Process Improvement Methodology Research Articles

Enhancing operational efficiency: implementing business process improvement by integrating the command center in the Indonesian toll road operator company

<p>Business process improvement is a well-known technique for organizations to identify processes that enhance business performance. This study aims to analyze and improve business processes in the company's principal operational processes that are directly related to controlling service requests for assistance with traffic problems on the toll road (Command Center), specifically in communication and handling requests for assistance and complaints from users of one of the toll road operators in Indonesia. Research is conducted by identifying existing processes, the underlying causes of existing problems, and analyzing business processes using the Business Process Improvement methodology and the Bizagi Modeler with Process Modeling and Notation (BPMN). An improvement within this approach is thus examined in a particular scenario. The as-is and to-be processes are measured using a technique of improvement design called the ESIA approach, consisting of four steps: eliminate, simplify, integrate, and automate. The result of the integration of Command Center services can decrease the response time for assisting requests from toll road users and enhance cost-effectiveness, improving customer satisfaction and the overall quality of toll road service.<em></em></p>

Exploring Patient-Centered Care Through Process Improvement: A Systematic Review of Satisfaction Outcomes

Patient-centered care (PCC) is a vital approach in modern healthcare, focusing on the individual needs, preferences, and values of patients to enhance their overall experience and satisfaction. Process improvement methodologies, such as Lean, Six Sigma, and workflow optimization, aim to streamline healthcare delivery, reduce inefficiencies, and improve quality of care. This systematic review examines the impact of process improvement interventions on patient satisfaction within PCC frameworks. Database searches of PubMed, Scopus, Web of Science, and CINAHL were conducted, targeting peer-reviewed articles from 2016 to 2024 that measured patient satisfaction outcomes related to process improvements. Thirty-five studies met the inclusion criteria, encompassing various healthcare settings and patient populations. Findings indicate that process improvements, particularly Lean and Six Sigma, positively impact patient satisfaction by reducing wait times, minimizing errors, and improving communication and patient flow. Workflow optimization, although showing slightly varied results, also contributed positively when tailored to specific settings. This review highlights the importance of sustainable, patient-centered process improvement practices and suggests further research to assess long-term impacts and explore innovative tools. The study concludes that integrating process improvement methodologies within PCC frameworks can effectively enhance patient satisfaction and overall healthcare quality.Patient-centered care

Enhancing Patient-Centered Care Through Process Improvement: A Systematic Review of patient Satisfaction Outcomes

Patient-centered care has become a cornerstone in modern healthcare, focusing on personalized, respectful, and effective treatment that meets patients' unique needs and preferences. Process improvement methodologies, such as Lean, Six Sigma, and workflow optimization, have been increasingly adopted to streamline healthcare operations, reduce inefficiencies, and improve the quality of care. However, the specific impact of these methodologies on patient satisfaction within patient-centered care frameworks remains to be systematically evaluated. This systematic review aims to examine the effects of Lean, Six Sigma, and workflow optimization on patient satisfaction outcomes in patient-centered care settings, offering evidence-based insights for healthcare providers and policymakers.A comprehensive search was conducted across multiple databases, including PubMed, CINAHL, and Cochrane Library, to identify studies published from 2016 onward that evaluated patient satisfaction outcomes related to Lean, Six Sigma, and workflow optimization within patient-centered care models. Eligible studies were screened, assessed for quality, and analyzed based on patient satisfaction outcomes. Data extraction and quality assessments followed PRISMA guidelines.Findings from the selected studies indicate that process improvement methodologies positively impact patient satisfaction, with notable improvements in wait times, care coordination, and communication quality. Lean and workflow optimization showed a significant reduction in bottlenecks, while Six Sigma was associated with error reduction and standardized practices, contributing to higher patient satisfaction scores.Lean, Six Sigma, and workflow optimization methodologies offer promising avenues to enhance patient-centered care by improving patient satisfaction metrics. These methodologies provide healthcare organizations with structured approaches to meet patient needs more effectively and consistently, reinforcing the critical role of process improvement in achieving high-quality, patient-centered healthcare.

