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Burgess, Nicola. "Evaluating lean in healthcare." Thesis, University of Warwick, 2012. http://wrap.warwick.ac.uk/50272/.
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The overarching aim of this thesis is to evaluate Lean implementation in the English NHS. Against a background of financial austerity measures and the ostensible widespread adoption of Lean in the UK public sector, and particularly by healthcare organisations, the objective is to understand how Lean is being implemented by NHS hospital Trusts, and whether there is any quantitative evidence that Lean implementation is improving hospital performance. Adopting Pettigrew and Whipp’s (1991) framework of strategic change, this thesis aims to present theoretically sound and practically useful research through an exploration of the context, process and content of Lean implementation by English hospital Trusts. In order to achieve this, the research employs a mixed methods research design incorporating document analysis3, quantitative analysis and case study analysis to afford an insight into the implementation of Lean from multiple viewpoints and facilitate the development of new insights relating to the phenomena of Lean implementation in English hospital Trusts. The research provides a contribution to knowledge in three key areas: firstly through the identification and validation of a typology of approaches to Lean implementation by English hospital Trusts i.e. a characterisation of the method of Lean implementation; secondly through quantitative analysis and discussion of the potential link between Lean implementation and increased performance; and thirdly a set of propositions that provide a narrative and logic to explain the influence of contextual factors upon the process of Lean implementation in English hospitals.
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Casteberg, Anna, and Emelie Hägglund. "Lean : En komparativ studie mellan Lean Service och Lean Healthcare." Thesis, Södertörns högskola, Institutionen för ekonomi och företagande, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:sh:diva-9402.
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Camber, Henrik. "Lean Production vs Lean Healthcare : En jämförelse inom sjukvården." Thesis, Södertörns högskola, Institutionen för samhällsvetenskaper, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:sh:diva-26741.
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This thesis focuses on how to describe how Lean adapts within the healthcare. Lean has become a control system as more and more companies are using in order to create competition in order to increase the quality and efficiency. This theory has now become implemented in the healthcare. The project has been organized with patients and that has created a flow in the daily work. Our study has used qualitative research strategy where we have started from secondary data presented for hospitals in the Stockholm area and a report written by John Rognes and Anna Svarts “Lean i vården” (2011). To map which hospitals are using Lean. The purpose is to identify how lean production has been implemented into four hospitals in the Stockholm area, to study how the difference are between the hospitals version of Lean compare to the fundamental, Lean production. The study describe that Lean within the healthcare is not so different compared to Lean Production in the industry. But the big different is that Lean within the healthcare is more focused on the patients and their process during the hospital visit. Lean Production is more focused on the production to the final product.
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Dalbom, Emil, and Ludvig Danielsson. "Lean Healthcares spridning och översättning : en PMI-studie och innehållsanalys över Lean Healthcare i svensk sjukvård." Thesis, Uppsala universitet, Företagsekonomiska institutionen, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-417742.
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Denna studie undersöker Lean Healthcare, som är ett koncept ursprungligen från industrisektorn för att bland annat minimera fel och genomföra tidsbesparingar och som nu har anpassats till vården. Teorin utgår från att managementkoncept följer ett mode där det är svängningar i popularitet under dess livscykel samt att det sker en översättning av koncept som reser. Genom en PMI-studie undersöks populariteten i media och ser hur det har varierat över livslängden. En kvantitativ innehållsanalys används sedan på ett urval av det insamlade materialet för att se hur konceptet har blivit översatt genom media. Resultatet visar att Lean Healthcare följer den traditionella livscykeln för managementkoncept till stor del men avviker i form av en andra uppgång. Konceptet har översatts från en positiv framställning där argument som resursbesparing och effektivisering belystes till en negativ framställning där en sårbarhet med Just-in-time användes som argument.This study examines Lean Healthcare, which is a concept originally from the industrial sector with the intention to, among other things, minimize errors and facilitate time savings. The concept has later been adapted to healthcare. The theoretical framework assumes that management concepts follows a fashion in which there are fluctuations in popularity during its lifecycle. The concept also goes through a translation process as it travels. A PMI study examines the popularity of the concept in media and analyses how it has varied over the life span. A quantitative content analysis is then used on a selection of the collected material to see how the concept has been translated through the media. The result shows that Lean Healthcare largely follows the traditional life cycle of management concepts but deviates in the form of a second upturn. The concept has been translated from a positive view where arguments such as resource saving and streamlining were highlighted to a negative presentation where a vulnerability from Just-in-time was used as an argument.
