No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Development of a Data-Centric Design Thinking Process for Innovative Care Delivery
Abstract
Objectives
This work aims to improve the quality of care provided to patients by equipping caregivers with comprehensive set of problem-solving tools and competencies. This is achieved through the development of a customized health design process that incorporates both human-centric and data-centric tools.
Background
To meet the growing complexity of today’s clinical practice, caregivers need to be empowered with the tools and competencies necessary to address the multifaceted challenges they encounter. This has emphasized the need to broaden the traditional role of caregivers as evidence-based practitioners to include being healthcare problem-solvers and innovators who utilize their creative and critical thinking skills.
Method
While design thinking (DT) is a popular methodology that fosters caregivers’ empathy and creativity, it does not provide tools for evaluating the quality of obtained solutions. To address this gap, a problem-solving process that combines DT and data-centric tools of the Lean Six Sigma method was developed in this work.
Results
The evaluation of this customized design process was based on targeted competencies derived from the six aims of healthcare. The potential benefits are then highlighted through mapping the possible outputs of every phase with the targeted set of caregivers’ skills. Additionally, an implementation plan was outlined for a local hospital, showcasing the potential impact this process can have in empowering caregivers with the necessary competencies to create effective and innovative solutions for care delivery.
Conclusion
Overall, This unique approach has the potential to contribute to the ongoing effort to transform healthcare into an efficient system that meets the needs of both patients and caregivers.
... Alman et al. (2018) find that in comparison with conventional expert-driven healthcare methods, design thinking may lead to improvements in effective interventions arising from improved usability and acceptability of healthcare products and services. The need for innovative healthcare delivery through design thinking has also been advocated for application to process innovation (Houssaini et al., 2024). The application of design thinking in healthcare is important as the landscape of health has seen radical changes in the past decade and has continued to grapple with a variety of challenges regarding variations in quality and increasing cost of care delivery (Houssaini et al., 2024). ...
... The need for innovative healthcare delivery through design thinking has also been advocated for application to process innovation (Houssaini et al., 2024). The application of design thinking in healthcare is important as the landscape of health has seen radical changes in the past decade and has continued to grapple with a variety of challenges regarding variations in quality and increasing cost of care delivery (Houssaini et al., 2024). Given the ever-increasing health challenges, increasing healthcare sector competitiveness requires organizations to seek alternative options to improve their healthcare offerings and processes. ...
... medical service providers would require disruptive approaches and/or strategies to enhance the treatment process and bolster the creation of transformational care to offer a high level of patient care and patient satisfaction. Accordingly, design thinking in healthcare offers the desired problem-solving solution to approach the complex challenges towards meeting the needs of both healthcare providers and patients (Houssaini et al., 2024). ...
Nowadays, healthcare innovation is the main tool that improves the provision of medical care in developing countries, especially in countries with low resources. This research case presents the innovation journey of Goliath Robotics, a startup company in sub-Saharan Africa, specifically Ghana that operates in the health space and produces electric wheelchairs. The case focuses on three theories, particularly the resource-based view, effectuation theory and the bottom of the pyramid integrated with the design thinking process to show how these theories can be applied together in a business model to achieve affordability, accessibility and sustainability. The co-founders not only strive to source raw materials themselves but also fill in skills gaps required to produce the wheelchairs, as well as overcome a bevvy of technical hurdles in their startup journey. The research aims to bridge the literature gap regarding entrepreneurs producing affordable health solutions using the design thinking approach in underserved markets. It also delves into the importance of involving various stakeholders in developing solutions. The paper applied a case study approach. Data was collected using interviews, which were recorded, transcribed, and data analyzed interpretively. The study results show that integrating these theories creates a comprehensive framework for guiding innovation in healthcare delivery and the end user's involvement at the base of the pyramid to develop appropriate, cost-effective solutions. By integrating these theories, entrepreneurs and firms can use design thinking to identify opportunities to serve low-income populations, leverage local, available and affordable resources and internal capabilities, make effective decisions and adapt to uncertainty. Researchers can test this framework in other markets or developing countries for future studies.
New product development (NPD) exists at the fuzzy front end (FFE) of innovation – the time when companies must make often ill-defined decisions based on limited information. Many industry-generic studies focus on the causes of this fuzziness: uncertainty, complexity, and equivocality — also identified as ambiguity. In this paper we explore the FFE of innovation in the Swedish medical devices industry where the public sector is a prominent player. Based on our empirical data from the interviews, we constructed a conceptual FFE framework Our findings reveal when public sector organisations purchase medical devices, the fuzziness in the FFE increases for the medical devices industry. Uncertainty and complexity in the FFE increase when medical devices companies must consider the degree of product risk as well as the laws, regulations, and practices involved in sales to the public sector. In addition, equivocality (ambiguity) increases when industry actors and public sector actors have different interpretations of product costs.