Enhancing Patient Procedures through Process Improvement: A Systematic Review of Patient-Centered Care Approaches

Patient-centered care is increasingly recognized as a fundamental component of high-quality healthcare, emphasizing the need for healthcare systems to optimize patient procedures. This systematic review explores the role of process improvement methodologies in enhancing patient procedures while aligning with patient-centered care approaches. A comprehensive search of studies published between 2016 and 2023 was conducted across multiple databases, focusing on healthcare interventions using Lean, Six Sigma, and Total Quality Management methodologies. The findings demonstrate that process improvement techniques significantly reduce waiting times, procedural errors, and inefficiencies, ultimately improving patient satisfaction and safety. Moreover, integrating patient-centered care approaches ensures that patients’ needs, preferences, and values are central to healthcare decision-making, further enhancing procedural effectiveness. However, challenges such as resistance to change and resource limitations were noted. This review underscores the importance of combining process optimization with patient-centered care to achieve sustainable improvements in patient outcomes and procedural efficiency. Future research should focus on the long-term impact of these methodologies and the role of technology in further advancing patient-centered approaches.

Implementing Mental Health Screening for Adolescent Hematology and Oncology Patients: A Quality Improvement Initiative.

Purpose: Adolescents and young adults (AYA) with chronic illnesses experience an increase in mental health concerns. A mental health screening (MHS) process for hematology and oncology patients was implemented in a single institution. The quality improvement project was conducted to integrate a MHS process, educate providers about the importance of mental health in this patient population, and evaluate the process. Methods: The COM-B (capability, opportunity, motivation-behavior) model for behavior change was used to inform strategic planning and Plan-Do-Study-Act (PDSA) methodologies for process improvement. Retrospective chart reviews and surveys were conducted to determine missed screening rates and providers' perceptions, knowledge, attitudes, and skills of the MHS process. Results: Of 334 eligible patient encounters, the missed screening rate was 15.0%, the overall error rate of completing the screening was 3.8%, the error rate of completing the suicide or self-harm indicator was 2.6%, and the missed medical social worker touch point was 4.8%. Conclusion: The rising rates of mental health concerns in AYA hematology and oncology patients call for streamlined MHS processes to improve the identification of patients who may need intervention and services. Processes should be tailored to workflows and available resources. Future PDSA cycles will include providing dedicated nursing education and determining the cost needed to meet the rising mental health needs of the AYA hematology and oncology population.

A Lean Six Sigma, Industry 4.0 and Circular Economy-driven methodology for wine supply chain process improvement

Scientific literature recognizes that Lean Six Sigma (LSS), Industry 4.0 (I4.0) and Circular Economy (CE) offer significant opportunities to improve operational performance and decrease the environmental impact. Wine supply chains represent a strategic asset for the world economy and an ideal setting for the implementation of LSS, I4.0 and CE, but studies that integrate these three approaches to improve wine supply chain processes are lacking. The present research intends to demonstrate how wine supply chain processes (SCPs) can be improved by deploying the synergies between LSS, I4.0 and CE, so as to face the quality, efficiency and sustainability challenges modern competition poses to wine companies. To this aim, this study proposes an original methodology that adopts a step-by-step procedure inspired by the Define-Measure-Analyze-Improve-Control (DMAIC) cycle to systematically improve SCPs throughout the different phases of wine supply chains (i.e., vineyard, cellar, distribution). The methodology has been conceptualized starting from three sources - review of scientific literature, interviews with experts and personal contribution – and assembles in an original way some concepts and tools referring to different bodies of literature such as strategic decision making, data-driven process improvement, lean management, industry 4.0 and circular economy. The methodology has been tested in a real case to evaluate its utility for practice and relevance.

Staffing Models: Making Increased Acuity Safe in the Pediatric ICU.

Traditional staffing models rely on the productivity metric of hours per patient day, lacking the ability to adequately capture the nursing workload. Acuity-based staffing considers the patient population's acuity for appropriate nursing workload. Using process improvement methodology, a pediatric ICU transitioned to an acuity-based staffing model resulting in an 11.3% ( P < 0.05) reduction in the acuity per nursing assignment and a decrease in reportable safety events by 61.3% ( P < 0.05).

Improving Time to Antibiotics for Long-Bone Open Fractures: A Quality Improvement Initiative.

