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Figure 4 - available via license: Creative Commons Attribution 4.0 International

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Fishbone for OR Stock Management.

Source publication

Using Lean Six Sigma to Redesign the Supply Chain to the Operating Room Department
of a Private Hospital to Reduce Associated Costs and Release Nursing Time to Care

Article Full-text available Oct 2021

Lisa O’Mahony · Kerrie McCarthy · Josephine O’Donoghue · [...] · Martin S Mcnamara

Continuity of the supply chain is an integral element in the safe and timely delivery of health services. Lean
Six Sigma (LSS), a continuous improvement approach, aims to drive efficiencies and standardisation in
processes, and while well established in the manufacturing and supply chain industries, also has relevance
in healthcare supply chain man...

Cite Download full-text

Context in source publication

Context 1

... identified two return journeys per day and 27 min per journey, a total of 56 min per day. We used an Ishikawa
fishbone diagram ( Figure 4 ) to view cause and effect visually. Root causes for over-processing and stock waste
included environmental issues (lack of structure in the Main store, overstocked trollies, the same product in
multiple locations), lack of formal stock management over the redline, and lack of defined ownership. ...

View in full-text

Citations

... It is evident that economic and technological factors are closely intertwined. Various studies have
emphasized the enabling effects of technology on cost efficiency, supply chain visibility, inventory
management, supplier relationships, economic analysis, and innovation within the healthcare context
[97] . By effectively leveraging technology, healthcare supply chains can achieve economic sustainability
while simultaneously enhancing patient safety [98]. ...

A novel hybrid sustainable healthcare supply chain model for patient safety: A case study
of Cambodia

Article Full-text available Feb 2024

Chayada Kanokphanvanich · Wanchai Rattanawong · Varin Vongmanee

This research focuses on elucidating the attributes of a Sustainable Healthcare Supply Chain (SHSC) that play a
pivotal role in enhancing patient safety, particularly in developing nations. Patient safety in healthcare supply
chains is paramount, particularly in the face of inherent risks and vulnerabilities associated with disruptions an…
uncertainties. A hybrid selection model, integrating factor analysis, structural equation modeling (SEM), and the
View
Fuzzy Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS), is introduced to rank these
attributes. Twenty-two SHSC attributes are categorized into four facets: social, environmental, economic, and
technological. A survey conducted across five Cambodian provinces gathered 361 valid responses from
healthcare professionals, forming the basis for a structural SHSC model. This model is subsequently
implemented in a Phnom Penh tertiary hospital. The findings underscore the imperative of incorporating patient
... Health systems adopt new policies to achieve diverse goals, including enhancing patient experiences
safety considerations into healthcare supply chains. The hybrid selection model helps healthcare leaders figure
and healthcare professionals work life, reducing costs, and improving population health [1]. Some policy
out what factors are most important for patient safety and rank them. This gives them information they need to
innovations comprise changing managerial practices to utilize resources more efficiently and increase
come up with effective strategies and long-lasting projects. The study's outcomes provide actionable insights for
production [2], for example, saving time for healthcare professionals and avoiding instrument waste [3] .
healthcare stakeholders. The multi-analytical approach of the model offers a comprehensive perspective to
Other policy innovations consist of changing organizational processes to improve healthcare provision. ...
address supply chain challenges, reduce extraneous costs, and minimize environmental footprints. In essence,
the effective implementation of sustainable healthcare supply chain strategies not only enhances care quality
and...fortifies
We can convince
patient maybe
safety three,
but also fourwith
aligns or ten
theofbroader
the regional directors
objectives that we gather
of healthcare here, or they gather,
entities.
and we go there, and try to convince them that now you can go home and do this and then ten of them do
it but not twenty-one, therefore not everyone has been convinced. Then you must invite them again and
that type of meeting, in such a chain, must be managed" (Individual interview 3) . ...