Doctors are nowadays experiencing many struggles in their daily practice, mainly due to new intricate challenges of the twenty-first century. However, despite the efforts of traditional medical education, it falls short in providing them with the required tools to effectively overcome these difficulties. In light of these shortcomings, this paper suggests the development of a new educational framework designed to guide medical educators in creating student-centered learning experiences. Which may be ensured by using Design Thinking (DT) as an instructional design method, merged with constructive alignment principles, and generative artificial intelligence. To demonstrate the effectiveness of this new educational approach, a case study is showcased wherein the framework was applied to design a new medical curriculum. The case study specifically focuses on first-year students in a Moroccan medical faculty and was developed based on DT principles, allowing students to engage in a transformative learning process that encourages innovation and creativity. The new curriculum includes lecture sessions, hands-on workshops, and project coaching where teams of medical students learn the design process and are given the opportunity to prototype and test their proposed solutions at local university hospital units. Overall, the showcased case study provides evidence of the framework's effectiveness in designing a new medical curriculum, illustrating its potential for enhancing medical education and engaging future doctors in impact-focused projects with long-term benefits for their career development.
While Lean Six Sigma (LSS) has been applied extensively in healthcare organisations, there has been limited research on the trends of LSS application in healthcare in recent years. This paper aims to present the key motivations and benefits of LSS in healthcare with a view to highlighting the types of problems that LSS in healthcare can aid in solving. The authors used a systematic literature review (SLR) approach to achieving the article’s purpose. Peer-reviewed journal articles published between 2011 and 2021 are considered to achieve the study objectives. The systematic review helped the authors to identify the evolution, benefits, and motivations for LSS in healthcare. This work includes directions for managers and healthcare professionals in healthcare organisations to embark on a focused LSS journey aligned with the strategic objectives. This study is perhaps one of the most comprehensive SLRs covering a vital agenda of LSS in healthcare. This study provides all the deliverables of LSS for its successful deployment in healthcare.
Lean hospital play a crucial role in the hospital service performance. It has been proved that implementing lean hospital management concept enhance the quality of hospital services. The purpose of this article is to investigate the waste and its causal factors. This paper is based upon a multi case study of lean hospital management practice of emergency unit in two generalhospital. Data collected by semi structured interview, document analysis andobservation. Value stream mapping is used to analyze hospital service process. Results of the analysis shows that waste identified on hospital services such as waiting times, defect in administrative services, inappropriate processes mainly due to lack coordination of officers, lack of thorough and administrative errors. Originality of this paper is analyzing thelean hospital management practice of integrated process of clinical and administrative process.
Objectives
The objective of this article is twofold. First, to present a comprehensive internal assessment of the hospital by different groups of stakeholders and, second, to determine whether there are common needs and wishes that, if incorporated in the hospital vision, will enable future development.
Background
The Children’s Memorial Health Center is the largest children’s hospital in Poland. The hospital began operations in 1977 with a vision to be a modern healthcare facility that provides comprehensive care for children. That vision has not changed over time but everything else did.
Methods
Six design thinking sessions were conducted with 83 employees and 40 respondents who used health services in the hospital in the past, along with in-depth interviews with 25 representatives of management to gather data for the hospital assessment.
Results
Sixty-three features influencing future development were identified. Seven groups of features were classified to be either transformation drivers (four groups) or enablers (three groups). We focused on features that were indicated by all groups of respondents to define a common vision for future development.
Conclusions
Depending on the respondent’s role in the healthcare ecosystem, the list of variables within each of seven groups defining the “hospital of the future” was different while evaluating the healthcare services. Therefore, all stakeholders must be engaged in the ideation process to create a strategy for a future care model driven by innovation.
Background
Empathy is a well-established facet of clinical competency that research suggests is associated with enhanced medical student well-being. Since little is known about empathy and well-being before students enter medical school—during pre-medical education—the main goal of this study is to test a conceptual model of how clinical empathy is related to two indicators of well-being, depression, and burnout among pre-medical students. The theoretical model hypothesizes that three dimensions of clinical empathy—Perspective-Taking, Compassionate Care, and Standing in Patients’ Shoes— will be directly and negatively related to depression, as well as indirectly through its inverse relationship with three facets of burnout, Emotional Exhaustion, Poor Academic Efficacy, and Cynicism.
Methods
Using survey data from a sample of 132 pre-medical students at an American Midwestern university, this study employs structural equation modeling (SEM) to test the theoretical model of the relationships between empathy, burnout, and depression among pre-medical students. We identify the direct effects of the three dimensions of the Jefferson Scale of Physician Empathy (JSE-S) on depression (CES-D), as well as the indirect effects of clinical empathy on depression through the three dimensions of the Maslach Burnout Inventory (MBI-S).
Results
SEM analyses show that while none of the three dimensions of the JSE-S are directly related to depression, clinical empathy does significantly affect depression indirectly through burnout. Specifically, as predicted, we find that Perspective-Taking decreases Emotional Exhaustion, but, contrary to expectations, Compassionate Care increases it. And, the positive relationship between Compassionate Care and Emotional Exhaustion is particularly strong. In turn, Perspective-Taking and Compassionate Care are associated with depression in opposite directions and to different degrees.