Open fractures, which are exposed to the external environment, are at a high risk of infection. Administering antibiotics within 60 minutes of emergency department (ED) arrival is crucial to prevent infection. However, this is difficult to achieve due to high ED patient volumes. The purpose of our project was to improve time to antibiotics for patients presenting with long-bone open fractures at a Level 1 trauma center ED. We used the Lean Six Sigma Define, Measure, Analyze, Improve, and Control project framework to guide our efforts. Our interventions composed of developing educational initiatives, creating an electronic medical record order set, and restructuring the ED workflow to prioritize long-bone open fractures for immediate evaluation and antibiotic administration in our critical care zone. After our intervention, the time to antibiotics for long-bone open fractures improved significantly, decreasing from 76 to 40 minutes ( p < .001), with the percentage of patients receiving antibiotics within 60 minutes of ED arrival increasing from 64% to 92% ( p < .001). Age, sex, mechanism of injury, antibiotic choice, and location of the open fracture remained consistent between the two groups. Our results highlight the successful application of process improvement methodologies in improving antibiotic administration time for long-bone open fractures.

Practical manual for the implementation of service and process improvement methodologies, quality models and tools

This study seeks to identify the common factors in the methodologies, practices and management models, as well as in the quality tools used by leading national companies through a systematic review in which the city of Guayaquil was taken as a sample reference, investigating the achievement of procedures in institutions that have adopted this simplification model. It responds to a result of the research project carried out by students and teachers of the TES: Practical manual for the implementation of methodologies for the improvement of services and processes, models and quality tools. The authors used instruments such as interviews, SWOT analysis, Ishikawa diagrams, among others, to collect qualitative and quantitative data. The technique used was documentary review, using record cards as an instrument. The results obtained allow us to conclude that the authors' analysis highlights the need to apply specific strategies to improve organizational efficiency. They also seek to reflect the impact that quality management has had on the country's competitiveness. In addition, the importance of adopting proactive approaches to address the challenges identified in other studies is emphasized.

Theory of constraints in healthcare: a systematic literature review

PurposeTheory of Constraints (TOC), though a well-established process improvement methodology in manufacturing, is still a novel philosophy for healthcare and an exhaustive review of literature is needed to summarize the key findings of various researchers. Such a review can provide a direction to the researchers and academicians interested in exploring the application of TOC in the healthcare sector. This paper aims to review the existing literature of TOC tools and techniques applied to the healthcare environment, and to investigate motivating factors, benefits and key gaps for identifying directions for future research in the domain of healthcare.Design/methodology/approachIn this paper, different electronic repositories were searched using multiple keywords. The current study identified 36 articles published between January 1999 to mid-2021 to conceptualize and summarize the research questions used in the study. Descriptive analysis along with pictorial representations have been used for better visualization of work.FindingsThis paper presents a thorough literature review of TOC in healthcare and identifies the evolution, current trends, tools used, nature of services chosen for application and research gaps and recommends future direction for research. A variety of motivating factors and benefits of TOC in healthcare are identified. Another key finding of this study is that almost all implementations listed in literature reported positive outcomes and substantial improvements in the performance of the healthcare unit chosen for study.Practical implicationsThis paper provides valuable insight to researchers, practitioners and policymakers on the potential of TOC to improve quality of services, flow of patients, revenues, process efficiency and cost reduction in different health care settings. A number of findings and suggestions compiled in the paper from literature study can be used for diagnosing, learning and making substantial changes in healthcare. The methodologies used by different researchers were analysed and combined to propose a generic step by step procedure to apply TOC. This methodology will guide the practising managers about the appropriate tools of TOC for their specific need.Social implicationsGood health is always the first desire of all men and women around the globe. The global aim of healthcare is to quickly cure more patients and ensure healthier population both today and in future. This article will work as a foundation for future applications of TOC in healthcare and guide upcoming applications in the booming healthcare sector. The paper will help the healthcare managers in serving a greater number of patients with limited available resources.Originality/valueThis paper provides original collaborative work compiled by the authors. Since no comprehensive systematic review of TOC in healthcare has been reported earlier, this study would be a valuable asset for researchers in this field. A model has been presented that links various benefits with one another and clarifies the need to focus on process improvement which naturally results in these benefits. Similarly, a model has been presented to guide the users in implementation of TOC in healthcare.

