Continuous Improvement Methodology Research Articles

A Structured Model for continuous improvement methodology deployment and sustainment: A Case Study

This research focuses on designing a clear methodology for problem-solving. It investigates the application of a defined ‘Lean’ methodology for the proactive application of process improvement activities using a phased digitized measurement and monitoring system. This case study in a Medtech organisation utilised the Plan, Do, Check, Act (PDCA) model to develop a Lean system and structure to support managing the process improvement or project management element of a Continuous Improvement (CI) framework. The results from the pilot of this study delivered financial gains and demonstrated how a robust structure and methodology to measure improvement activity and success provided a strong, sustainable foundation for customer satisfaction, efficiency, cost reduction and employee engagement improvement. It also highlighted the importance of focusing on proactive process improvement as part of a CI framework. The study provides valuable insights into the effective implementation of Lean principles and process improvement via a sustainable model, thereby contributing to the body of knowledge in this field.. This study demonstrated how the developed model supported process improvement activity underpinning the development of a wider continuous improvement culture to support Lean deployment and sustainment and that systems can drive behaviour. Additionally, this application in the healthcare manufacturing sector adds to the sparse application in the literature from this sector.

Customer-Centric quality management: A framework for organizational excellence in SMEs

In an era where customer expectations are continually evolving, Small and Medium Enterprises (SMEs) must adopt innovative quality management practices to achieve organizational excellence. This review presents a customer-centric quality management framework designed specifically for SMEs, emphasizing the pivotal role of customer satisfaction in enhancing operational efficiency, product quality, and overall business performance. The framework is built on the premise that customer feedback and engagement are integral to quality management processes. By prioritizing customer needs and expectations, SMEs can develop quality assurance strategies that not only meet but exceed customer requirements. This approach involves systematic collection and analysis of customer feedback, enabling organizations to identify areas for improvement and innovate their offerings accordingly. Central to the framework are key components such as continuous improvement, employee involvement, and process optimization. Continuous improvement methodologies, like Lean and Six Sigma, are tailored to suit the unique challenges faced by SMEs, fostering a culture of quality that empowers employees at all levels. Engaging employees in quality initiatives cultivates a sense of ownership and accountability, essential for driving organizational change and enhancing service delivery. Furthermore, the framework emphasizes the importance of aligning quality management practices with customer-centric strategies. This alignment ensures that quality initiatives are not only reactive but also proactive, anticipating customer needs and adapting processes to deliver superior value. Incorporating customer relationship management (CRM) tools enhances communication, allowing SMEs to gather insights that inform quality improvements and strengthen customer loyalty. Implementing a customer-centric quality management framework can significantly impact an SME's competitiveness by enhancing product reliability, reducing defects, and improving customer satisfaction. Ultimately, this approach fosters organizational excellence, leading to increased market share and long-term sustainability. In conclusion, this framework equips SMEs with the necessary tools to integrate customer-centricity into their quality management processes, driving continuous improvement and excellence. Keywords: Customer-Centric Quality Management, Smes, Organizational Excellence, Customer Satisfaction, Continuous Improvement, Lean, Six Sigma, Employee Involvement, Process Optimization, CRM Tools, Competitiveness.

Literature Review: Financial Management in Hospitals Using Process Improvement Methods

Financial management in hospitals faces significant challenges due to increasing healthcare costs and the demand to maintain high-quality patient care. Process Improvement methods such as Lean and Continuous Improvement have been adopted by hospitals to address these challenges. This study aims to review the literature regarding the impact of implementing Lean and Continuous Improvement methodologies on hospital financial management. The research methodology employed a systematic approach, analyzing studies published between 2018 and 2023. The results of the review showed that the implementation of Lean and Continuous Improvement methods significantly improved operational efficiency, leading to cost reductions of up to 30%, while simultaneously enhancing patient care quality and staff satisfaction. In conclusion, these methodologies offer a sustainable approach for hospitals to manage financial pressures without compromising the quality of care. Hospitals are encouraged to adopt these strategies to achieve long-term financial stability and operational excellence.

Maturity Assessment of the Health Information System Using Stages of Continuous Improvement Methodology: Results From Serbia.

Since the health information system (HIS) in public health care services in Serbia was introduced in 2009, it has gradually expanded. However, it is unclear how well the HIS components have developed and the whole system's stage of maturity. In June-September 2021, a maturity assessment of the Serbian HIS was conducted for the first time using the HIS Stages of Continuous Improvement (SOCI) toolkit. The toolkit measures HIS status across 5 HIS domains: leadership and governance, management and workforce, information and communication technology (ICT), standards and interoperability, and data quality and use. The domains were further divided into 13 components and 39 subcomponents whose maturity stage was assessed on a 5-point Likert scale, indicating the level of development: (1) emerging/ad hoc; (2) repeatable; (3) defined; (4) managed; and (5) optimized. The toolkit was applied in a working group of 32 professionals and experts who were engaged in developing the new national eHealth strategy and action plan. The overall maturity score of the Serbian HIS was 1.6, which indicates a low level. The highest baseline score (2) was given to the standards and interoperability domain, and the lowest (1.1) was given to ICT infrastructure. The remaining 3 domains (leadership and governance, Management and Workforce, and Data Quality and Use) were similarly rated (1.7, 1.7, and 1.6, respectively). A baseline assessment of the maturity level of Serbian HIS indicates that the majority of components are between the emerging/ad hoc stage and repeatable, which represent isolated, ad hoc efforts, with some basic processes in place and existing and accessible policies. This exercise provided an opportunity to address identified weaknesses in the upcoming national eHealth strategy.