Conclusions
Findings suggest that clinical empathy as measured by the JSE-S produces both positive and negative effects on personal well-being. We conclude that further conceptual clarity of clinical empathy is needed to better discern how the different dimensions impact different indicators of well-being. Given that pre-medical education is a crucial time for emotional socialization, the challenge for medical education will be fostering the positive, cognitive aspects of clinical empathy while simultaneously mitigating the adverse effects of affective empathy on medical student well-being.
Design thinking is a process that applies both creativity and innovation to iteratively develop and implement a new product. The design thinking process also enhances design thinking skills that are essential for personal and professional life in a complex world. Health care is increasingly being faced with complex problems, and the education of current and future doctors in design thinking is an important curricular challenge for all medical educators. Medical educators will need to enhance their own design thinking skills to enable them to effectively respond to this challenge.
Aim::
To use Value-Focused Thinking to investigate what is important in the design of inpatient stroke rehabilitation facility buildings.
Background::
Many stroke patients require inpatient rehabilitation in a dedicated facility. Rehabilitation facilities are healthcare spaces, but they are also learning spaces where patients practice targeted tasks to acquire new skills and to reacquire skills and abilities that were compromised as a result of their stroke. There is currently no consensus regarding how the design of inpatient rehabilitation facilities could be optimized for patients' learning.
Method::
We used Value-Focused Thinking to develop a framework of what interdisciplinary experts consider important for inpatient stroke rehabilitation facility design. Two workshops were conducted. The following experts were invited to participate: past patients with experience of stroke rehabilitation; stroke rehabilitation clinicians; stroke rehabilitation academics; healthcare environments academics; learning environments academics; architects, designers, and wayfinders with experience designing healthcare or learning environments; and healthcare design policy makers.
Results::
Thirty experts participated. The experts' final framework included 16 criteria that were considered fundamentally important for inpatient stroke rehabilitation facility design, and 14 criteria that were considered instrumentally important. Inpatient stroke rehabilitation facility design should maximize efficiency, maximize effectiveness (i.e., patients' clinical and functional outcomes), foster emotional well-being, and maximize safety. Opportunities to practice physical, cognitive, and social activity were considered important for patients' outcomes.
Conclusions::
Value-Focused Thinking was an effective and equitable means of engaging experts from multiple disciplines. Designers, planners, and developers of inpatient stroke rehabilitation facilities should consider the rehabilitation-specific framework developed in this study alongside evidence from other healthcare settings.
Introduction:
Applying Design Thinking to health care could enhance innovation, efficiency, and effectiveness by increasing focus on patient and provider needs. The objective of this review is to determine how Design Thinking has been used in health care and whether it is effective.
Methods:
We searched online databases (PubMed, Medline, Web of Science, CINAHL, and PyscINFO) for articles published through March 31, 2017, using the terms "health," "health care," or "healthcare"; and "Design Thinking," "design science," "design approach," "user centered design," or "human centered design." Studies were included if they were written in English, were published in a peer-reviewed journal, provided outcome data on a health-related intervention, and used Design Thinking in intervention development, implementation, or both. Data were collected on target users, health conditions, intervention, Design Thinking approach, study design or sample, and health outcomes. Studies were categorized as being successful (all outcomes improved), having mixed success (at least one outcome improved), or being not successful (no outcomes improved).
Results:
Twenty-four studies using Design Thinking were included across 19 physical health conditions, 2 mental health conditions, and 3 systems processes. Twelve were successful, 11 reported mixed success, and one was not successful. All 4 studies comparing Design Thinking interventions to traditional interventions showed greater satisfaction, usability, and effectiveness.
Conclusion:
Design Thinking is being used in varied health care settings and conditions, although application varies. Design Thinking may result in usable, acceptable, and effective interventions, although there are methodological and quality limitations. More research is needed, including studies to isolate critical components of Design Thinking and compare Design Thinking-based interventions with traditionally developed interventions.
The purpose of this study is to examine the interaction between New Product Development (NPD) capabilities and Business Model Innovation (BMI) by studying the adaptation of capabilities in a manufacturing firm as it adopts a service business model.
Approach: An in-depth case study is used to identify design capabilities and document how these have been developed as the firm has adapted its NPD processes to the needs of its service business model.
Design capabilities are proposed as a facilitator of servitization, allowing a manufacturing firm to develop service offerings that build on resources such as knowledge and experience. Conversely, the scope of servitization is restricted by the extent to which these design capabilities can be updated to suit the demands of a new business model.
Servitization is presented as an imperative for manufacturing firms, yet research has not addressed the implications for NPD nor investigated how BMI affects NPD capabilities. This study shows the need to identify whether current NPD processes help or hinder BMI and proposes how managers can adapt NPD processes to a new business model.
A three-stage process is identified for adapting NPD processes – as BMI changes the nature of products and services required, existing processes are supplemented by design activities requiring expert knowledge, these are subsequently refined into design methods that can be incorporated into the NPD process, and eventually design tools allow automation and efficiency.
Background:
We conducted a randomized controlled trial of a digital health system supporting clinical care through monitoring and self-management support in community-based patients with moderate to very severe chronic obstructive pulmonary disease (COPD).