Adopting standardized cancer patient pathways as a policy at different organizational levels

in the Swedish Health System

Article Full-text available Nov 2023 · Health Res Pol Syst

Petter Fjällström · Anna-Britt Coe · Mikael Lilja · Senada Hajdarevic

Background Standardized cancer patient pathways as a new policy has been adopted in healthcare to improve
the quality of cancer care. Within the health systems, actors at different levels manage the adoption of new
policies to develop healthcare. The various actors on different levels play an important role and influence the…
policy adoption process. Thus, knowledge about how these actors use strategies when adopting cancer patient
View
pathways as a policy in the health system becomes central. Method The study’s aim was to explore how actors
at different organizational levels in the health system adopted cancer patient pathways. Our overarching case
was the Swedish health system at the national, regional, and local levels. Constructivist Grounded Theory
Method was used to collect and analyze qualitative interviews with persons working in organizations directly
involved in adopting cancer patient pathways at each level. Twelve individual and nine group interviews were
... Similar results were also achieved in the study of Godley et al. 16 . Ultimately, the study carried out by
conducted including 53 participants. Results Organizational actors at three different levels used distinct
O'Mahony et al. 24 employed Six Sigma methodology to streamline the operating room's supply chain.
strategies during the adoption of cancer patient pathways: acting as—missionaries, fixers, and doers. Acting as
The study's authors identified an overall decrease of 17.7% in the value of stock inventory within the
missionaries consisted of preaching the idea of cancer patient pathways and framing it with a common purpose
operating theater, an impressive reduction of 91.7% in stock items reaching their expiration, and a
to agree upon. Acting as fixers entailed creating a space to put cancer patient pathways into practice and
remarkable 45% reduction in clinical staff time spent preparing necessary stock for procedures. ...
overcome challenges to this. Acting as doers comprised balancing breadth and speed in healthcare provision
with not being involved in the development of cancer patient pathways for the local context. These strategies
were not developed in isolation from the other organizational levels but rather, each level interacted with one
Six Sigma
another. can significantly
Conclusions reduce
When adopting costs of
new policies, it ispoor quality
important to beofaware
the surgical instruments
of the different strategies and
sterilization
actors at various process and improve
organizational surgeon
levels in health andEven
systems. operating room
when actors onpersonnel satisfaction
different levels developed
separate strategies, if these contribute to fulfilling the four domains of inter-organizational collaboration, they can
Article
work Full-texttoavailable
well together adopt newAug 2023 Our study highlighted that the application of two domains was lacking,
policies.
which meant that local actors were not sufficiently involved in collaboration, thus constricting the local use and
Andrea Saporito · Claudio Tassone · Antonio Di Iorio · Marcella Barbieri Saraceno · Davide La Regina
optimization of cancer patient pathways in practice.
Operating room (OR) management is a complex multidimensional activity combining clinical and managerial
aspects. This longitudinal observational study aimed to assess the impact of Six-Sigma methodology to optimize
surgical instrument sterilization processes. The project was conducted at the operating theatre of our tertiary…
regional hospital during the period from July 2021 to December 2022. The project was based on the surgical
View
instrument supply chain analysis. We applied the Six Sigma lean methodology by conducting workshops and
practical exercises and by improving the surgical instrument process chain, as well as checking stakeholders’
satisfaction. The primary outcome was the analysis of Sigma improvement. Through this supply chain passed
314,552 instruments in 2022 and 22 OR processes were regularly assessed. The initial Sigma value was 4.79 ±
1.02σ, and the final one was 5.04 ± 0.85σ (SMD 0.60, 95%CI 0.16–1.04, p = 0.010). The observed improvement
... Their combined use has been identified as having an impact on health outcomes, processes and quality
was estimated in approximately $19,729 of cost savings. Regarding personnel satisfaction, 150 questionnaires
of care, finance, and patient and staff satisfaction [29]. For example, Lean Six Sigma has been used to
were answered, and the overall score improved from 6.6 ± 2.2 pts to 7.0 ± 1.9 pts (p = 0.013). In our experience
streamline pathways for people following hip fracture [30] and to release time to care for nurses in
the application of the Lean Six Sigma methodology to the process of handling the surgical instruments from/to
hospitals, both private [31] [32] [33] and public [34][35][36]. The literature demonstrates improvement at
the OR was cost-effective, significantly decreased the costs of poor quality and increased internal stakeholder
patient, staff, and organisational levels [37]. ...
satisfaction.

... Preand post-intervention studies involve the measurement of variables of interest before and after the
intervention in the same study site, on the assumption that any difference in measurement between
'before' and 'after' is attributable to the intervention. Although this design has the limitation of ascribing
outcomes to an intervention with certainty [4], this study design has been widely used to implement and
evaluate Lean Six Sigma interventions in healthcare [13,21,23,30, [32] [33][34][35]. ...

... The OR is a complex and high-stakes environment where collaborative teams of surgeons,
anaesthetists, and nurses work together with other healthcare professionals and support staff to provide
safe and effective patient care [33]. Achieving optimal flow in the OR is critical for patient safety, surgical
outcomes, and team efficiency [32, 33,50]. Lean Six Sigma has demonstrated its effectiveness as an
improvement methodology when applied to the following in the OR: ...

