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The health care context The chapter presents the crucial environmental factors, i. The first section lists the arguments which urge the transformation of health care in general, and hence give a significant impetus to Lean.
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Then it quotes some works bmj learning access code call the attention to errors and wastes in hospital care. The rest of the chapter is devoted to the characteristics of health care services, different in many respects from those of production, and of relevance for the interpretation of the results.
Actuality of the transformation of health care: macro-level challenges In bmj learning access code bmj learning access code, the performance and expenditures of health care systems have moved to the focus of social and political attention in the advanced countries. In the globalising world, ever fewer of these economies can afford to finance the operation cél kezelés cukorbetegség their welfare systems in the same way as before de Koning et al.
The health care systems, in particular, warrant special attention due to their significant and growing share in public expenditures Figure 5and their consequent major effect on such macro-economic indicators as the development of the general government deficit, for example. The growth of health care expenditures is the result of such trends, typical in the advanced economies, as the aging of society, conducive to the widening of the circle of beneficiaries as a matter of course, or the application of the results of scientific development, which implies the use of more and more expensive procedures, instruments and medicines.
However, several countries, struggling in the grip of globalisation, can simply not bear a further growth of expenditures. Source: www. Many sources agree that this sector is characterised by poor quality — poor results and wasteful operation — in many countries of the world. If that is so, then society has every right to demand the service providers concerned to reduce the wastes and improve the results of care provision.
The governments have set the bmj learning access code of the cost reduction or at least the prevention of the further drastic increase of expenditures the world over. These administrative measures, however, have proved ineffective already in the medium run, since people insisted on being provided quality health care Gulácsi, As stated by a former - 32 - István Jenei: Lean transformation of hospital processes — Structuring foreign and Hungarian experiences, PhD Dissertation, Corvinus University of Budapest, Doctoral School in Business Administration director of the clinical administration, the lancet diabetes and endocrinology abbreviation developments must find new courses; a mere increase of the resources will not produce adequate results and, as far as the NHS is concerned, capacity problems are due to everyday routines, habits, which no one has ever tried to change Bennett — Lister, cited by Parnaby — Towill, De Koning et al.
Health care professionals can influence that De Koning et al. The macro-level system is the totality of the entities institutions constituting the health care system. Initiatives which affect several institutions in the same way will obviously produce change also at macro level.
Actuality of the transformation of health care: micro-level challenges This section demonstrates why it is inevitable to transform health care at the level of service provider institutions.
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In particular, why it is important to improve the quality and cost-effectiveness of the health service processes in the developed countries Hungary included. It presents some international researches which highlight these problems.
Although they mostly present the health services of the US and the UK, given the nature of the problem, the situation is probably similar also in the other advanced economies. This hypothesis is apparently corroborated by the experiences of research projects carried out in other countries Laursen et al.
The consultants were invited by the hospital management to survey the hospital processes. Of course, this is but one example from the bmj learning access code hospitals of the world.
Nevertheless, as will be shown later on, it is not an exceptional one. Indeed, more people die annually from medical errors alone than from workplace injuries. And, although errors may be more easily detected in hospitals, the problems extend to every health cares setting, including day-surgery and outpatient clinics, retail pharmacies, nursing homes and home care.
Add the financial cost to the human tragedy, and medical error easily rises to the top ranks of urgent, widespread health problems. Moreover, for every patient who dies due to medical error or hospital infection, there are 5 to 10 others bmj learning access code suffer infection with less severe bmj learning access code.
In other words, at the turn of the millennium, in the USA, of people subjected to hospital care for some reason, 88 were infected, injured or provided wrong therapy, and 6 among them actually died due to that Spear, In the other services, a quality rate of even As addendum to the above, it is worth getting acquainted with the results of a research project which observed the activity of 26 nurses in 9 hospitals for a total of hours. Records were kept of errors made i. Data analysis yielded the far-from-surprising result that the number of problems exceeded by far that of the errors.
However, one must not forget that, as indicated by Westcited: New et al. To get a realistic picture of the rate of the daily occurrence of problems which hinder the activity of the medical staff, but which have never been in the centre of attention, although they deteriorate service quality and, not in the last, financial efficiency, the frequency-of-errors data must be complemented with these observations.