Objective:
The aim of this study was to determine the efficacy of a fully automated Internet-linked, tablet computer-based system of monitoring and self-management support (EDGE' sElf-management anD support proGrammE) in improving quality of life and clinical outcomes.
Methods:
We compared daily use of EDGE with usual care for 12 months. The primary outcome was COPD-specific health status measured with the St George's Respiratory Questionnaire for COPD (SGRQ-C).
Results:
A total of 166 patients were randomized (110 EDGE, 56 usual care). All patients were included in an intention to treat analysis. The estimated difference in SGRQ-C at 12 months (EDGE-usual care) was -1.7 with a 95% CI of -6.6 to 3.2 (P=.49). The relative risk of hospital admission for EDGE was 0.83 (0.56-1.24, P=.37) compared with usual care. Generic health status (EQ-5D, EuroQol 5-Dimension Questionnaire) between the groups differed significantly with better health status for the EDGE group (0.076, 95% CI 0.008-0.14, P=.03). The median number of visits to general practitioners for EDGE versus usual care were 4 versus 5.5 (P=.06) and to practice nurses were 1.5 versus 2.5 (P=.03), respectively.
Conclusions:
The EDGE clinical trial does not provide evidence for an effect on COPD-specific health status in comparison with usual care, despite uptake of the intervention. However, there appears to be an overall benefit in generic health status; and the effect sizes for improved depression score, reductions in hospital admissions, and general practice visits warrants further evaluation and could make an important contribution to supporting people with COPD.
Trial registration:
International Standard Randomized Controlled Trial Number (ISRCTN): 40367841; http://www.isrctn.com/ISRCTN40367841 (Archived by WebCite at http://www.webcitation.org/6pmfIJ9KK).
The business community has learned the value of design thinking as a way to innovate in addressing people’s needs – and health systems could benefit enormously from doing the same. This paper lays out how design thinking applies to healthcare challenges and how systems might utilize this proven and accessible problem-solving process. We show how design thinking can foster new approaches to complex and persistent healthcare problems through human-centered research, collective and diverse teamwork and rapid prototyping. We introduce the core elements of design thinking for a healthcare audience and show how it can supplement current healthcare management, innovation and practice.
The incidence of chronic diseases in low- and middle-income countries is rapidly increasing both in urban and rural regions. A major challenge for health systems globally is to develop innovative solutions for the prevention and control of these diseases. This paper discusses the development and pilot testing of SMARTHealth, a mobile-based, point-of-care Clinical Decision Support (CDS) tool to assess and manage cardiovascular disease (CVD) risk in resource-constrained settings. Through pilot testing, the preliminary acceptability, utility, and efficiency of the CDS tool was obtained.
The CDS tool was part of an mHealth system comprising a mobile application that consisted of an evidence-based risk prediction and management algorithm, and a server-side electronic medical record system. Through an agile development process and user-centred design approach, key features of the mobile application that fitted the requirements of the end users and environment were obtained. A comprehensive analytics framework facilitated a data-driven approach to investigate four areas, namely, system efficiency, end-user variability, manual data entry errors, and usefulness of point-of-care management recommendations to the healthcare worker. A four-point Likert scale was used at the end of every risk assessment to gauge ease-of-use of the system.
The system was field-tested with eleven village healthcare workers and three Primary Health Centre doctors, who screened a total of 292 adults aged 40 years and above. 34% of participants screened by health workers were identified by the CDS tool to be high CVD risk and referred to a doctor. In-depth analysis of user interactions found the CDS tool feasible for use and easily integrable into the workflow of healthcare workers. Following completion of the pilot, further technical enhancements were implemented to improve uptake of the mHealth platform. It will then be evaluated for effectiveness and cost-effectiveness in a cluster randomized controlled trial involving 54 southern Indian villages and over 16000 individuals at high CVD risk.
An evidence-based CVD risk prediction and management tool was used to develop an mHealth platform in rural India for CVD screening and management with proper engagement of health care providers and local communities. With over a third of screened participants being high risk, there is a need to demonstrate the clinical impact of the mHealth platform so that it could contribute to improved CVD detection in high risk low resource settings.
Background:
Web-based programs have been developed for informal caregivers of people with Alzheimer's disease (PWAD). However, these programs can prove difficult to adopt, especially for older people, who are less familiar with the Internet than other populations. Despite the fundamental role of usability testing in promoting caregivers' correct use and adoption of these programs, to our knowledge, this is the first study describing this process before evaluating a program for caregivers of PWAD in a randomized clinical trial.
Objective:
The objective of the study was to describe the development process of a fully automated Web-based program for caregivers of PWAD, aiming to reduce caregivers' stress, and based on the user-centered design approach.
Methods:
There were 49 participants (12 health care professionals, 6 caregivers, and 31 healthy older adults) that were involved in a double iterative design allowing for the adaptation of program content and for the enhancement of website usability. This process included three component parts: (1) project team workshops, (2) a proof of concept, and (3) two usability tests. The usability tests were based on a mixed methodology using behavioral analysis, semistructured interviews, and a usability questionnaire.