A plan to transform primary and community care at Catalonia based on a process improvement methodology

Abstract Aim: This article outlines the implementation and deployment strategy defined by the Catalan healthcare system which sought to promote a plan to strengthen and transform primary care in order to provide high-quality healthcare services whilst making an optimal use of resources across the Catalan region. Background: Following the COVID-19 pandemic, the Catalan healthcare system initiated a plan to enhance primary care services. The Lean methodology has been used extensively in other sectors for process improvement. More recently, it has been adopted in large hospitals, showing good results, so Lean was selected as the most appropriate method to achieve this project’s goal. The Process Office of the Catalan Health System, which is made up of experts in Lean methodology, has been involved in defining and deploying the strategy to all 374 Primary Care Teams (PCTs) within the Catalan healthcare system. Methods: The deployment strategy was executed in four phases (each consisting of a number of sessions): (1) explaining the project’s goals and training the professionals in the methodology; (2) assessing the current status regarding the processes with the various PCTs; (3) identifying and implementing improvement projects; and (4) defining key performance indicators to monitor the impact of the projects. Findings: As a conclusion, this project has allowed to successfully define and implement a standard at a strategic and deployment level of a project for primary care improvement that may be replicated in other regions. The key elements to ensure success have been the following: leadership, implementation of an improvement methodology, standardization of sessions, and involvement and training of front-line professionals.

Leveraging AI and Machine Learning in Six-Sigma Documentation for Pharmaceutical Quality Assurance.

The pharmaceutical industry must maintain stringent quality assurance standards to ensure product safety and regulatory compliance. A key component of the well-known Six Sigma methodology for process improvement and quality control is precise and comprehensive documentation. However, there are a number of significant issues with traditional documentation procedures, including as slowness, human error, and difficulties with regulatory standards. This review research looks at innovative ways to employ machine learning (ML) and artificial intelligence (AI) to enhance Six Sigma documentation processes in the pharmaceutical sector. AI and ML provide cutting-edge technologies that have the potential to drastically alter documentation processes by automating data entry, collection, and analysis. Natural language processing (NLP) and computer vision technologies have the potential to significantly reduce human error rates and increase the efficacy of documentation processes. By applying machine learning algorithms to support real-time data analysis, predictive analytics, and proactive quality management, pharmaceutical organizations may be able to identify potential quality issues early on and take proactive efforts to address them. Combining AI and ML improves documentation accuracy and reliability while also strengthening compliance with stringent regulatory criteria. The primary barriers and limitations to the current state of Six Sigma documentation in the pharmaceutical industry are identified in this study. It examines the fundamentals of AI and ML with an emphasis on their specific applications in quality assurance and potential benefits for Six Sigma processes. The report includes extensive case studies that highlight notable developments and explain how AI/ML enhanced documentation is used in the real world.

Improving Quality Health Care Services by Implementing DMAIC Approach in Paediatric Cardiology Department of Public Hospital of Sindh, Pakistan: A Case Study

Objectives: The hospital industry has changed its dimension from diagnosis to complete total patient satisfaction. This study aims to identify the critical variables that can enhance overall patient satisfaction in the hospital industry. The study identified three critical factors for any hospital to provide quality service. Methodology: The study adopted the lean Six Sigma process improvement methodology to identify the critical service factors in hospitals. Lean Six Sigma is a flexible problem-solving tool that comprehensively solves any problem. DMAIC process improvement methodology is used to define, measure, analyze, improve, and control the overall experience in the hospital. CTQ (critical to quality) was defined and represented by Kano methodology. After filtration through cause and effect analysis, three core dimensions and 25 sub-dimensions of critical quality were identified. The impacts of these 25 sub-dimensions were evaluated and prioritized using the Kano Model of patient satisfaction. This identifies the most critical service requirement. This study is an initiative for service quality improvement in the hospital industry. In the future, this technique can be modified and adopted by different public and private hospitals to enhance the practical implementation. Results: Findings indicate that healthcare organizations demonstrate enhanced system-wide capabilities, optimizing resource utilization. Understanding patient needs propels satisfaction and delight. Three overarching factors, with 25 sub-factors, significantly impact patient satisfaction, predominantly yielding positive effects across the categories. Conclusion: This research concludes that providing quality service is critical in the hospital industry. Quality service is pivotal in the evolving hospital industry, transitioning from a focus on diagnosis to holistic patient satisfaction. This study aims to identify critical variables essential for enhancing overall patient satisfaction, pinpointing key factors crucial for delivering quality service in any hospital.