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Lindsay, Claire Frances. "Lean in healthcare : an evaluation of Lean implementation in NHS Lothian." Thesis, Edinburgh Napier University, 2016. http://researchrepository.napier.ac.uk/Output/455610.
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The overarching aim of this thesis is to critically evaluate the implementation of Lean in NHS Lothian, a National Health Service (NHS) Health Board in Scotland. Against challenging financial times, Lean has been endorsed for adoption in the provision of healthcare by The Scottish Government and NHS Scotland and so the objectives are to understand how Lean is implemented in healthcare, the impact on the organisation and what role(s) are held by front-line staff including medical staff, in this implementation. This is an exploratory and descriptive interpretivist case study incorporating content analysis, observational and interview data which is based on a qualitative and inductive approach. The interpretative and inductive nature of the research is used to identify emergent themes and to afford greater insight into the implementation process, outcomes and the role of healthcare staff. The sociology of professions is used to evaluate the role of the medical professional within Lean from the emergent data, with the focus being on behaviours expected and demonstrated in Lean implementations. The findings provide a mapping of the process for implementing Lean. It is also demonstrated that although medical professionals are expected to hold a crucial role in Lean implementations, their identity as a professional with corresponding power and autonomy provides challenges for implementing Lean in hierarchical areas such as healthcare. This professional identity also impacts on project initiation and sustainability as other stakeholders recognise hierarchical constraints. However, evidence grounded in the data illustrates that Lean breaks down hierarchies and has resulted in improved working in services. The implementation of Lean has been programmatic in line with best-practice case examples and has been driven by strategy and target pressures faced by services. This research provides a contribution to knowledge in three key areas: firstly through mapping the approach to Lean implementation which is a contribution to Programme Theory. Secondly medical professionals are explored through the lens of professionalism which has received limited attention to date within Lean; and finally a set of propositions are generated as a framework for Lean implementation in healthcare.
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Costa, Luana Bonome Message. "Evidências de lean healthcare em hospitais brasileiros." Universidade Federal de São Carlos, 2015. https://repositorio.ufscar.br/handle/ufscar/3782.
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Previous issue date: 2015-02-24Studies show that healthcare sector in Brazil is a highlighted sector in the current scenario of the country, mainly due to dissatisfaction of the population with respect to the services provided. This sector is under continuous pressure to improve services and patient safety and reduce costs, waiting times, and errors. In view of this scenario, it is evident the importance of research that present strategies and tools to assist the healthcare sector to improve its performance in Brazil, Lean is one of these strategies. To assess the state of the art on the subject, it was performed a review, classification and analysis of the literature, aiming to update the literature reviews of Mazzocato et al. (2010) and Souza (2009), and thus present the current developments in the subject area. To better understand the Lean Healthcare implementation process, and the benefits gained from such implementation, a case study was conducted in two Brazilian hospitals. It was studied two sectors of Hospital-Case A: Sterile Services Department and Pharmacy; and three sectors of Hospital-Case B: Chemotherapy, Operating Room and Radiotherapy. The analysis of the cases and the literature reviewed shows that it is important to use Lean tools in a logical and structured manner; the barriers and critical factors to the success of Lean implementation are associated with human factor and cultural changes; and the results obtained indicate that the work is targeted to reduce the lead time (patient and information), increased capacity and improved financial performance.
Estudos mostram que o setor de saúde no Brasil é um setor em destaque no cenário atual do país, devido principalmente à insatisfação da população com relação aos serviços prestados. Este setor encontra-se sob contínua pressão para melhorar os serviços e a segurança do paciente, bem como reduzir custos, tempos de espera, e erros. Frente ao cenário apresentado, fica evidente a importância de pesquisas que apresentem estratégias e ferramentas para auxiliar a área de saúde a melhorar seu desempenho no Brasil, sendo o uso de Lean Healthcare uma dessas estratégias. Para avaliar o estado da arte sobre o assunto, foi realizada uma revisão, classificação e análise da literatura, atualizando as revisões de Mazzocato et al. (2010) e Souza (2009), e assim, pode-se apresentar a evolução atual do assunto na área. Para melhor entender o processo de implementação de Lean Healthcare, e os benefícios obtidos com tal implementação, foram estudados os casos de dois hospitais brasileiros, sendo estudados dois setores do Hospital-Caso A: Central de Material Esterilizado e Farmácia; e três setores do Hospital-Caso B: Quimioterapia, Centro Cirúrgico e Radioterapia. A análise dos casos e da literatura revisada mostra que é importante usar as ferramentas Lean de forma lógica e estruturada; que as barreiras e os fatores críticos para o sucesso da implementação Lean estão associados com fator humano e mudança cultural; e que os resultados obtidos apontam que os trabalhos estão direcionados para redução de lead time (paciente e informação), aumento da capacidade e melhoria do desempenho financeiro.