The Utilization of Lean Six Sigma Methodologies in Enhancing Surgical Pathways and
Surgical Rehabilitation

Article Full-text available Jun 2023

Seán Paul Teeling · Michelle McGuirk · Martin McNamara · Marie McGroarty · Aileen Igoe

The authors offer their perspective on the application of Lean Six Sigma methodology to surgical pathways, from
referral to post-operative rehabilitation, and how it has resulted in sustainable improvements in patient outcomes,
and patient and staff satisfaction. The origin of Lean Six Sigma is described before considering its application t…
improving scheduled surgical care. The concept of ‘flow’, and its relevance to pre-, intra-, and post-operative
View
care, is discussed as well as the role of Lean Six Sigma in supporting innovation and in promoting an
organizational culture that promotes openness to new ideas. The elements of the methodology that render it
especially suitable for the redesign of surgical pathways include eliciting the customer voice, co-design, enabling
system awareness and inculcating a continuous improvement mindset. The necessary conditions for the
successful implementation of Lean Six Sigma initiatives include managerial support, high-quality education and
... Em relação à categoria das instituições, foram distribuídas em: hospital (13), hospital/centro médico
training, and alignment with organizational strategy. Future directions for practice and research are discussed
universitário (7), atenção primária (2) e laboratório (2). A redução do tempo de espera para
before presenting a key finding from the literature and from the authors’ collective experience: Lean Six Sigma
consulta/tratamento foi identificada em 12 estudos 12,[15][16][17][18][24][25][29][30][31]33,35 , seguido
initiatives will not lead to sustainable improvements where the key elements of the methodology are not
por aumento da satisfação do paciente (oito) [15][16][24][25]27,29,[32][33] , redução no tempo de
recognized and enacted, and where the necessary conditions are absent.
internação (seis) 13,16,18,[22][23]27 , redução do tempo gasto sem valor agregado/aumento no tempo
da equipe de saúde disponibilizado na assistência (seis) 14,[19][20] [21] [25][26] , redução do
superprocessamento (cinco) 14,16,19,23,27 , redução dos custos/aumento de lucro financeiro (cinco) [13]
[14]16,21,26 , aumento no giro de leito (quatro) 13,16,23,27 , aumento da satisfação da equipe
profissional (quatro) [27][28][29]34 , em menor quantidade a redução do cancelamento de cirurgia e
redução de estoque (um estudo cada) 16,21 , no entanto, com grandes impactos relevantes. O número
de achados de repercussões (n=52) é superior à amostra final de artigos (n=24), visto que, um mesmo
estudo pode expressar mais de um resultado de acordo com a redução e/ou eliminação de desperdícios
e os valores agregados ao cliente, ao profissional e à instituição. ...

... Em relação à categoria das instituições, foram distribuídas em: hospital (13), hospital/centro médico
universitário (7), atenção primária (2) e laboratório (2). A redução do tempo de espera para
consulta/tratamento foi identificada em 12 estudos 12,[15][16][17][18][24][25][29][30][31]33,35 , seguido
por aumento da satisfação do paciente (oito) [15][16][24][25]27,29,[32][33] , redução no tempo de
internação (seis) 13,16,18,[22][23]27 , redução do tempo gasto sem valor agregado/aumento no tempo
da equipe de saúde disponibilizado na assistência (seis) 14,[19][20][21][25][26] , redução do
superprocessamento (cinco) 14,16,19,23,27 , redução dos custos/aumento de lucro financeiro (cinco) [13]
[14]16, 21, 26 , aumento no giro de leito (quatro) 13,16,23,27 , aumento da satisfação da equipe
profissional (quatro) [27][28][29]34 , em menor quantidade a redução do cancelamento de cirurgia e
redução de estoque (um estudo cada) 16,21 , no entanto, com grandes impactos relevantes. O número
de achados de repercussões (n=52) é superior à amostra final de artigos (n=24), visto que, um mesmo
estudo pode expressar mais de um resultado de acordo com a redução e/ou eliminação de desperdícios
e os valores agregados ao cliente, ao profissional e à instituição. ...