Improving Infrastructure Budget Allocation with Lean Six Sigma

The U.S. Army’s Chemical Biological Center (CBC) is a research and development center for chemical defense that operates out of Aberdeen Proving Ground (APG), MD. Aberdeen Proving Ground is an aging installation that requires significant infrastructure maintenance and improvement. Currently, the CBC’s infrastructure sustainment process is running above budget and behind schedule. As a result of process inefficiencies, $105M of priority infrastructure projects were unfunded in FY2021. This paper uses Lean Six Sigma, a process improvement methodology, to analyze process inefficiencies within the CBC’s service order process. The paper makes a series of recommendations to reduce costs and errors in the service order process, allowing the CBC to execute more of its currently unfunded projects.

Lean and Safety Management in Primary Care Centres: an Italian Case Study

The primary care sector is globally recognised as the pillar of an efficient and patient-centred care model. Despite its importance, many countries fail to ensure equitable access and individualised care. This problem significantly impacts the most vulnerable part of the population, such as chronic and elderly patients. In this context, considering the large number of people affected by multiple diseases, multidisciplinary and multi-organisation teamwork has become fundamental to guarantee high levels of quality, increasing patient satisfaction, and continuity of care. Furthermore, working in a multidisciplinary primary care team can improve information exchange between care providers and patients, positively impacting on clinical performance. Despite these opportunities, the primary care workforce is often overloaded in its daily activities and not adequately organised and coordinated to avoid burnout experiences and inefficient skills deployment. In this context, implementing Lean and Safety Management (L&amp;SM) as a process improvement methodology can increase care pathways performance and integration, patient safety and satisfaction through the reduction of wastes and risks. The current study aims to implement L&amp;SM in a primary care centre in Italy, with the final goal of increasing productivity and effectiveness in daily activities performed by primary care physicians. This project is carried out following the DMAIC cycle; a managerial approach that combines qualitative and quantitative techniques to support process improvement. The implementation roadmap will combine HLM and CRM, planning to achieve the main steps listed as follows: mapping the care demand and the available resources to define the focus of the study; identifying the most representative and critical patients; mapping the target care pathway; identifying wastes and risk and their root causes; identifying critical aspects and improvement events; implementing countermeasures; evaluating and monitoring results. The expected results of the forthcoming months consist of measurable improvements within the healthcare pathway, supporting the optimisation of the primary care centre. Moreover, this initiative may represent a pilot case for other similar projects, contributing to spread L&amp;SM culture throughout primary care centres with benefits for both patients and clinical staff.

Integra at Home: A flexible continuum of in-home medical care for older adults with complex needs.

As individuals age, they may need new strategies to manage exacerbations of chronic disease to maintain their dignity and independence. Many end up in a revolving cycle of emergency department visits, hospitalizations, and post-acute care. Support to stay at home, which is often their preference, becomes a challenge and varies with insurance coverage, location, and financial status. There are few home-based options sufficiently agile enough to respond when acute conditions arise particularly with exacerbations of chronic disease. In 2018, Integra designed a home-based option to treat acute exacerbations of chronic illness. A partnership with community paramedicine enabled faster response times and provided additional treatment tools. Using process improvement methodology, we developed "Integra at Home" workflows and team-based care. We counted averted emergency visits and hospitalizations, patient and staff satisfaction, and evidence of financial sustainability as a result of our program. Integra successfully developed a suite of home-based services, including responses to acute problems, to address beneficiaries' fluctuating medical needs. Following responses to 415 acute events, 74% (N = 307) resulted in averted emergency department visits. Based on InterQual® criteria, 34% (N = 103) of averted visits would have qualified as an averted hospitalization. All 64 respondents to patient surveys (N = 170) stated they would recommend our program. The staff indicated the model is a better way of caring for patients with higher rewards than traditional settings. The average length of stay in hospice for patients referred from the program (N = 22) was 4 weeks. Home-based care continuums are feasible, yet resources to manage acute exacerbations remain inadequate. To fill this gap, we created higher acuity services to respond to urgent needs and monitor symptoms between episodes. Amid successes and challenges, we are serving higher acuity older adults in Integra's home-based continuum model. We encourage further spread of longitudinal home-based acute care models.