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Liscio, Mark. "Lean Healthcare Solutions, Inc.| A business proposal." Thesis, California State University, Long Beach, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10116159.
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Federal healthcare reform has been a major driver for the widespread shift towards high-quality, value-based care at healthcare organizations in the United States. With increased emphasis on quality and value in healthcare, process and performance improvement have been identified and capitalized upon as methods by which to achieve higher quality clinical outcomes, increase patient safety and satisfaction and improve care coordination. For past several decades, lean management and related doctrines and principles have been widely adopted among healthcare organizations in the United States for process and performance improvement purposes. This business plan proposes a lean management consulting firm for healthcare organizations of all sizes and delivery models in the Greater Los Angeles area with a mission to deliver state-of-the-art lean education and training to management and staff of all backgrounds and roles. The aim of the proposed firm is to train, develop and empower its clients to ensure continuous quality improvement and eventually become one of the biggest lean consulting players in the market.
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Duke, Caitlin R. "How Healthcare Accounting Adapts to Lean Practices." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/honors/388.
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Healthcare has recently begun a push towards more lean practices and management. Healthcare accounting, in an effort to reflect business practices, must change to accurately reflect reality. This research seeks to explore how healthcare providers improve their accounting systems to keep up with an ever-changing lean environment. By examining both healthcare and accounting literature, this comprehensive literature review seeks to answer the question, “How does healthcare accounting adapt to lean philosophies?”.
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Berggren, Lillemor. "Lean Healthcare - Hur införande av Lean påverkat informationsförsörjning inom ett kliniskt mikrosystem." Thesis, Linnéuniversitetet, Institutionen för datavetenskap, fysik och matematik, DFM, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-13377.
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En kvalitetsförbättrande metod som senaste åren blivit vanlig inom Hälso- och sjukvård är Lean Healthcare - en verksamhetsfilosof som går ut på att eliminera slöseri och skapa värde för patienterna. I takt med att informationssystem och informationsteknik (IT) har utvecklats har informationsförsörjning fått en allt viktigare roll i vårdprocessen. Tidigare undersökningar visar dock att vårdpersonalen upplever att det finns många brister kopplade till informationssystem och IT. En explorativ fallstudie genomfördes där kvalitativ data samlades in med hjälp av intervjuer, dokumentstudier samt observation. Syftet var att beskriva hur informationsförsörjningen påverkats i ett kliniskt mikrosystem och i en vårdprocess som infört Lean. Resultatet visar att mikrosystemets leaninförande har fått positiva resultat inom framgångsgrupperna patienter, personal, resultat/processer/flöden och ledarskap. Däremot har information och IT haft mycket litet betydelse i förbättringsarbetet. Mikrosystemets informationsmiljö har dock förändrats, den visuella informationen har blivit mycket viktig och den analoga mer allmänna informationen har påverkats positivt. Trots mängden analog och visuell information är det inom digitala informationssystem och dokumentation som mikrosystemet upplever att det förekommer mest slöseri. När det gäller analog information känner vårdpersonalen att de kan eliminera slöseri med hjälp av leanprinciper och metoder, exempelvis 5S. Däremot anser de inte att de har möjlighet att påverka den digitala informationen i samma utsträckning och för vårdpersonalen faller sig inte förbättring av informationsflöden lika naturligt som att förbättra patientnära aktiviteter i vårdprocessen.
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Simões, Filipe Miguel Coutinho do Amaral. "Lean Healthcare : o conceito Lean aplicado à realidade dos serviços de saúde." Master's thesis, Universidade de Aveiro, 2009. http://hdl.handle.net/10773/1729.