Impact of Applying PDCA Circulation Method on Surgical Care Interventions in the Operating Room on Patients Undergoing Cardiothoracic Surgery: A Retrospective Study

Background: The Plan-Do-Check-Act (PDCA) cycle is a widely recognized methodology for continuous quality improvement. This study evaluated the impact of applying the PDCA cycle on surgical care interventions in the operating room for patients undergoing cardiothoracic surgery. Methods: A retrospective study was conducted on the treatment of patients who underwent continuous cardiothoracic surgery in our Hospital from July 2020 to June 2023. Participants were divided into control and PDCA groups on the basis of the application of the PDCA cycle in their surgical care. Various outcomes were assessed, including psychological well-being (Hospital Anxiety and Depression Scale [HAMA] and Hamilton Depression Rating Scale [HAMD] scales), quality of life (using the QLQ-C30 tool), patient satisfaction, incidence of adverse accidents, clinical parameters, and laboratory measures. Results: The study comprised 133 patients, with 62 in the control group and 71 in the PDCA group. The psychological well-being, as measured by the HAMA and HAMD scales, of the PDCA group showed significant improvements compared with that of the control group (p < 0.05). The Quality-of-Life scores were higher in the PDCA group than in the control group (p < 0.05). In the PDCA group, the patient satisfaction scores related to hospital satisfaction were significantly higher than that in the control group, and the incidence of adverse accidents was lower (all p < 0.05). No significant differences were noted in clinical parameters (ejection fraction and B-type natriuretic peptide levels) nor laboratory measures (serum protein and C-reactive protein (CRP) levels) between the groups (p > 0.05 for all). Conclusion: The implementation of the PDCA cycle in the operating room for patients undergoing cardiothoracic surgery significantly improved psychological well-being and patient satisfaction and reduced the incidence of adverse accidents in the operating room, indicating that this quality improvement approach can enhance patient care experience. Although no significant differences were observed in clinical and laboratory parameters, the findings suggest that the PDCA cycle's strengths lie in its systematic approach to care process optimization and patient-centered outcomes.

Analysis of the disruptions of the digital revolution and its impacts on the evolution of continuous improvement methodologies and lean six-sigma

This research paper delves into the importance of continuous and lean improvements within the context of Industry 4.0. As businesses navigate the digital revolution, enhancing efficiency, effectiveness, and adaptability becomes paramount for maintaining competitiveness. The paper examines the principles of continuous and lean improvements, assessing their relevance in the Industry 4.0 landscape. Utilizing a grounded theory approach, it scrutinizes Industry 4.0 characteristics, market dynamics, disruptive forces, change management tools, and the attainment of lean operations. The findings emphasize the crucial role of continuous and lean improvements in enabling firms to navigate the dynamic Industry 4.0 landscape, effectively respond to market disruptions, and deliver enhanced value to customers. By providing actionable insights, the research paper equips companies to thrive in the digital revolution and leverage Industry 4.0 for sustainable growth. Data from 156 firms, gathered through a five-points-Likert scale questionnaire, informs the research paper. The Statistical Package for the Social Sciences (SPSS) and Analysis of Moment Structures (AMOS) software are used for statistical analyses that look at multicollinearity, content validity, and consistency, construct validity, Analysis of Variance (ANOVA), and the links between technological disruptions, the rise of agile companies, and overall performance. Results indicate that industry transformations directly and indirectly influence the evolution of Industry 4.0 and agility, empowering companies to develop effective strategies to overcome challenges posed by the digital revolution. To achieve this, companies must overhaul production systems, adopt innovative relationship management approaches, recognize and utilize existing organizational knowledge, and integrate it into product development, production operations, and marketing strategies.

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.

COVID-19's impact on lean programs and implementation in energy-based utilities

PurposeLean is a continuous improvement methodology that has succeeded in eliminating waste in a variety of industries. Yet, there is a need for more research on Lean implementation in several under-studied contexts, including crisis situations such as those created by the recent COVID-19 pandemic. This research investigates how Lean programs were impacted by COVID-19, while previous research has primarily explored how Lean was used to solve problems created by the pandemic.Design/methodology/approachA mixed-method research approach was used to analyze employee feedback on how COVID-19 impacted the Lean programs using data from various levels of four energy-based utilities in the United States. First, an online questionnaire collected qualitative and quantitative data from a broad sample of participants. Then, a follow-up semi-structured interview allowed the elaboration of perceptions related to the research question using a smaller sample of participants.FindingsOut of the 194 responses from the four companies, only 41% of the respondents at least somewhat agreed that COVID-19 impacted the Lean program at their company; of the remaining 59%, 35% indicated they were neutral, while 24% disagreed. The themes from the qualitative portion indicated that, while employees believed their companies had successfully found a new way to do Lean within the constraints of not always being in person, the collaboration and engagement were more challenging to sustain, and COVID-19 also otherwise made it more difficult to implement Lean. Meanwhile, some believed there was no impact on the Lean program.Originality/valueThe COVID-19 and Lean peer-reviewed literature published from 2020 to September 2023 focused primarily on using Lean to address problems created by the COVID-19 pandemic vs studying the pandemic's impact on Lean programs. This research partially fills this literature gap in understanding the impact COVID-19 had on Lean initiatives.

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