... Em relação à categoria das instituições, foram distribuídas em: hospital (13), hospital/centro médico
universitário (7), atenção primária (2) e laboratório (2). A redução do tempo de espera para
consulta/tratamento foi identificada em 12 estudos 12,[15][16][17][18][24][25][29][30][31]33,35 , seguido
por aumento da satisfação do paciente (oito) [15][16][24][25]27,29,[32][33] , redução no tempo de
internação (seis) 13,16,18,[22][23]27 , redução do tempo gasto sem valor agregado/aumento no tempo
da equipe de saúde disponibilizado na assistência (seis) 14,[19][20][21][25][26] , redução do
superprocessamento (cinco) 14,16,19,23,27 , redução dos custos/aumento de lucro financeiro (cinco) [13]
[14]16,21,26 , aumento no giro de leito (quatro) 13,16,23,27 , aumento da satisfação da equipe
profissional (quatro) [27][28][29]34 , em menor quantidade a redução do cancelamento de cirurgia e
redução de estoque (um estudo cada) 16, 21 , no entanto, com grandes impactos relevantes. O número
de achados de repercussões (n=52) é superior à amostra final de artigos (n=24), visto que, um mesmo
estudo pode expressar mais de um resultado de acordo com a redução e/ou eliminação de desperdícios
e os valores agregados ao cliente, ao profissional e à instituição. ...

Repercussões obtidas nos serviços de saúde com a implantação do Lean Healthcare:

revisão integrativa

Article Full-text available May 2023

Mariah de Souza · Paula Carla de Meneses · Hellen Maria de Lima Graff Fernandes · Valéria Aparecida
Masson · Priscila Moreno Sperling Cannavan

Objetivou-se identificar quais tipos de serviços/setores de saúde implantaram o Lean Healthcare e as

repercussões obtidas. Trata-se de revisão integrativa seguindo a diretriz Preferred Reporting Items for
Systematic Reviews and Meta-Analyses – PRISMA. Realizadas buscas em bases e portais eletrônicos em…
saúde, resultando 24 artigos publicados entre os anos 2012-2022. Evidenciou-se que o último quinquênio
View
apresentou 88% das publicações, inclusive durante o período de pandemia COVID-19. Dos serviços de saúde
que implementaram o Lean, 58,4% não citaram o tipo de administração, 25% eram de perfil institucional privado
e 16,6% público. A predominância da implementação foi em hospitais e instituições universitárias, seguido da
atenção primária e laboratório. As repercussões mais evidentes foram a redução do tempo de espera, aumento
da satisfação do paciente e da equipe profissional. Conclui-se que a filosofia Lean mostrou-se eficaz nos
... Eight out of the nine papers in this part of the Special Issue report on distinct process improvement
diversos cenários da assistência à saúde. Ressalta-se a importância de estudos longitudinais que apresentem a
projects in a single organization [3][4][5][6][7][8][9] [10] . Each of these papers outlines how the project
manutenção dos resultados obtidos.
achieved its process improvement goals, while taking a person-centred and systems perspective. ...

Making a Sustainable Difference to People, Processes and Systems: Whole-Systems

Approaches to Process Improvement in Health Systems

Article Full-text available Mar 2023 · Int J Environ Res Publ Health

Martin McNamara · Marie Ward · Seán Paul Teeling

The eighteen papers in this Special Issue, ‘Whole-Systems Approaches to Process Improvement in Health
Systems’, address an enduring challenge in healthcare: to improve efficiency with existing or reduced resources,
while maintaining safe and effective care [...]

View

... According to O'Mahony et al. (2021) , overstocking also occur in addition to the fear for stock outs and
the significant complications it creates on patient care. Having items in multiple locations can contribute to
overstocking, although it is a natural instinct of fear for running out or not having the items available when
needed (O'Mahony et al. 2021). ...

... According to O'Mahony et al. (2021), overstocking also occur in addition to the fear for stock outs and
the significant complications it creates on patient care. Having items in multiple locations can contribute to
overstocking, although it is a natural instinct of fear for running out or not having the items available when
needed (O'Mahony et al. 2021 ). Pandey and Raut (2016), stated that quality control methods can be
used to prevent stock wastage by packing items Proceedings of the International Conference on Industrial
Engineering and Operations Management Manila, Philippines, March 7-9, 2023 © IEOM Society
International that were received first in front for staff to utilize it first. ...