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Mestrado em Gestão da Tecnologia, Inovação e ConhecimentoPresentemente a evolução de conceitos e a crescente necessidade de apresentar uma gestão eficaz num sistema recheado de dificuldades, algumas delas quase crónicas, como é o da saúde, leva a que se criem pontos de intersecção com as boas práticas de gestão. Desse modo, o presente trabalho procura identificar uma metodologia de gestão denominada de Lean e a sua introdução e aplicabilidade nos serviços de saúde, adiante designado de Healthcare, particularmente em ambiente hospitalar Português. Pretende-se, assim, desenhar um estudo exploratório para a actual realidade em termos de penetração desta metodologia tendo sido efectuadas visitas a um conjunto de Hospitais de forma a caracterizar o estado de arte actual, em Lean Healthcare. Assim, e considerando as diferenças entre as diversas realidades hospitalares que obrigariam a um exercício mais profundo e que fugiria do âmbito deste trabalho, apresenta-se um estudo comparativo e algumas conclusões entre duas realidades ao nível do supply chain hospitalar. ABSTRACT: Nowadays the evolution of concepts and growing need to present a racional and effective management of resources in an environment filled with difficulties, some of them chronic, has the Healthcare, almost obliges to take some intersection points with the management best practices. Therefore, this paper tries to identify a management methodology called Lean and its introduction and applicability in Healthcare, mainly in the Portuguese hospitals environment. This paper seeks to present a exploratory study of the actual degree of Lean methodology penetration in Healthcare at Portuguese Hospitals. In order to understand the actual state of the art in Lean Healthcare a group of hospitals was visited. Considering that each hospital as a different reality, fact that could oblige to a more profound study that would escape from the focus of this paper, we present a comparative study and some conclusions between two realities on the level of hospital supply chain.
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Bertani, Thiago Moreno. "Lean healthcare: recomendações para implantações dos conceitos de produção enxuta em ambientes hospitalares." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/18/18156/tde-29102012-235205/.
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O sistema de produção que foca na geração de valor para o cliente e na eliminação de desperdícios já demonstrou seu poder no setor manufatureiro e agora começa a chamar a atenção do setor de bens e serviços. Um enfoque crescente, em particular, está sendo dado à aplicação dos conceitos lean no setor de saúde, sendo comumente denominado lean healthcare. A literatura apresenta diversos casos de hospitais que iniciaram sua jornada lean e já colhem seus resultados. Este trabalho visa analisar alguns desses casos, acompanhar e relatar uma aplicação prática conduzida pelo autor e, como resultado, contribuir com recomendações para condução de futuras implantações de conceitos lean em hospitais.The production system that focuses on eliminating waste and generating value for the customer has already demonstrated its power on manufacturing sector and now is beginning to draw the attention of industry goods and services. An increasing focus, in particular, is being given to the application of lean concepts in the health sector, commonly known as Lean Healthcare. The literature contains several cases of hospitals that began their lean journey and most have good results. This paper aims to examine some of these cases, report a practical application conducted by the author and, as a result, to contribute with recommendations for future implementations of lean concepts in hospitals.
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FARIA, PAULA AMARAL. "LEAN HEALTHCARE: A STUDY OF THE APPLICATION OF LEAN THINKING IN HEALTH SERVICES." PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIRO, 2013. http://www.maxwell.vrac.puc-rio.br/Busca_etds.php?strSecao=resultado&nrSeq=23297@1.
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PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIROO crescimento do setor de serviços e a percepção do aumento da utilização e dos benefícios do Sistema Toyota de Produção, especificamente no setor de saúde, motivaram o desenvolvimento desta dissertação. O objetivo do trabalho está centrado em identificar a aplicação dos princípios, conceitos e ferramentas do pensamento enxuto em serviços de saúde e avaliar o potencial de ganhos de desempenho e melhorias para o setor. Para atingir esse objetivo, primeiramente foi utilizado um método de busca bibliográfica sobre o Sistema Toyota de Produção e sobre serviços de saúde. Em seguida, foram mapeados e estudados casos relatados da aplicação de pensamento enxuto nesta área, caracterizado na literatura como Lean Healthcare. Como resultado, foi possível identificar a existência de casos consolidados de aplicação de práticas enxutas em diversos países. Além disso, foi possível elencar resultados de melhorias de desempenho significativos nos casos analisados. Em conclusão, foi possível perceber uma real utilização dos princípios e foi considerada como relevante, porém não restritiva, a necessidade de adaptação daqueles. Por fim, o Lean Healthcare possui um grande potencial de contribuição para um melhor desempenho das empresas do setor de saúde.
