multidisciplinary teams that are involved in defining and sharing data, design, and project management resources. In 2021, the first annual symposium was launched and brought together over 200 stakeholders from across the organization to support continuous education, training, and scaling of the framework. As a result of this foundation, two pilot initiatives have been funded and launched, the innovation accelerator model developed and is supporting over ten unique innovative and transformative clinical and operational programs, and several research grant applications have been submitted citing learning health system methodologies. DISCUSSION/SIGNIFICANCE: Our LHS framework has broken down silos and institutional barriers, creating a network of stakeholder groups. Our interdisciplinary approach has enabled us to create sustainable processes, resources and training on rapid, rigorous design, evaluation and implementation of interventions using real-time informatics data and digital health tools.

Gestión del conocimiento para el proceso de innovación en las organizaciones

Every hundred years throughout history there has been a strong transformation, in a matter of years society is reorganized, its worldview, its basic values, its social and political structures, its production structures, there is a new world, our era is a period of transformation and innovation. At this present time the transformation is not limited to Western or Eastern society or history. There is only world history and civilization. In this context, knowledge is the main resource for individuals and for the economy that make up an organization or company, whose main purpose is the integration of specialized knowledge in a common good, which facilitates innovation processes as a strategic factor allowing excellence, valuation and international recognition of an organization. That is why innovation processes in organizations become relevant for having their own and different characteristics such as information, data and knowledge, as well as their transformation, technological surveillance and technology itself, foresight, competitive intelligence and the same impulse of creativity in the conception of ideas and intellectual property that at any time of the innovation management process will be influenced by these aspects, contributing to new business models in organizations. Although innovation processes are changeable and unpredictable, they can be systematized and organized through an innovation management system based on the application of the continuous improvement methodology. Innovation processes interrelated with the vertiginous advances of knowledge have modified the narrow framework of microeconomics, with innovative business models connected to a Knowledge Based Economy, through networks supported by powerful technologies that influence the dynamic capabilities that allow organizations to connect and identify the types of customers or users to configure the supply chain that adds value and allows monetization in a common good. For this reason it is increasingly significant the existence of organizations that recognize the importance of knowledge management and innovation management as a key factor that allows the agile and modern creation of successful business models that generate value, are profitable, transcend over time and leave a deep mark in a globalized market, even in environments characterized by uncertainty, volatility, ambiguity and complexity.

A Data Quality Framework for the European Health Data Space for secondary use

Abstract A cornerstone in the development of the European Health Data Space for secondary use of data (EHDS2) is the design, implementation and assessment of a Data Quality Framework (DQF). Consistently, the Joint Action TEHDAS has a dedicated work program where, learning from others’ experiences across Europe and abroad, the work package is building the concepts and methods for such a DQF. The scope of this work program is to provide recommendation to the Member States and the European Commission on the concept of DQF to foster, where (institutions) the DQF should be implemented, when in data life cycle, how should be implemented and by whom. In terms of the concept, the DQF raises the importance of quality assurance procedures at data processor level and the level of quality of the data collections in terms of reliability, relevance, timeliness, coherence, coverage and completeness. When it comes to when along the data life cycle, DQF is expected operate when data needs harmonization at data processor level (ie, the effective application of interoperability standards), in the publication of the data sources (ie providing users knowledge on the provenance of data and the content of data source); or, when data sources have to be integrated and sensitive data pseudonymized (ie, the quality of the linkage and losses after pseudonymisation). Finally, when it comes to the methodology, TEHDAS suggests a three-fold approach - some quality measures in the DQF could be translated into legislation (eg, the requirement of regular auditing for a data processor to be a trusted party in the EDHS2); some could be kept as good-practices (eg, recommendation of archival procedures when a research project finalizes); and, under the assumption of continuous data quality improvement, an assessment, benchmarking and promotion methodology (eg, a grading system at data processor level).

INTEGRATED QUALITY MANAGEMENT TO CREATE A SCHOOL AS A CENTER OF EXCELLENCE AT JUNIOR HIGH SCHOOL IN BANDUNG CITY (Description Study at SMP Negeri 5 and SMP Negeri 3 Bandung)

Schools are providers of formal education and centers of excellence for human empowerment. Salis stated that Integrated Quality Management (MMT) is “a philosophy of continuous improvement methodology, which provides a set of practical tools for every educational institution in meeting the needs, wants, and expectations of customers, current and future”. In general, the purpose of this study is to describe and analyze the concept of developing quality schools as MMT-based centers of excellence with the development of excellent services. This study uses a qualitative approach and data sources through interviews, observations and documentation through the principal, vice principal, teachers, and students. The results of data analysis showed that the principal's leadership in implementing MMT in SMP Negeri 5 and SMP Negeri 3 Bandung was quite effective in accordance with school planning. This is marked by the principal's continuous efforts to make improvements and changes as a whole in achieving quality, so that schools are realized as a source of excellence. The general conclusion is that the principal has management capabilities that are implemented in schools as a place for comfortable, harmonious, fun and quality education, as well as being highly competitive and having effective management supported by superior human resources to produce superior human resources with target achievement. set.

G Is for Geometric: A G-Chart Primer for Surgeons

In this issue of The Annals of Thoracic Surgery, Glenn and colleagues1 detail their experience with development, implementation, monitoring, and evaluation of a surgical wound infection (SWI) prevention bundle in a high-volume congenital heart surgery program. The study is a valuable and elegant example of applied modern continuous quality improvement (CQI) methodology, and I applaud the authors for their contribution. The authors’ use and evaluation of g-charts should be highlighted. A g-chart is a type of statistical process control (SPC) chart.