Optimizing Inventory Control in A Microbiology Laboratory to Provide High Quality Patient

Results

Conference Paper Full-text available Mar 2023

Kemlall R Ramdass · Mulde Van Der Wateren · Bongumenzi T Mncwango

The measurement for quality in a clinical laboratory is to deliver reliable patient results within a specific time
frame. To do so, it always needs sufficient stock levels. Unfortunately, little attention is given to inventory
management and a designated laboratory worker is assigned to do inventory management tasks. In order to…
optimize inventory management, principles should be implemented to plan for future demands, buffer for present
View
stock shortage, eliminate obsolete stock and modernize the system to ease follow ups on orders and back orders
for all relevant staff. An experimental approach was used where known principles and methods were applied to
determine if the outcome would add value. Interviews with staff, historical data, and observations in terms of time
and money were statistically analyzed. It was concluded that all principles, including modifying safety stock were
valuable in optimizing inventory management. The amount of safety stock to carry should be determined by the
... Global Health: Science and Practice 2023 | Volume 11 | Number 1 commodities. [11][12][13] [14] By
balance between cost and services needed. The principles should be extended to the entire inventory and real-
relying on a collaborative team effort, MOH and GHSC-PSM used the QMIA to apply these methodologies
time receiving should be investigated and implemented for added improvement
to improve supply chain performance by systematically removing waste and reducing variation. ...

The Quality Management Improvement Approach: Successes and Lessons Learned From a
Workforce Development Intervention in Rwanda’s Health Supply Chain

Article Full-text available Jan 2023

Rogers Kigenza · Eliezer Nsengiyumva · Vincent Sabagirirwa

Background: Rwanda's supply chain is decentralized, with regional warehouse pharmacies and service delivery
points (SDPs) ensuring a reliable health commodities supply. However, in 2016, the Rwanda Ministry of Health
(MOH) identified challenges with the supply chain workforce contributing to a high stock-out rate, inventory sto…
inaccuracies, and underutilization of the electronic logistics management information system (e-LMIS). We aimed
View
to document successes and lessons learned from implementing a workforce development intervention to
address these challenges. Program description: Rwanda's MOH and the U.S. Agency for International
Development Global Health Supply Chain Program-Procurement and Supply Management project implemented
a workforce development intervention, the Quality Management Improvement Approach (QMIA), to improve and
sustain Rwanda's service delivery and medicines availability. The QMIA monitors the performance of supply
... The availability is the key factor to ensure the stakeholders in HSC can monitor and track product
chain professionals while continuously building their capacity to run a smooth supply chain operation. The QMIA
availability to increase the timely delivery of supplies, especially in life-saving procedures [19], [20], [21]
includes supervisory visits to measure key performance indicators and discussion sessions for experience-
Innovative Technology The potential of innovation always lights up expectations of less invasive and more
sharing and skill-building. The central level conducts both components, supporting regional warehouses that in
accurate healthcare outcomes in the future, with lesser complications, faster recovery time, and better
turn assist SDPs through supervisory visits and discussion sessions. Results: Since 2017, the QMIA has been
quality of life [22] Reliability When illicit products are supplied via illicit routes to hospitals and be used in
conducted twice a year in 596 SDPs and 30 regional warehouses and has trained 1,296 supply chain staff
surgical procedures, risks are present and harm to patients can occur. It is very essential to build and
members. The intervention has contributed to major improvements in several key supply chain outcomes (2017
evaluate the strengths and weaknesses in every step of HSC in order to ensure the safety and effective
versus 2019): increased utilization of the e-LMIS (55% to 96%), higher inventory data accuracy (25% to 85%),
care provided to all patients [23], [24] Skill, Knowledge, and Experience Skills, knowledge, and experience
and reduced stock-outs (10% to 1%). Conclusions: The QMIA has proven to be a successful training and
are the most critical resources. ...
capacity-building platform for supply chain management in Rwanda, enhancing system utilization and availability
of accurate data to guide decision-making. Notably, the approach fosters a positive behavioral change to build
local solutions and improves communication.
A Meta-Analysis of Health care Supply Chain Performance for Patient Safety

Conference Paper Dec 2022

Chayada Kanokphanvanich · Wanchai Rattanawong · Varin Vongmanee

View

... Numerical analysis showed that coordination of inventory management of surgical instruments and
material handling decisions could improve the service level provided by operating rooms. O'Mahony et al.
[21] used lean six sigma to redesign the supply chain to the operating room department of a private
hospital. They reduced costs and release nursing time to care. ...

Robust Multi-Objective Supply Chain Optimization of Surgical Supplies Considering Costs

and Satisfaction of Surgeon, and ranking Suppliers Using ARAS Method

Article Sep 2022

Sahar Karimyan · Parvaneh Samouei

View

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