Results:
The user-centered design approach provided valuable guidelines to adapt the content and design of the program, and to improve website usability. The professionals, caregivers (mainly spouses), and older adults considered that our project met the needs of isolated caregivers. Participants underlined that contact between caregivers would be desirable. During usability observations, the mistakes of users were also due to ergonomics issues from Internet browsers and computer interfaces. Moreover, negative self-stereotyping was evidenced, when comparing interviews and results of behavioral analysis.
Conclusions:
Face-to-face psycho-educational programs may be used as a basis for Web-based programs. Nevertheless, a user-centered design approach involving targeted users (or their representatives) remains crucial for their correct use and adoption. For future user-centered design studies, we recommend to involve end-users from preconception stages, using a mixed research method in usability evaluations, and implementing pilot studies to evaluate acceptability and feasibility of programs.
An iterative user-centered design method was used to develop and test mobile technology (the It's LiFe! tool/monitor) embedded in primary care, followed by a three months feasibility study with 20 patients and three nurses. The tool consists of an accelerometer that transfers data to an app on a Smartphone, which is subsequently connected to a server. Physical activity levels are measured in minutes per day compared to pre-set activity goals, which are set by patients in dialogue with nurses. Nurses can monitor patients' physical activity via a secured website. The counseling protocol is based on the Five A's model and consists of a limited number of behavior change consultations intertwined with interaction with and responses from the tool. The technology supports nurses when performing physical activity counseling. Provided that no connectivity problems occur, the It's LiFe! intervention is feasible, and its longitudinal effects will be tested in a cluster RCT.
The research in this paper is based on a theoretical and practical approach to the concept of Design Thinking, its background, characteristics, process models and toolkit. Alongside the literature review, a qualitative analysis of five well-known models of the Design Thinking process and of ten of the most applied DT tools is made. The paper provides a critical approach to Design Thinking to help the innovation management community to understand better the potential the concept has for implementing and developing creative thinking in business, and in society in general. By describing in a synthetic way the evolution and key elements of the DT concept and its toolkit, the study contributes to the current literature in innovation management, and also provides practical advice.
Recognize market opportunities, master the design process, and develop business acumen with this 'how-to' guide to medical technology innovation. A three-step, proven approach to the biodesign innovation process - identify, invent, implement - provides a practical formula for innovation. The experiences of hundreds of innovators and companies, in the form of case studies, quotes and practical advice, offer a realistic, action-orientated roadmap for successful biodesign innovation. Real-world examples, end-of-chapter projects, and Getting Started sections guide the reader through each of the key stages of the process and provide a template to create their own new medical devices. Addressing common medical, engineering, and business challenges to develop well-rounded expertise, this book is the complete package for any biodesign entrepreneur. The text is supported by valuable resources, including up-to-date industry changes: found at ebiodesign.org.
Healthcare is a very important sector as our lives depend on it. During the novel corona virus pandemic, it was evident that our healthcare organizations still lack in terms of efficiency and productivity. Especially in the developing nations, the problems were much bigger. Lean Six Sigma (LSS) is a methodology which when implemented in an organization, helps to increase the process capability and the efficiency, by reducing the defects and wastes. The present study systematically reviews the research studies conducted on LSS in the healthcare sector. It was found that comparatively less studies are focused on improving the medical processes, most of the studies targeted the management processes. Moreover, lesser number of studies were being conducted for developing nations, but now it seems that the focus of research scholars has shifted towards the developing nations also. But it was observed that the studies in these nations were majorly empirical in nature, very few studies were conceptual or exploratory. There is a need for guiding healthcare professionals on creating a continuous improvement environment, which sustains the improvements achieved after LSS implementation.
Purpose
The purpose of this article is to define design thinking, provide insights into how it may be integrated into the healthcare design process, and provide a checklist for future implementation.
Background
Design thinking is a collaborative method of inquiry that fosters innovative, team-generated solutions to complex scenarios, known as “wicked problems,” that are extraordinarily difficult to solve. It is a practical tool in the toolbox of the codesign team, which includes the client and design professionals as primary stakeholders. It is powered by team-based creativity that adaptively responds to a need for new approaches and products in an innovative and practically applicable way. The need for design thinking in healthcare is steadily increasing as the healthcare system and its care environments continue to grow in complexity. Although major medical breakthroughs have undeniably expanded the average human life span, the current healthcare system is inefficient. Now, more than ever, design thinking and the innovative, human-centered solutions it enables are needed within healthcare design. Although the use of design thinking as a method within the field of architecture is not new, many design teams struggle integrating it fully within the design process, particularly in healthcare. The knowledge, design method, checklists, and direction provided in this article can benefit healthcare design teams to successfully integrate the method into practice.
Conclusion
If design thinking is integrated into the healthcare architectural design process with the creative problem-solving method, opportunities will arise for innovative solutions and deeper insights into problems to benefit healthcare delivery.
Purpose – This study aims to develop a practical methodology to identify possible areas of improvements as well as exploring how to improve the health-care staff flow within a selected department in a hospital.