The example of the US is not unique among the advanced countries as far as quality problems are concerned.
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Surveys carried out in the National Health Service hospitals in the United Kingdom showed that one of every 10 hospital patients is the victim of a negative event of some kind: they get the wrong medication, fall down or off fekélyek a cukorbetegségben lábápolás, suffer infection or are given the wrong diagnosis National Audit Office, ; Fillingham, Burgess et al.
Deficiencies impacting on patient security as well as errors of care are related to low process efficiency Tucker, ; Tucker and Edmondson, ; New et al. Based on own research, New et al.
Thus, for instance, if medicines are arranged in some order and stored separately from liquids, nurses will probably spend less time finding what they are looking for. According to Mezőfiin Hungarian emergency patient care, 28 minutes of patient care on average is associated with minutes of patient waiting time, that is, only one fifth of the time spent by the patient in the system is useful.
Jimmerson et al. These circumstances, of course, imply higher costs, lower efficiency, higher error rates and, last but not least, a frustrated staff Jimmerson et al. In - 36 - István Jenei: Lean transformation of hospital processes — Structuring foreign and Hungarian experiences, PhD Dissertation, Corvinus University of Budapest, Doctoral School in Business Administration the health care organisations, the staff usually work in bmj learning access code silos: the wards operate individually, the process-centred approach is absent.
The information processes associated with service provision are even more complicated: they may amount to five or six times the patient journey. Unclear and over-complicated processes generate many errors, duplications and delays, and they frustrate staff members in direct contact with the patients, who cannot provide service of satisfactory quality despite their best intentions Fillingham,Parnaby — Towill, Let us note again that a major part of the problem is attributable not to the inadequate professional skills, attitude or efforts of the staff, but to the system in, and the processes amidst which they must work Spear, The primary cause is the historical heritage.
Traditionally, hospitals relied on their highly skilled and devoted professional staff members to ward off occasional operational errors. That is, quality service used to be guaranteed by the excellent medical and nursing staff, not by excellent systems.
This approach, however, is about to change now, due exactly to the relevant, growing, social pressure. For, an increasing number of initiatives target the systematic identification and elimination of errors Tucker and Edmondson, The Hungarian programme called NEVES, for example, was designed to explore the generic root causes systematic errors in care provisionand to improve communication, information supply, education, process organisation and management, to fine-tune staff planning and organisation, and to upgrade the allocation, use and operation of equipment and instruments Belicza, The initiatives concerned, however, have seldom resulted in a quantum leap.
Despite some successful projects, most organisations have difficulties in the comprehensive application of the system to this day. Although they can already achieve results on a small scale, the extension of individual bmj learning access code to organisation-level sustainable developments has remained a problem.
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Patients want not only high quality professional services, but also want it within a reasonable time. According to a recent survey which was representative in Hungary, the customers of Hungarian health service providers rated waiting times and the keeping of appointments lowest WEBBeteg, Waiting times usually affect only the degree of satisfaction of the patient, but the length of hospital stays certainly affects their state of health as well: the longer the period of in-patient care, the higher the risk of undesirable events e.
As indicated by the circumstances described above 1.
Health care services are characterised by low process efficiency; 2. Health care services are in need of cost-effectiveness development, due also to external factors; 3.
Health care should pay more attention to the quality of the service; 4. Despite some initiatives to implement quality development programmes in health care, these have typically had no breakthrough effect. What has been reviewed in this chapter certainly explains the intensifying interest in Lean of health care administrations and managers the world over.
Effects of the special features of health care on lean transformation It is imperative to take stock of branch-specific differences in connection with the examination of the new application of Lean in health care.
Prevalence and trends of urinary incontinence in adults in the United States, to J Urol. The relationship of vaginal prolapse severity to symptoms and quality of life.
This chapter will tackle that issue. Since the patient himself exerts a major influence on the care process and its outcome, it is rather difficult to assess the real performance of the system.
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This large array of possible performance evaluation options is a significant problem as far the unambiguous performance measurement and direct employee feedback objectives of the lean system are concerned.
The relevant causes due mainly to the specific health care financing system will be described in detail later on. Let us investigate now the three essential feature clusters of health care services which have significant influence on the adaptability of lean management: 1. Health care is a service, not a production activity.