Continuous Improvement Methods Research Articles

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.

Response to Comment on A Method for Continuous Surgeon Improvement in Rectal Cancer

Response to Comment on A Method for Continuous Surgeon Improvement in Rectal Cancer

Comment on A Method for Continuous Surgeon Improvement in Rectal Cancer: Observed Minus Expected (O-E) Chart Versus CUSUM Chart.

Comment on A Method for Continuous Surgeon Improvement in Rectal Cancer: Observed Minus Expected (O-E) Chart Versus CUSUM Chart.

ISight - Navigable Path Detection for Visually Impaired using Semantic Segmentation

Abstract: This project introduces a new educational service that uses machine learning algorithms in Python and the OpenCV library to detect and prevent tampering, providing blind people with better freedom and personal security. Thanks to the integration of real-time detection equipment, the system can identify various hazards in different locations without using conventional equipment. Topics covered include optimizing algorithms for immediate use and maximizing efficiency for portable devices. Python supports rapid development, while OpenCV's modularity enables scalable development. This approach performs existing processes accurately, quickly and efficiently, using flexible methods for continuous improvement. Future developments include the integration of advanced learning models and user insights to provide more accurate feedback and pave the way for new products.

Ambulatory Quality Improvement Despite COVID-19: Blueprint for a Successful System for Continuous Improvement.

In this article, we describe our experience developing and implementing a multipronged approach to improve performance across a strategic subset of quality measures within primary care. Detailed techniques include data visualization and analytics, process reengineering, team engagement, visual project management, continuous improvement methods and training, and incentives and recognition. We achieved positive change across 12 high priority measures which we deemed the "High Value Framework (HVF)" by fostering a collaborative, nonpunitive, problem-solving culture. We focused on measures that had the greatest potential for impact from a clinical, reimbursement, and reputational perspective. More importantly, we sustained gains despite the challenges posed by the COVID-19 pandemic, thereby demonstrating programmatic resilience and high process reliability. This systematic approach serves as a practical blueprint for other healthcare entities seeking to navigate the complexities of quality improvement in a dynamic environment. The model provides a strategic framework for prioritizing and standardizing quality measures, effectively engaging stakeholders, and managing organizational change. Our model emerged from a need to address real-world operational challenges, rather than as an academic or theoretical exercise, and was developed independently of existing literature on measure prioritization and standardization at the time of its inception.

A Method for Continuous Surgeon Improvement in Rectal Cancer: Risk-Adjusted Cumulative Sum.

To develop and analyze a risk-adjusted cumulative sum (RA-CUSUM) chart as a potential method to monitor individual surgeon performance in robotic total mesorectal excision (TME) for rectal cancer. Currently, surgeons lack real-time tools to monitor and enhance their performance beyond residency completion. While national quality programs exist, granular, individual-level data is crucial for continuous improvement. Previous studies suggest CUSUM charts hold promise in identifying performance trends and outliers. This retrospective study analyzed data from 640 robotic TME cases performed by 12 surgeons at two institutions. RA-CUSUM charts were generated for three outcomes: complications, operative time, and length of stay. The overall RA-CUSUM curves for operative time and complications showed an initial learning phase followed by a plateau or downward slope, indicating proficiency or improvement. However, individual surgeon curves revealed significant heterogeneity. Three surgeons consistently excelled in operative time, while five minimized complications most effectively. Potential quality improvement could be implemented to drive performance toward positive outliers. No differences were found in unadjusted outcomes, including conversion, number of lymph nodes harvested, and positive circumferential margins. The RA-CUSUM chart is a promising method for identifying individual surgeon performance in robotic TME. It could help surgeons, teams, and leaders identify improvement areas and benchmark themselves against positive outliers. Further studies are needed to explore the potential of RA-CUSUM for implementing interventions to improve surgical quality.

Quality Improvement of Floor Cleaner Packaging Using Six Sigma and Continuous Improvement

There was a product defect in the 700 ML Lemongrass Refill Floor Cleaner packaging, which was 26,236 units from June to December 2021. The cost overrun was Rp. 15,085,700. This study aimed to improve the quality of the 700 ML Lemongrass Floor Cleaner packaging. The research method used was quantitative, and examined the quality of product packaging with Six Sigma and Continuous Improvement methods. The results of research conducted for the DPMO value before any improvement was 65,121 with a sigma level of 4.51. Then improvements were made so that the DPMO value became 12,517 with a sigma level of 5.26, resulting in a decrease in waste in the production process. So it can be concluded that we can provide solutions by replacing spare parts that are no longer suitable for use, making sure the machine is set correctly, making the standard materials used without defects and maintaining their shape, arranging the pouch arrangement as neatly and efficiently as possible, checking the pouch at the supplier, adjusting the machine settings, making sure it is neatly organized and performing regular machine maintenance according to the SOP.
 Keywords: continuous improvement, floor cleaner packaging, six sigma, quality