The growth of the service sector and the perceived increase in the use and benefits of the Toyota Production System, specifically in the health sector, motivated the development of this dissertation. The aim of the work is focused on identifying the application of concepts and tools of lean thinking in healthcare services and to evaluate the potential performance gains and improvements for the sector. To achieve this goal, first we used a method of searching the literature on the Toyota Production System and on health services. Then, reported cases of applying lean this area, characterized in the literature as lean Health Care, were mapped and studied. As a result, it was possible to identify the existence of the consolidated cases of application of lean practices in various countries. Moreover, it was possible to list results in significant performance improvements analyzed cases. In conclusion, it was possible to realize a genuine use of the principles and was considered relevant, but not restrictive, the need for adaptation of those. Finally, the Lean Healthcare has a great potential to contribute to a better performance of companies in the healthcare sector.
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FAISAL, MUHAMMAD, and AFRIDI ADNAN ALI. "Lean Implementation in Healthcare : Redesign and organizational behavior." Thesis, KTH, Tillämpad maskinteknik (KTH Södertälje), 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-211451.
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Hansen, Emily. "Implementing Lean healthcare : Things to consider when making the change." Thesis, Linköpings universitet, Institutionen för datavetenskap, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-85146.
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The pressure on the healthcare sector is increasing all over the world. The amount of treatable diseases increases and the time spent with each patient decreases. As a reaction towards the way the healthcare works today, patient-centred healthcare has become increasingly popular. Bringing the patient into the centre also needs changes in the staffs’ way of working. One way of making these changes is by implementing Lean healthcare. This thesis uses a systematic review approach to find out what organisational changes have been made at hospitals where they have implemented Lean healthcare and how the implementations were done. The results showed that the most important thing was to engage the staff at an early point. Those hospitals that had representatives from all the different categories of the staff were the ones who managed to make the modifications with less effort and they also had an easier way of maintaining them. The most obvious similarities in the organisational changes the hospitals had made were that they clearly defined who were supposed to do what and that they changed the work into multi-disciplinary teams. By that the hospitals saved a lot of time both for the staff and for the patients. Lean thinking has similarities theories of cognitive science, like distributed cognition and safety barriers and it could get inspiration from these areas to enhance the implementations. There are few articles concerning the organisational changes that have been made at hospitals when implementing Lean healthcare. However the results of this thesis was that the most important thing when implementing Lean healthcare is to involve everyone at an early stage and the only way to get Lean healthcare to really work is by changing the attitude and making people realise that improvement is a never ending process. The changes that were most common among the hospitals were to clearly define and document who was supposed to do what and to change the structure to multi-disciplinary teams working together.
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Persson, Moa, and Alexander Sundqvist. "Lean Healthcare och verksamhetsstyrning : En fallstudie på sex svenska sjukhus." Thesis, Linnéuniversitetet, Institutionen för ekonomistyrning och logistik (ELO), 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-35789.
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Bakgrund: Under de senaste decennierna har den offentliga svenska sjukvården genomgått stora förändringar. Ett av de begrepp som implementeras är Lean Healthcare. Begreppet bör ses som en filosofi och strategi. Verksamhetsstyrningen bör anpassas efter vald stra-tegi, som exempelvis Lean Healthcare. Det finns dock inte en universell metod för hur styrningen bör anpassas efter Lean Healthcare, utan styrningen bör vara individuellt anpas-sad. Syfte: Syftet med denna studie är att genom att studera sex sjukhus utreda hur sjukhusens verksamhetsstyrning stödjer strategin Lean Healthcare. Metod: Vi uppfyllde vårt syfte genom att göra en multipel fallstudie på sex sjukhus tillhö-rande två landsting, Skåne och Jönköping Vi har intervjuat personer med olika befattningar på sjukhusen för att skapa oss en uppfattning om hur Lean Healthcare stöds i sjukhusens verksamhetsstyrning. Datainsamlingen skedde med hjälp av semistrukturerade intervjuer. Resultat/Slutsats: Vi har med utgångspunkt i den teori som sammanställts och den empiri som insamlats kommit fram till att olika delar av verksamhetsstyrning i olika stor utsträck-ning stödjer Lean Healthcare. I analysen av de fem kategorierna framgår det att de olika delarna på olika sätt stödjer Lean Healthcare.
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Juréen, Katarina. "The lean healthcare entrepreneur : Is the lean startup methodology applicablewhen facing a helthcare challenge?" Thesis, KTH, Maskinkonstruktion (Inst.), 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-146607.