Reducing time toxicity: Impact of a fast-track infusion pathway on overall wait-times and patient satisfaction at a large safety-net health system.

386 Background: Time toxicity is an emerging concept focusing on the impact of cancer care beyond traditionally measured outcomes: the time spent towards receiving care. Although the inherent complexity of cancer care can pose a challenge to improve time toxicity, addressing system and workflow inefficiencies through process improvement is an effective mitigation strategy. Here we present the impact of a fast-track infusion pathway on the wait-times and patient satisfaction at a large safety-net system. Methods: Parkland Health (PH) is the safety-net system for Dallas County, TX. The PH oncology infusion center supports cancer disciplines and other subspecialties. Factors such as timely patient arrivals, preference for coupled visits and same-day lab draws, and heterogeneity of treatments (medicine specialties vs. oncology) significantly impact wait times. In July 2022, a multidisciplinary team was formed to reduce wait times at the infusion center, including members who had previously participated in the ASCO Quality Training Program (QTP). This report is focused on developing a fast-track pathway for patients with injections or &lt;30-minute infusions. Patients with coupled appointments and same-day lab draws were eligible for fast-track. Wait times were calculated from the time patients were checked in at the front desk to the first medication administered. A dedicated team (RN and MA) and separate waiting areas/infusion bays were designated for fast-track patients. Fast-track patients were surveyed for satisfaction. Results: Baseline infusion volume for the 3 months prior to fast-track implementation was 106 patients per day with average wait time of 167 minutes. In the seven-month period after fast-track implementation, average daily fast-track and main infusion center combined volume was 115. The first PDSA cycle was focused on improving workflows and communication with pharmacy. In the second PDSA cycle, the fast-track infusions were moved to another area to infusion chairs to better patient flow. In May 2023, average volumes and wait times for fast-track and main infusion were 28/80 minutes and 87/107 minutes, respectively. This represents a 40% decrease in wait time for fast-track and 36% for main infusion. In our survey, 89% of fast-track patients reported their wait time to be shorter and 92% rated their experience good or excellent. Conclusions: Implementing and optimizing a separate process for short treatments reduced the wait times for both the short infusions (fast-track) as well as long infusions (main infusion) without a need for additional staff, infusion chairs, or space. The observed decrease in main infusion wait-time is likely the result of decongestion of their process by moving some of the volume to fast-track. We hope to further decrease our wait-times through additional PDSA cycles and leveraging process improvement methodology.

Lean Six Sigma implementation in medical school.

426 Background: While medical schools teach advanced medical, surgical, and radiation interventions in oncology, we often don’t teach students how to identify deficits in existing modalities and methodically implement change. Medical students are underexposed to concepts of QI, and many medical educators feel that tools like Lean Six Sigma are too advanced or esoteric for student involvement. A gap exists to create a QI curriculum that invites medical student engagement, while also allowing them to develop self-efficacy to begin a lifelong career of continue process improvement in medicine. Methods: We previously demonstrated that a Value-based Care competition, can serve as a medical school QI curriculum with high levels of student engagement in both local and national competitions. Teams of students collaborate with key stakeholders at their hospital to implement QI projects through the Lean Six Sigma process improvement methodology. This competition is currently completing its third year, and recruiting for the 4th cycle. We performed a multi-year review of student engagement, the degree to which students progressed down the steps of Lean Six Sigma, and the outcomes of QI projects developed through these competitions. Results: For the 2022-23 competition cycle, six medical schools across the country (MCG, UCSD, Florida State University (FSU), Baylor, Penn State, and even internationally at the University of Queensland ran local competitions, representing a 50% growth over the previous cycle (four schools total in 2021-22). Of these schools, four of them are now participating in the National Competition to implement their projects using Lean Six Sigma; representing a 33% growth compared to last year (three schools total in 2021-22). In terms of implementation tools, students have successfully achieved IRB approvals, development of implementations timetables, defining and measuring controls and outcomes, and recruiting patients. Conclusions: Despite being busy with many other components of their medical education, and despite the entirely voluntary nature of the competition, there continues to be a strong appetite amongst medical students to participate in quality improvement. Students have demonstrated their willingness and ability to learn and implement QI projects using Lean Six Sigma. We have also employed a ‘see one, do one, teach one’ model of peer mentorship to create a sustainable multi-year, multi-school, and now multi-national curriculum that continues to grow.