Performance evaluation method of the service quality dimensions using Six Sigma metrics, the main components’ quality indicator and the geometric capacity indicator

Abstract This research aims to propose an evaluation and monitoring method with the Six Sigma performance metrics, the main component quality indicator, and the geometric capacity indicator to control service quality dimensions. The research was quantitative and evaluative. It was developed using primary historical information on the quality criteria of hotel service in twelve periods of 2019. It was possible to demonstrate that the geometric indicator was the most demanding capacity with a value of 0.91163, followed by the multivariate main components’ indicator with a value of 0.9559, establishing as a relevant finding the integrality of the three performance criteria to evaluate a service. Topics of service quality, Six Sigma metrics, multivariate main component and geometric capacity indicators were addressed as a theoretical foundation. The research provides a unique contribution in the form of an innovative and efficient continuous improvement method, which makes services more reliable and accurate. Univariate and multivariate statistics were intensively used to evaluate and improve the dimensions of a service from different perspectives. This method has not been considered from the same approach despite its great usefulness in quality control.

ИННОВАЦИОННЫЕ МЕТОДЫ, ПОВЫШАЮЩИЕ ЭФФЕКТИВНОСТЬ БЕРЕЖЛИВОГО ПРОИЗВОДСТВА В РОССИЙСКОЙ ПРОМЫШЛЕННОСТИ

The article is devoted to the study of the features of the application of the lean manufacturing concept in Russian industry. Particular attention is paid to the possibility of increasing labor productivity using traditional and innovative methods of continuous improvement of business processes in industry. The purpose of this article is to study the concepts of lean production as a factor in increasing labor productivity of Russian companies and to develop innovative methods that increase the efficiency of lean production. As part of the study, an assessment was made of the impact of the implementation of the National Project “Labor Productivity” on the growth of industrial efficiency, the dynamics of the productivity index from the moment the measures began state support. The regions leading in productivity growth and the regions of the Central Black Sea Region are considered. The results of the study show that in general, for the type of economic activity “Manufacturing”, the growth rate of the labor productivity index is negative during the implementation of the national project; there is only a jump in 2020. It is suggested that this is not related to the implementation of the project, but to the general crisis bifurcation situation in economics.
 The article shows that the experience of those regions that have achieved success despite the general socio-economic instability in the country and industry deserves a closer look. Summarizing best practices, the article systematizes the main methods of lean production, paying special attention to innovative methods that can be used not only in industry, but also in all types of economic activity. A survey was conducted of the opinions of specialists representing a number of industrial enterprises of the Central Black Sea Region involved in the implementation of the National Project “Labor Productivity”, this made it possible to generalize productive methods of lean production and identify the main problems in applying the concept of lean production in Russian industry.

Global Health Education Revamped: Implementation of a Cross-Cultural Virtual Elective Through Continuous Improvement Methods.

Virtual platforms can increase access to global health (GH) education and cross-cultural communication. The Cleveland-Cusco Connection (CCC) is a virtual GH elective between medical schools in the USA and Peru. This elective was held annually from 2020 to 2023, with monthly virtual sessions held in English and Spanish to facilitate bidirectional learning about healthcare systems, culture, and barriers to care in both nations. Using student surveys throughout the electives, we report the outcomes, barriers, and changes of the CCC over 3years. We administered pre- and post-elective surveys to students in the elective in their native languages. We evaluated self-reported non-native language skills, health systems, GH knowledge, and cultural sensitivity. We also surveyed students about course efficacy in achieving learning objectives and areas for improvement. We performed non-parametric statistical analyses to evaluate trends in survey responses. Over three academic years, 92 students participated in CCC. Students from the US had statistically significant increases in their self-reported understanding of the Peruvian healthcare and medical education systems (p = 0.013). US students also saw an increase in cultural sensitivity scores, with statistically significant increases in the knowledge (p = 0.035) and motivation components (p = 0.031). The most frequently reported challenges encountered throughout the course included: competing coursework assignments, scheduling conflicts, and language barriers. Cross-cultural virtual electives demonstrate effectiveness in teaching trainees about international healthcare systems and can improve cultural sensitivity. Strategies to improve the elective include reducing workload, improving engagement for partner countries, and teaching bilingually. The online version contains supplementary material available at 10.1007/s40670-023-01941-6.

Lean Performance Indicators and Facilitators of Outcomes in U.S. Public Hospitals.

