Reducing surgical cancellations: a successful application of Lean Six Sigma in healthcare.

Objective: The COVID-19 pandemic emphasises the need to use healthcare resources efficient and effective to guarantee access to high-quality healthcare in an affordable manner. Surgical cancellations have a negative impact on these. We used the Lean Six Sigma (LSS) methodology to reduce cardiac surgical cancellations in a University Medical Center in the Netherlands, where approximately 20% of cardiac surgeries were being cancelled.

An intelligent real-time scheduler for out-patient clinics: A multi-agent system model.

Scheduling of resources and patients are crucial in outpatient clinics, particularly when the patient demand is high and patient arrivals are random. Generally, outpatient clinic systems are push systems where scheduling is based on average demand prediction and is considered for long term (monthly or bimonthly). Often, planning and actual scenario vary due to uncertainty and variability in demand and this mismatch results in prolonged waiting times and under-utilization of resources.

[Health care claims per medical specialty in the Netherlands: a 10-year overview].

Objective: To analyse the quantity and size of health care claims per medical specialty in the past 10 years.

Design: Descriptive, evaluative and comparative study.

Method: Anonymised damage claim data from Centramed and MediRisk were used for this study.

Integral patient scheduling in outpatient clinics under demand uncertainty to minimize patient waiting times.

This study addressed the problem of scheduling walk-in patients in real time. Outpatient clinics encounter uncertainty in patient demand. In addition, the disparate departments are locally (department-centric) organized, leading to prolonged waiting times for patients.

[More and higher claims for damages: analysis of claims for damages in Dutch hospital care 2007-2016].

Objective: To investigate the number and extent of claims concerning hospital care at a national level, thereby affording insight to the profession.

Design: A quantitative, descriptive and comparative study.

Method: We used anonymised data on all claims for damages from regular hospital care that were submitted to Centramed and MediRisk between 1 January 2007 and 31 December 2016.

Inpatient flow management: a systematic review.

Purpose: In hospitals, several patient flows compete for access to shared resources. Failure to manage these flows result in one or more disruptions within a hospital system. To ensure continuous care delivery, solving flow problems must not be limited to one unit, but should be extended to other departments - a prerequisite for solving flow problems in the entire hospital.

[Implementation of innovations in healthcare: radiotherapy as an example].

The implementation of innovations is considered necessary in healthcare, both for improving patient outcomes and services and to reduce costs. Two problems can occur during the implementation process: innovations that have not been properly evaluated in terms of patient outcomes or cost-effectiveness can sometimes spread quickly, whereas innovations that have shown to lead to significant improvements in a research study setting may struggle to find their way into clinical practice. Problems may also arise when organizational innovations are implemented that are not evidence-based: an example would be the implementation of a new ICT system that affects the patient's environment negatively upon introduction.

Demand, capacity, and access of the outpatient clinic: A framework for analysis and improvement.

Rationale: While theoretical frameworks for optimization of the outpatient processes are abundant, practical step-by-step analyses to give leads for improvement, to forecast capacity, and to support decision making are sparse.

Aims And Objectives: This article demonstrates how to evaluate and optimize the triad of demand, (future) capacity, and access time of the outpatient clinic using a structured six-step method.

Methods: All individual logistical patient data of an orthopaedic outpatient clinic of one complete year were analysed using a 6-step method to evaluate demand, supply, and access time.

The Use of Operational Excellence Principles in a University Hospital.

The introduction of Operational Excellence in the Maastricht University Medical Center (MUMC+) has been the first of its kind and scale for a university hospital. The policy makers of the MUMC+ have combined different elements from various other business, management, and healthcare philosophies and frameworks into a unique mix. This paper summarizes the journey of developing this system and its most important aspects.

Improving the Prediction of Total Surgical Procedure Time Using Linear Regression Modeling.

For efficient utilization of operating rooms (ORs), accurate schedules of assigned block time and sequences of patient cases need to be made. The quality of these planning tools is dependent on the accurate prediction of total procedure time (TPT) per case. In this paper, we attempt to improve the accuracy of TPT predictions by using linear regression models based on estimated surgeon-controlled time (eSCT) and other variables relevant to TPT.

Introducing an integrated intermediate care unit improves ICU utilization: a prospective intervention study.