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Healthcare firms spend years developing a product uncertain whether it will work, if it will besafe and tolerated, or if anyone will invest in their efforts once the product reaches the market.At the same time the flow of new and improved products in the healthcare sector has escalatedresulting in shorter life cycles for products. Although user driven innovation during the initialstage of product development in the healthcare sector has proved to enhance the chance to hitthe market with greater precision and gain better return on investment, few studies haveexamined this field of research. The lean startup methodology encourage innovators to stayopen-minded towards modifying their product or approaching a different customer segment,prior to having launched the final product and spent all of their venture capital. The methodologyhas mostly been applied by high-tech startups experimenting with web applications. Could thehealthcare innovator also apply this lean methodology?This investigation identified how the high-tech web-startup was different from a healthcareventure. Thereafter a framework inspired by Maurya’s running lean and user driven methodswas used to carry out the initial stage of a healthcare project entitled ‘Motivation-driven Selfmanagedpost-Stroke rehabilitation’. The project set up to explore the problem area andconceptualise solutions for a personalised self-managed stroke-rehabilitation system.While examining the case study it became clear that the two sectors are different, thus theframework was slightly modified. For example the lean business model approach was notapplicable in the early stage of the project. Further, the healthcare sector is built around a widerange of different users and stakeholders whom all should take part in the developmentprocess. Thus the lean narrow and agile focus, often referred to as the product/market fit, wasneither applicable.The conclusion presents a conceptual framework and six recommended conditions for success,which can be used in future similar projects during the initial stage of product development,guiding the lean entrepreneur as he or she navigates through the precarious health care setting.These conditions are as follows: Involve different types of users from start, Practice a bothneed-and business model-driven approach, Use users as a valuable source of information, Getout of the building, Employ a strategic push and finally Make use of multidisciplinary expertise.Företag verksamma inom sjukvåden ägnar ofta flera år för att utveckla en produkt osäkra på om denkommer att fungera, vara säker för användaren och accepteras av regelverket, eller om någonkommer att investera i deras ansträngningar när produkten väl når marknaden. Samtidigt escalerarflödet av nya och förbättrade produkter inom vårdsektorn vilket resulterar i kortare livscykler fördessa produkter. Trots att användardriven innovation under det initiala skedet avproduktutvecklingen inom vårdsektorn har visat sig öka chansen att nå marknaden med störreprecision och få bättre avkastning på sin investering, har få studier undersökt dettaforskningsområde. Teorierna om Lean-entreprenörskap uppmuntrar innovatörer att övervägamöjligheten att ändra sin produkt eller närmar sig ett annat kundsegment, innan man lanserat denslutliga produkten och spenderat hela sitt riskkapital. Metodiken har främst tillämpats avhögteknologiska startups som experimenterar med webbapplikationer. Kan sjukvårdens innovatörockså applicera denna metodik ?Denna undersökning har identifierat hur ett högteknologiska web-startup skiljer sig från ett företaginom sjukvården. Därefter har ett ramverk, inspirerat av Mauryas Running lean och användardrivnametoder, använts för att genomföra det initiala skedet av vård-projektet ‘Motivations-driven egenrehabiliteringefter stroke’. Projektet inrättades för att undersöka problemområdet ochkonceptualisera lösningar för ett egenrehabiliterings-system för stroke patienter.Genom undersökningen av fallstudien framkom det att de två sektorerna är olika och ramverketmodifierades något. Till exempel bedömdes det fokus på en affärsmodell lean förespråkar inte vartillämpningsbart i det initiala skedet av projektet. Vidare består vårdsektorn av ett stort antal olikaanvändare och intressenter som alla bör ta del av utvecklingsprocessen. Således ansågs det inteheller lämplig att fokusera på en typ av användare eller lösning, vad som av lean metodiken brukaridentifieras som en iterativ ansats för att identifiera en product/market fit.Undersökningen resulterade i ett konceptuellt ramverk och sex rekommenderade förutsättningar förett framgångsrikt projekt. Dessa rekommendationer skulle kunna vägleda entreprenören införframtida liknande projekt inom sjukvårdssektorn. Villkor är som följer: Engagera olika typer avanvändare från start , Applicera en både behovs- och affärsmodells-driven strategi, Involveraanvändare som en värdefull källa till information, Ta dig ut och testa i verkligheten, Mobiliseraintressenter och slutligen Utnyttja tvärvetenskaplig expertis .
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Khasho, Jozef, and Lundin Jessica Thörn. "Lean Healthcare på Akademiska sjukhuset i Uppsala : En kvalitativ studie om hur läkare upplever att den professionella autonomin påverkas av Lean Healthcare." Thesis, Uppsala University, Department of Business Studies, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-127043.