Design/methodology/approach – It focuses on showing how to properly study and analyze the health-care services and processes practiced at a selected department within a hospital. For this, several techniques like non-value-adding activities, time motion study, spaghetti diagram, layout analysis, etc. are used.
Findings – To test the proposed methodology, a neonatal intensive care unit (NICU) of a hospital in Oman was considered as a case study. The study revealed that this unit has several potential improvements capabilities. Further, this study also discussed possible areas of improvements of this case unit and suggested how such improvements can be implemented.
Originality/value – Several possible improvements are suggested and are discussed with the hospital authority, which can be clarified as the re-layout of the NICU rooms, reorganization of the store to improve the staff flow, increase the work efficiency, introduction of Help Us Support Healing policy, etc., which can enhance the entire operational system at the studied NICU.
This paper includes the systematic literature review on lean business models used in the healthcare industry to aid in reducing waste, costs, and improving overall patient care and satisfaction. A systematic literature review was conducted to analyze lean business models used in the healthcare industry regarding lean thinking in healthcare, object technology, Six Sigma and quality models, organizational culture and lean implementation, healthcare delivery method study, clinical services redesign program, process improvement cost model, vendor managed inventory, supply chain innovation, strategic customer service orientation, and the model of care in the healthcare industry. The systematic review of the literature on lean business models suggests that the models such as several process improvement cost models, lean thinking models, managerial process improvement, and models of care can be used in the healthcare industry to reduce waste and costs and improve patient satisfaction. Sustaining competitive advantage for accountable care organisations was also found to help in accomplishing the value demands required by customers and competitors. This paper can be used as a guide for implementing lean business models and lean practices and the review can be used to help organisations see the benefits in using lean practices in the healthcare industry.
This paper includes the systematic literature review on lean business models used in the healthcare industry to aid in reducing waste, costs, and improving overall patient care and satisfaction. A systematic literature review was conducted to analyze lean business models used in the healthcare industry regarding lean thinking in healthcare, object technology, Six Sigma and quality models, organisational culture and lean implementation, healthcare delivery method study, clinical services redesign program, process improvement cost model, vendor managed inventory, supply chain innovation, strategic customer service orientation, and the model of care in the healthcare industry. The systematic review of the literature on lean business models suggests that the models such as several process improvement cost models, lean thinking models, managerial process improvement, and models of care can be used in the healthcare industry to reduce waste and costs and improve patient satisfaction. Sustaining competitive advantage for accountable care organisations was also found to help in accomplishing the value demands required by customers and competitors. This paper can be used as a guide for implementing lean business models and lean practices and the review can be used to help organisations see the benefits in using lean practices in the healthcare industry.
The healthcare industry continues to emphasize quality and productivity improvements. This study focuses on the implementation of Six Sigma and Lean Six Sigma (LSS) principles in hospitals. Through a qualitative analysis of 35 published case-based papers (33 of specific case studies plus two studies with more than one reported case), the authors found that implementing Six Sigma and LSS concepts can significantly contribute to improving process performance, including waiting time reduction and patient flow with the subsequent impact of increasing patient satisfaction. At the same time, these process improvement techniques also reduce operating costs and inventories, which translate into significant savings for hospitals, thereby creating a win-win situation. This study also shows that taking a multidisciplinary team approach, coupled with Six Sigma training, is critical to successfully implementing Six Sigma and LSS. The limitations to implementation appear to be primarily related to the organization (political hierarchy) and infrastructure of the hospitals. The authors' analysis of these cases clearly demonstrates that Six Sigma and LSS can provide effective solutions to improving the quality and processes in a healthcare service environment while simultaneously creating a cultural change within the organization by involving everyone associated with the process being evaluated.
Purpose:
To explore what, when, and how Lean methods and tools can add value during the programming phase of design through providing additional resources and support to project leadership and the architectural design team.
Background:
This case study-based research took place at one large academic hospital during design efforts of a surgical tower to house 19 operating rooms (ORs) and support spaces including pre- and postop, central processing and distribution, and materials management. Surgical services project leadership asked for support from Lean practitioners during the design process.
Methods:
Lean exploration loops (LELs) were conducted to generate evidence to support stakeholders, as they made important decisions about the new building design. The analyses conducted during LELs were primarily focused on the relative advantages of a large footprint with few floors or a smaller footprint with more floors and support spaces not collocated adjacent to ORs on the same floor.
Results:
LELs resulted in quantifications of key operational and design features (e.g., design preferences of employees and patients, horizontal distance travel, and elevator utilization studies), which in turn complemented the architectural design process and created an opportunities to gain buy-in and consensus from stakeholders through their active participation in many of the analyses.
Conclusions:
We found Lean tools and methods to be of most value during programming phase when focused on the high-level operational and design issues to help establish buy-in and consensus among stakeholders, while acknowledging that there is often not enough design detail to perform accurate analysis.