Lean Six Sigma and quality performance in Italian public and private hospitals: a gender perspective

PurposeLean Six Sigma in public and private healthcare organisations has received considerable attention over the last decade. Nevertheless, such process improvement methodologies are not generalizable, and their effective implementation relies on contextual variables. The purpose of this study is to explore the readiness of Italian hospitals for Lean Six Sigma and Quality Performance Improvement (LSS&QPI), with a focus on gender differences.Design/methodology/approachA survey comprising 441 healthcare professionals from public and private hospitals was conducted. Multivariate analysis of variance was used to determine the mean scores on the LSS&QPI dimensions based on hospital type, gender and their interaction.FindingsThe results showed that public healthcare professional are more aware of quality performance improvement initiatives than private healthcare professionals. Moreover, gender differences emerged according to the type of hospital, with higher awareness for men than women in public hospitals, whereas for private hospitals the opposite was true.Research limitations/implicationsThis study contributes to the Lean Six Sigma literature by focusing on the holistic assessment of LSS&QPI implementation.Practical implicationsThis study informs healthcare managers about the revolution within healthcare organisations, especially public ones. Healthcare managers should spend time understanding Lean Six Sigma as a strategic orientation to promote the “lean hospital”, improving processes and fostering patient-centredness.Originality/valueThis is a preliminary study focussing on analysing inter-relationship between perceived importance of soft readiness factors such as gender dynamics as a missing jigsaw in the current literature. In addition, the research advances a holistic assessment of LSS&QPI, which sets it apart from the studies on single initiatives that have been documented to date.

Developing an enhanced business process improvement methodology (EBPIM)

PurposeThis research paper aims to develop and validate an enhanced business process improvement methodology (EBPIM) by integrating the DMAIC (define, measure, analyze, improve and control) and the comprehensive business process management (CBPM) methodologies.Design/methodology/approachA systematic literature review and analysis were conducted to prove the novelty of the research approach and identify the similarities, differences, strengths and weaknesses of the DMAIC and the CBPM methodologies. The EBPIM was proposed based on the analysis results. Then, a focus group approach was used to evaluate and validate the methodology.FindingsThe EBPIM consists of nine activities: preparation, selection, description, quantification, modeling, enactment, improvement opportunities selection, analysis and improvement and monitoring. The proposed methodology adopted the systematic and structured process of the DMAIC methodology by having one tollgate between every two activities to check the progress and authorize the team to go to the next activity. At the same time, it has the ability of the CBPM methodology to enhance the interaction between human activities and business process management systems (BPMS).Research limitations/implicationsThe EBPIM was evaluated and validated by a focus group of academic professors. However, the main limitation of the proposed methodology is that it is still theoretical and needs to be empirically tested. Therefore, future work will focus on testing the EBPIM in different industries and organization sizes.Practical implicationsFrom the theoretical perspective, the proposed methodology adds value to the knowledge in the scope of business processes improvement methodologies (BPIMs) by integrating the DMAIC and the CBPM methodologies. It takes advantage of and combines the strengths of the DMAIC and CBPM methodologies. From the practical perspective, the proposed methodology presents a valuable tool that can facilitate the organization’s mission to improve the areas that need improvement using a systematic improvement methodology that will effectively enhance organizational performance (OP).Originality/valueThe BPIMs literature analysis proved that most of the reviewed methodologies could not support all phases of the business process improvement (BPI) activities. It was concluded that integrating the DMAIC and the CBPM methodologies is a novel approach. The proposed methodology will enhance the efficiency of both methodologies, fill the gaps that may exist in both of them and lead to better results in terms of BPI.