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Hagg, Heather. "Large System Transformation within Healthcare Organizations utilizing Lean Deployment Strategies." Digital WPI, 2013. https://digitalcommons.wpi.edu/etd-dissertations/415.
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"Multiple U.S. healthcare organizations have been recognized as successful in enterprise-level transformation to create healthcare delivery systems that are safe, effective, patient-centered, timely, efficient and equitable. Many of these organizations have specifically cited the development, deployment and integration of enterprise-level deployment of Lean Management Systems as key to their transformational efforts. Given the intense national interest in improving quality, efficiency and efficacy of healthcare delivery systems, a greater understanding of the strategies utilized by these organizations was required in order to provide an understanding of the mechanisms that drive successful, sustained, enterprise-level transformation. We conducted a realist review of large system transformation utilizing enterprise-level Lean Deployment methods within healthcare organizations. Synthesis and analysis of the results from this review indicate that there are five primary strategies associated with successful healthcare-based Lean deployments: Respect for People; Strategic Alignment; Strategic Deployment; Large Scale System Improvement Efforts; and Small-Scale, Local Improvement Efforts. Additional findings from this review indicate that the applications of the specific mechanisms with these strategies are emergent within multiple transitional phases spanning 6-8 years. To supplement the findings from the realist review, a series of dynamic hypotheses and system dynamics model was created in order to explore how the mechanisms and context interact to drive phase transitions within healthcare-based enterprise-level Lean deployments. The results from this model indicate that no steady state initial conditions exist that support sustained enterprise-level transformation and that the emergent nature of these deployments is necessary to overcome constraints related to the organizational capacity and capability. Additionally, we investigate the design and deployment of enterprise-level Lean programs in order to increase rate of success and decrease deployment cycles. "
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Mohajeri, Naraghi Ashkan, and Ravipati Uday Pavan. "Lean Healthcare in the Emergency Ward of Sahlgrenska Hospital." Thesis, Högskolan i Borås, Institutionen Ingenjörshögskolan, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-19579.
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Customer satisfaction in healthcare organizations has higher priority than in industrialcompanies because the patient is the customer and the health of patient is the aim. So, amethodology like Lean which can help to increase patient satisfaction is practical and usefulfor implementation in healthcare sectors. This dissertation is based upon a Lean healthcare inthe emergency ward of Sahlgrenska hospital and explains that the main step of Leanhealthcare is to change the culture from traditional thinking to Lean thinking. In order toreach this goal, the research instruments used are: interview, triage data base, spending timeat emergency ward, and value stream mapping. The focus of this thesis work is to find thebest combination of medicine doctors and surgeons that would optimize the performance. Byusing Arena simulation software, it has been identified that three medicine doctors and threesurgeons can decrease the non-value added time and total time in sequence 13.1% and 1.6 %for each patient. Indeed, the 5S steps in all parts of the emergency ward have been practicedas best suited to the surroundings of the ward. The place of Triage room two for the patientswho arrive by ambulance is extended for better and faster service. A Lean team is trained forfollowing up the Lean principles in the ward and report the progress to the management.The results and suggestions are in two kinds. First are short term suggestions like to hire onemedicine doctors and two surgeons, to hold more training classes for all staff, and to allot anumber for each patient bed. Second are long term recommendations such as to change thelayout of the emergency ward and use a partition instead of a room.
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Brey, Zameer. "Towards building a theory of Lean implementation in healthcare." Doctoral thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/10216.
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Includes bibliographical references.Lean, a management system based on the Toyota Production System, is increasingly being applied to healthcare contexts with mixed outcomes. While there are many case studies reporting on the outcomes of Lean implementation, there is little empirical evidence indicating which factors influence Lean implementation. Furthermore, there is an absence of critical and theory building research of Lean implementation. This study specifically addressed these gaps by identifying some of the enablers and inhibitors of Lean implementation, using empirical methods.
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Skogmalm, Martin, and Catharina Carlqvist. "Lean inom sjukvården : en studie av motivet bakom införandet av lean samt dess effekter." Thesis, Linnéuniversitetet, Ekonomihögskolan, ELNU, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-17044.