Purpose:
A significant proportion of veterans use dual care or health care services within and outside the Veterans Health Administration (VHA). In this study conducted at a VHA medical center in the USA, the authors used Lean Six Sigma principles to develop recommendations to eliminate wasteful processes and implement a more efficient and effective process to manage medications for dual care veteran patients. The purpose of this study is to: assess compliance with the VHA's dual care policy; collect data and describe the current process for co-management of dual care veterans' medications; and draft recommendations to improve the current process for dual care medications co-management.
Design/methodology/approach:
Input was obtained from the VHA patient care team members to draw a process map to describe the current process for filling a non-VHA prescription at a VHA facility. Data were collected through surveys and direct observation to measure the current process and to develop recommendations to redesign and improve the process.
Findings:
A key bottleneck in the process that was identified was the receipt of the non-VHA medical record which resulted in delays in filling prescriptions. The recommendations of this project focus on the four domains of: documentation of dual care; veteran education; process redesign; and outreach to community providers.
Research limitations/implications:
This case study describes the application of Lean Six Sigma principles in one urban Veterans Affairs Medical Center (VAMC) in the Mid-Western USA to solve a specific organizational quality problem. Therefore, the findings may not be generalizable to other organizations.
Practical implications:
The Lean Six Sigma general principles applied in this project to develop recommendations to improve medication management for dual care veterans are applicable to any process improvement or redesign project and has valuable lessons for other VAMCs seeking to improve care for their dual care veteran patients.
Originality/value:
The findings of this project will be of value to VA providers and policy makers and health care managers who plan to apply Lean Six Sigma techniques in their organizations to improve the quality of care for their patients.
Purpose – The aim of this work is to provide an initial picture of how some design agencies are
contributing toward a paradigm shift and how they are developing in the future to better inform design
policies and interdisciplinary work. There is a general agreement that the current government and
public sector structure and modes of operation need radical transformation. In this scenario, a shift from
New Public Management towards New Public Governance paradigm has been auspicated. Design has
attracted attention as a potential approach to support this transformation, but research into Service
Design, as well as discussions on its future development, for public sector innovation is limited. This
paper is an exploratory study into the individual work of seven representative UK design agencies
operating for and within the public sector.
Design/methodology/approach – The paper reviews literature on public sector reform and innovation
to inform comparative studies of contemporary design agencies working for public sector reform.
Interviews with seven designers from NHS Institute for Innovation and Improvement, Participle,
Innovation Unit, Uscreates, Collaborative Change, Futuregov and Snook are conducted to review their
perceived role for public sector reform, their design approaches, exemplar projects and main
challenges.
Findings – Emerging design strategies for Public Sector reform are: a collaborative design approach
that considers all stakeholders as equal co-creators of public value; operating at different
complementary levels to aim at systemic change; designing from the inside out (innovation culture) and
outside in (market change). These different strategies imply the development of possible different
business models. Existing creative tensions appear between embedding and outsourcing strategies,
acting as facilitators vs designers, developing both designing and service delivery roles.
Research limitations/implications – This paper is based on a limited sample of design agencies, and
it is not a systematic study into the impact of their design work, which should be the object of a following
study.
Practical implications – This paper brings Service Design practice into public sector innovation
debate to inform future interdisciplinary research and innovation policies. It positions existing design
innovation strategies within the wider picture of public sector reform to support a more informed design
practice.
Originality/value – Few studies have looked at the UK design agencies for public sector innovation
and discussed their possible future developments. This paper provides an original and holistic
description of design for public sector innovation with considerations on how it should be interpreted
when developing supporting innovation and design policies
Designers can and should play a critical role in shaping a holistic healthcare experience by creating empathetic design solutions that foster a culture of care for patients, families, and staff. Using narrative inquiry as a design tool, this case study shares strategies for promoting empathy.
Designing for patient-centered care infuses empathy into the creative process. Narrative inquiry offers a methodology to think about and create empathetic design that enhances awareness, responsiveness, and accountability.
This article shares discoveries from a studio on empathetic design within an outpatient cancer care center. The studio engaged students in narrative techniques throughout the design process by incorporating aural, visual, and written storytelling. Benchmarking, observations, and interviews were merged with data drawn from scholarly evidence-based design literature reviews.
Using an empathy-focused design process not only motivated students to be more engaged in the project but facilitated the generation of fresh and original ideas. Design solutions were innovative and impactful in supporting the whole person. Similarities as well as differences defined empathetic cancer care across projects and embodied concepts of design empowerment, design for the whole person, and design for healing.
By becoming more conscious of empathy, those who create healthcare environments can better connect holistically to the user to take an experiential approach to design. Explicitly developing a mind-set that raises empathy to the forefront of the design process offers a breakthrough in design thinking that bridges the gap between what might be defined as "good design" and patient-centered care.
© The Author(s) 2015.
Kaiser Permanente implemented a new model of nursing communication at shift change-in the bedside nursing report known as the Nurse Knowledge Exchange (NKE) in 2004-but noted variations in its spread and sustainability across medical centers five years later.