This study investigated the association between Lean and performance outcomes in U.S. public hospitals. Public hospitals face substantial pressure to deliver high-quality care with limited resources. Lean-based management systems can provide these hospitals with alternative approaches to improve efficiency and effectiveness. Prior research shows that Lean can have positive impacts in hospitals ranging in ownership type, but more study is needed, specifically in publicly owned hospitals. We performed multivariable regressions using data from the 2017 National Survey of Lean/Transformational Performance Improvement. The data were linked to publicly available hospital performance data from the Agency for Healthcare Research and Quality and the Centers for Medicare & Medicaid Services. We examined 11 outcomes measuring financial performance, quality of care, and patient experience and their associations with Lean adoption. We also explored potential drivers of positive outcomes by examining Lean implementation in each hospital, measured as the number of units using Lean tools and practices; leader commitment to Lean principles; Lean training and education among physicians, nurses, and managers; and use of a daily management system among C-suite leaders and managers. Lean adoption and implementation were associated with improved performance in U.S. public hospitals. Compared with hospitals that did not adopt Lean, those that did had significantly lower adjusted inpatient expenses per discharge and higher-than-average national scores on the appropriate use of medical imaging and timeliness of care. The study results also showed marginally significant improvements in patient experience and hospital earnings before interest, taxes, depreciation, and amortization margins. Focusing on these select outcomes, we found that drivers of such improvements involved the extent of Lean implementation, as reflected by leadership commitment, daily management, and training/education while controlling for the number of years using Lean. Lean is a method of continuous improvement centered around a culture of providing high-value care for patients. Our findings provide insight into the potential benefits of Lean in U.S. public hospitals. Notably, they suggest that leader buy-in is key to success. When executives and managers support Lean initiatives and provide proper training for the workforce, improved financial and operational performance can result. This commitment, starting with upper management, may also play a broader role in the effort to reform healthcare while having a positive impact on patient care in U.S. public hospitals.

Toyota Kata for continuous improvement; an action research project in the construction industry

Purpose The purpose of this study is to investigate how Toyota Kata can be effectively applied in the engineer-to-order (ETO) manufacturing within the construction industry. The objective is to identify the critical success factors (CSFs) for the Toyota Kata implementation in this environment and to develop a continuous improvement (CI) method – based on Toyota Kata and adapted to the ETO manufacturing within the construction industry. Design/methodology/approach An action research (AR) approach was applied, which includes a participatory form of inquiry and learning from both intended and unintended outcomes, while simultaneously building up scientific knowledge about successful implementation of Toyota Kata. Findings All the CSFs in the AR project are addressed by the earlier literature, thus confirming the existing body of knowledge. Moreover, the existing knowledge was arguably extended through the modified Toyota Kata as an approach for CI. New elements regarding how to run the small experiments by extending the core team with personnel who work with the problem on a daily basis. Originality/value This research addresses a gap identified in the literature regarding how Toyota Kata can be adapted to the ETO manufacturing within the construction industry. It also presents an overview of CSFs for the Toyota Kata implementation in this environment.

Improving Demand Management Performance using Knowledge Management Approach in an Oil and Gas Company

The oil and gas industry has become one of the most important sectors of the global economy, providing energy for transportation, industry and power generation. Indonesia is one of the world’s largest producers of oil and gas and the oil and gas industries have been operating in Indonesia for several decades, contributing to the country’s economic growth and development. PT. COPI, one of the entity in the oil and gas industry which focuses on downstream segment, plays an important role in this industry. However, to anticipate industrial competition, it requires the company to adapt and meet the minimum standards in order to remain competitive, through Continuous Improvement method which is implemented in departments, including Supply Chain Management (SCM) where, through the “Supply Chain Optimization (SCO)” approach, several obstacles are found, including Demand Management Process. This research uses the Knowledge Management (KM) approach to address the obstacles by conducting KM maturity analysis in PT. COPI’s Supply Chain division and perform analysis and evaluation of the current KM practices in order to provide recommendations for improvement. This research uses qualitative methodology to perform data collection, obtained through an interview with the head of Supply Chain Management division of PT. COPI, using Asian Productivity Organization (APO) KM assessment tool which comprises seven APO audit elements: Leadership, Process, People Technology, Knowledge Processes, Learning and Innovation, and KM Outcomes as the baseline for the interview questions. The research shows that KM maturity level of PT. COPI’s Supply Chain division sits at the fourth quadrant of the APO KM Maturity Model, which is refinement. Obstacles are identified from several audit elements of the APO KM assessment tool and marked as an area of improvement. This research provides recommendations for the identified area of improvements using the relevant KM method, which can be implemented by the company to increase their KM Maturity level, increase demand management performance and optimize Supply Chain Management process in the company.

Leadership practices and behaviours that enable and inhibit a continuous improvement culture in an NHS trust

BackgroundHealthcare providers and systems globally are increasingly recognising the benefits of adopting continuous improvement methods to transform hospital services. Creating a continuous improvement culture relies on giving frontline staff the...