Background: Improvement of appropriate bed use and access to intensive care (ICU) beds is essential in optimizing utilization of ICU capacity. The introduction of an intermediate care unit (IMC) integrated in the ICU care may improve this utilization.

Method: In a before-after prospective intervention study in a university hospital mixed ICU, the impact of introducing a six-bed mixed IMC unit supervised and staffed by ICU physicians was investigated.

Reflecting on the efficacy of cognitive mapping for decision-making in intellectual disability care: a case study.

The central aspect of this study is a set of reflections on the efficacy of soft operational research techniques in understanding the dynamics of a complex system such as intellectual disability (ID) care providers. Organizations providing services to ID patients are complex and have many interacting stakeholders with often different and competing interests. Understanding the causes for failures in complex systems is crucial for appreciating the multiple perspectives of the key stakeholders of the system.

[Sustainable process improvement with application of 'lean philosophy'].

Process improvement is increasingly being implemented, particularly with the aid of 'lean philosophy'. This management philosophy aims to improve quality by reducing 'wastage'. Local improvements can produce negative effects elsewhere due to interdependence of processes.

Towards an organisation-wide process-oriented organisation of care: a literature review.

Background: Many hospitals have taken actions to make care delivery for specific patient groups more process-oriented, but struggle with the question how to deal with process orientation at hospital level. The aim of this study is to report and discuss the experiences of hospitals with implementing process-oriented organisation designs in order to derive lessons for future transitions and research.

Methods: A literature review of English language articles on organisation-wide process-oriented redesigns, published between January 1998 and May 2009, was performed.

Does case-mix based reimbursement stimulate the development of process-oriented care delivery?

Objectives: Reimbursement based on the total care of a patient during an acute episode of illness is believed to stimulate management and clinicians to reduce quality problems like waiting times and poor coordination of care delivery. Although many studies already show that this kind of case-mix based reimbursement leads to more efficiency, it remains unclear whether care coordination improved as well. This study aims to explore whether case-mix based reimbursement stimulates development of care coordination by the use of care programmes, and a process-oriented way of working.

Implementation by simulation; strategies for ultrasound screening for hip dysplasia in the Netherlands.

Background: Implementation of medical interventions may vary with organization and available capacity. The influence of this source of variability on the cost-effectiveness can be evaluated by computer simulation following a carefully designed experimental design. We used this approach as part of a national implementation study of ultrasonographic infant screening for developmental dysplasia of the hip (DDH).

Applying the quality improvement collaborative method to process redesign: a multiple case study.

Background: Despite the widespread use of quality improvement collaboratives (QICs), evidence underlying this method is limited. A QIC is a method for testing and implementing evidence-based changes quickly across organisations. To extend the knowledge about conditions under which QICs can be used, we explored in this study the applicability of the QIC method for process redesign.

The choice of obstetric care by low-risk pregnant women in the Netherlands: implications for policy and management.

In the Netherlands, pregnant women at low risk of complications during pregnancy, have the opportunity to choose freely between giving birth at home or in a hospital maternity unit. This study analyses how various attributes of obstetric care, socio-economic characteristics and attitudes influence the decisions that these women make with regard to obstetric care. The method of discrete-choice experiment was applied in the process of data collection and analysis.

Performance measurement in mental health care: present situation and future possibilities.

This paper describes performance measurement and its indicators for mental health care services. Performance measurement can serve several goals such as accountability, quality improvement and performance management. For all three purposes structure, process and outcome indicators should be measured.

Changes in hospital costs after introducing an intermediate care unit: a comparative observational study.

Introduction: The high cost of critical care resources has resulted in strategies to reduce the costs of ruling out low-risk patients by developing intermediate care units (IMCs). The aim of this study was to compare changes in total hospital costs for intensive care patients before and after the introduction of an IMC at the University Hospital Maastricht.

Methods: The design was a comparative longitudinal study.

The work setting of diabetes nursing specialists in the Netherlands: a questionnaire survey.

Aim: The aim of this study is to explore whether the work organisation of diabetes specialist nurses (DSNs) differs significantly from nurses working in hospital and nursing home and if so, does this difference result in positive or negative consequences regarding work and health.

Background: In traditional health care settings, nurses exhibit a high level of environmental uncertainty and low decision-making authority, which has a negative effect on psychological reactions towards work. In professional nursing, specialisation, e.