The six core elements of NKEplus were as follows: team rounding in the last hour before shift changes, pre-shift patient assignments that limit the number of departing nurses at shift change, unit support for uninterrupted bedside reporting, standardization for report and safety check formats, and collaboration with patients to update in-room care boards. In January 2011 Kaiser Permanente Southern California (KPSC; Pasadena) began implementing NKEplus in 125 nursing units across 14 hospitals, with the use of human-centered design principles: creating shared understanding of the need for change, minimum specifications, and customization by frontline staff. Champion teams on each nursing unit designed and pilot tested unit-specific versions of NKEplus for four to eight weeks. Implementation occurred in waves and proceeded from medical/surgical units to specialty units. Traditional performance improvement strategies of accountability, measurement, and management were also applied.
By the end of 2012, 100% of the 64 medical/surgical units and 47 (77.0%) of the 61 specialty units in KPSC medical centers implemented NKEplus-as had all but 1 of the specialty units by May 2013. The mean KPSC score on the NKEplus nursing behavior bundle improved from 65.9% in 2010 to 71.3% in the first quarter of 2014. The mean KPSC Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score for nurse communication improved from 73.1% in 2010 to 76.4% in the first quarter of 2014 (p < . 001).
Human-centered implementation appeared to help spread a new model of nursing handoffs and change the culture of professional nursing practice related to shift change.
The article's aim is to focus on the application of Six Sigma to minimise intraoperative and post-operative complications rates in a Turkish public hospital cataract surgery unit.
Implementing define-measure-analyse-improve and control (DMAIC) involves process mapping, fishbone diagrams and rigorous data-collection. Failure mode and effect analysis (FMEA), pareto diagrams, control charts and process capability analysis are applied to redress cataract surgery failure root causes.
Inefficient skills of assistant surgeons and technicians, low quality of IOLs used, wrong IOL placement, unsystematic sterilisation of surgery rooms and devices, and the unprioritising network system are found to be the critical drivers of intraoperative-operative and post-operative complications. Sigma level was increased from 2.60 to 3.75 subsequent to extensive training of assistant surgeons, ophthalmologists and technicians, better quality IOLs, systematic sterilisation and air-filtering, and the implementation of a more sophisticated network system.
This article shows that Six Sigma measurement and process improvement can become the impetus for cataract unit staff to rethink their process and reduce malpractices. Measuring, recording and reporting data regularly helps them to continuously monitor their overall process and deliver safer treatments.
This is the first Six Sigma ophthalmology study in Turkey.
Demand for health services a human-centred field guide for investigating and responding to challenges
- Unicef
Application of lean six sigma approach in Indian hospitals to improve patient care
- S Hinchageri
- D N R Patil
- S Teli
Hinchageri, S., Patil, D. N. R., & Teli, S. (2017).
Application of lean six sigma approach in Indian hospitals to improve patient care. International Journal
of Productivity and Performance Management.
Empathy mapping: The first step in design thinking
- S Gibbons
Gibbons, S. (2018, January 14). Empathy mapping:
The first step in design thinking. Nielsen Norman.
https://www.nngroup.com/articles/empathymapping/
Design thinking, agile and lean six sigma
- C Hare
Hare, C. (2019, November 6). Design thinking, agile
and lean six sigma. Medium [Online]. https://
medium.com/@labrlearning/design-thinking-agileand-lean-six-sigma-e60fd6fbed1d
Design Thinking as Facilitator for Innovation in Swedish Healthcare - A case study at Karolinska University Hospital
- A Tideholm
- O Rydén
Tideholm, A., & Rydén, O. (2015). Design Thinking as
Facilitator for Innovation in Swedish Healthcare -A case study at Karolinska University Hospital.
Lean Six Sigma some basic concepts. NHS Institute for Innovation and Improvement
- H Bevan
- N Westwood
- R Crowe
- M Connor
Bevan, H., Westwood, N., Crowe, R., & O'Connor, M.
(2013). Lean Six Sigma some basic concepts. NHS
Institute for Innovation and Improvement. https://
www.england.nhs.uk/improvement-hub/wp-con
tent/uploads/sites/44/2017/11/Lean-Six-Sigma-Some-Basic-Concepts.pdf
Designing with empathy: Humanizing narratives for inspired healthcare experiences
- C Carmel-Gilfilen
- M Portillo
Carmel-Gilfilen, C., & Portillo, M. (2016). Designing
with empathy: Humanizing narratives for inspired
healthcare experiences. Health Environments
Research & Design Journal, 9(2), 130-146.
https://doi.org/10.1177/1937586715592633
The field guide to human-centered design: Design kit
IDEO (Ed.). (2015). The field guide to human-centered
design: Design kit (1st. ed). Design Kit.
Demand for health services a human-centred field guide for investigating and responding to challenges
- B Umut
- P Sarvari
Umut, B., & Sarvari, P. (2016). Applying lean tools in
the clinical laboratory to reduce turnaround time for
blood test results. International Journal of
Advances in Science Engineering and Technology.
UNICEF. (2018). Demand for health services a
human-centred field guide for investigating and
responding to challenges. https://www.unicef.org/
innovation/media/10051/file/Demand%20for%
20Health%20Services:%20A%20Human-Cen
tred%20Field%20Guide%20for%20Investigating
20and%20Responding%20to%20Challenges.pdf