Objectives and Impetuses for Legal Reforms — Legal Reform Experience in the People’s Republic of China

Legal reform is a method of continuous improvement and promotion of laws. In order to promote legal reform, it is necessary to research and learn about excellent legal reform experiences. The People’s Republic of China (PRC) legal reform experience is worth studying and learning about because the PRC has rich reform achievements. There are two important factors contributing to the success of the PRC legal reform. One is that the PRC establishes correct and reasonable legal reform objectives, and the other is that the PRC provides impetuses for legal reform. Therefore, this paper will analyze the above two legal reform experiences to help other countries complete legal reforms.

Using FOCUS-PDSA Quality Improvement Methodology Model in Healthcare: Process and Outcomes.

Using FOCUS-PDSA Quality Improvement Methodology Model in Healthcare: Process and Outcomes.

Continued Performance Improvement—What Practicing Surgeons Can Learn From Athletes

This Viewpoint describes how surgeons can optimize performance with methods for continuous performance improvement used by athletes.

Absenteeism prevention in preschools in Chile: Impact from a quasi-experimental evaluation of 2011–2017 Ministry of Education data

IntroductionIn 2007, to promote social equity, Chile expanded coverage and subsidies for early childhood education (ECE). Fundación Educacional Oportunidad (OFE) aimed to improve ECE quality through its professional development program for teachers and school leaders, Un Buen Comienzo (UBC). An experimental evaluation showed that high levels of absenteeism moderated UBC’s impact: despite moderate to large positive impacts on preschool quality, only children who attended most frequently experienced positive impacts on targeted language and literacy skills. In 2012, OFE began prioritizing attendance promotion and chronic absenteeism prevention.MethodsUsing a Breakthrough Series Collaborative (BTS) that combines continuous quality improvement methods and networked peer learning, OFE tested a theory of change and several innovations, including Absenteeism Committees comprised of school teams and families; a new real-time data platform; and a set of universal and targeted strategies to apply with families at risk for chronic absenteeism. In 2014-2015, OFE expanded the UBC program to nineteen schools in Chile’s VI Region, five of which prioritized attendance promotion. This study describes the intervention strategies and BTS implementation approach, and we use publicly available Ministry of Education databases to analyze rates of absences and chronic absenteeism in public preschools in Chile’s VI region from 2011 to 2017 (n = 1,218 children per year; 63,689 child-months of data), comparing rates between UBC schools that prioritized attendance (n = 5), UBC schools that did not prioritize attendance (n = 14), and non-UBC schools (n = 27).ResultsChildren missed, on average, 14.0%–14.4% of schooldays. Rates of chronic absenteeism were 50.9%–54.2%. Statistical Process Control charts show an initial increase in the percentage of days absent per child each month (13.4% to 16.3%) in UBC Schools prioritizing attendance, followed by a decrease to 12.9%. The percentage of children with chronic absenteeism decreased from 54.2% to 35%. Interrupted time series analyses suggest that these reductions can be attributed to UBC participation.DiscussionThis study (1) replicates findings from prior research indicating that absenteeism rates are sufficiently high among Chilean preschoolers to diminish ECE’s potential benefits, and (2) demonstrates the effectiveness of multi-level strategies implemented using continuous improvement methods and networked peer learning to promote attendance and reduce chronic absenteeism.

The Trial Innovation Network Liaison Team: building a national clinical and translational community of practice.

In 2016, the National Center for Advancing Translational Science launched the Trial Innovation Network (TIN) to address barriers to efficient and informative multicenter trials. The TIN provides a national platform, working in partnership with 60+ Clinical and Translational Science Award (CTSA) hubs across the country to support the design and conduct of successful multicenter trials. A dedicated Hub Liaison Team (HLT) was established within each CTSA to facilitate connection between the hubs and the newly launched Trial and Recruitment Innovation Centers. Each HLT serves as an expert intermediary, connecting CTSA Hub investigators with TIN support, and connecting TIN research teams with potential multicenter trial site investigators. The cross-consortium Liaison Team network was developed during the first TIN funding cycle, and it is now a mature national network at the cutting edge of team science in clinical and translational research. The CTSA-based HLT structures and the external network structure have been developed in collaborative and iterative ways, with methods for shared learning and continuous process improvement. In this paper, we review the structure, function, and development of the Liaison Team network, discuss lessons learned during the first TIN funding cycle, and outline a path toward further network maturity.

A new master degree program in lean manufacturing technologies

Increasing productivity and operational effectiveness can be realized by professional managerial approach. The article considers the current lean manufacturing and production management education providers and find the necessary points for successful operation management realization. Also it is proposed the interaction between the university and industrial partners in order to build and update the education content, participate in the classes and enrich them with industrial cases and guarantee the future career for the students. Lean manufacturing education is based on DMAIC methodology and proper using of Quality Management methods for continuous improvement of organizations. This long-term program provides professional growth for the employees and build their improvement projects sustainable.