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Vården i Sverige har sedan länge kännetecknas av långa vårdköer och bristande resurser. Allt fler sjukhus och vårdcentraler däribland Brahehälsan, Hälsocentralen Akka, Akutmottagningen på Länssjukhuset i Kalmar samt Diagnostiskt centrum på Länssjukhuset i Kalmar väljer att möta dessa problem med hjälp av ”Lean Healthcare”. Denna nya modell och den filosofi den bygger på bidrar till ett nytt arbetssätt som är tänkt att medföra effektivisering av sjukvården. Är effektivisering av sjukvården det verkliga motivet eller finns det bakomliggande motiv för att införa ”Lean Healthcare”? Vid allt förändringsarbete är det viktigt att ha med sig medarbetarna. Deras motivation och acceptans för förändring av organisationen i samband med implementeringen av ”Lean Healthcare” är avgörande för slutresultatet. Hur har denna samverkan skötts och hur har arbetet gått till med att ta fram ett fungerande koncept för respektive sjukvårdsinrättning, d v s hur är deras förankrings- och implementeringsprocess. Har man uppmärksammat någon skillnad när det kommer till effektivitet och kvalité under arbetets gång vid de respektive sjukhusen och vårdcentralerna. Syftet med denna studie är att undersöka ovan frågeställningar samt se om det föreligger någon skillnad mellan privata och landstingsdrivna sjukvårdsinrättningar. Arbetet ämnar medverka till ökad kunskap om varför Lean implementeras inom sjukvården och om resultaten svarar mot förväntningarna. Syftet med studien åstadkoms genom en fallstudie på två vårdcentraler och två avdelningar på ett sjukhus samt en djupintervju med Prof. Håkan Aronsson. Studien bygger sin datainsamlingsmetod huvudsakligen på kvalitativa intervjuer med personer ifrån respektive sjukhus och vårdcentraler. Analys av empirin är gjord mot teorier om Lean, Kaizen, organisationsförändring, New Public Management (NPM) samt motivation. I analysen går det att utläsa att vissa faktorer har legat till grund för motivet att införa Lean samt påverkat förankrings- & implementeringsprocessen. Dessa motiv ger utslag på det slutliga resultatet av implementeringen. Att valet föll på ”Lean Healthcare” beror till stor del på att det ligger i tiden. Förankringsprocessen har skett genom kommunikation och utbildning. Vi har inte kunnat finna belägg för några större skillnader när det gäller huvudmannafrågan förutom ett mer grundligt tillvägagångssätt vid implementeringen vid den privata vårdcentralen. En faktor som arbetet med ”Lean Healthcare” har bidragit med är medarbetarnas möjlighet till identifiering av förändring samt genomförande av förändringsarbetet. Genom att möjliggöra detta genomför medarbetarna förändringar som leder till en mindre stressad arbetsmiljö. Alltså kan ”Lean Healthcare” ge upphov till högre effektivisering samt minskad stress på arbetet. ”Lean Healthcare” har visat sig ge goda resultat i de implementerade verksamheterna och förutsättningarna för framgång inom sjukvården finns. Men arbetet har nyss börjat och för att hela verksamheten ska anses genomsyrad av ”Lean”-filosofin krävs ett fortsatt långsiktigt arbete och förändringsvilja.The Care in Sweden has long been characterized by long waiting lists and lack of resources. More and more hospitals and medical centers including Brahehälsan, the medical centre of Akka, Emergency room at the county hospital in Kalmar and Diagnostic Centre at the County Hospital in Kalmar choose to address these problems by using Lean Healthcare. This new model and the philosophy it is based on contributes to a new approach that is intended to result in more efficient care. Is the efficiency of health care the real reason or are there ulterior motives for introducing Lean Healthcare? In all change processes it is important to involve and have abroad its employees. Their motivation and acceptance of change by the organization in conjunction with the implementation of Lean Healthcare is critical to the outcome. How has this interaction been handled and how has this work gone to develop a working concept for each medical institution, that is, how is their anchoring- and implementation process. Have one noticed any difference when it comes to efficiency and quality during the work at respective hospitals and health care centers. The purpose of this study is to investigate the above issues and see if there is any difference between private and governmental health care facilities. The work intends to contribute to a better understanding of why Lean is implemented in health care and if the results meet expectations. The purpose of this study is accomplished through a case study in two health centers and two departments in a hospital and an interview with Prof. Håkan Aronsson. The studys data collection methodology is mainly based on qualitative interviews with people from respective hospitals and health centers. Analysis of empirical data is made towards theories of Lean, Kaizen, organizational change, new public management and motivation. In the analysis it is possible to deduce that some factors have been the basis reason to introduce lean and also affected the anchor- & implementation process. These motives affect the final result of the implementation. The choice of Lean Healthcare is mainly due to that it is in fashion. The anchoring process has taken place through communication and education. We have not been able to find evidence of any major differences in the Principals of the question except for a more thorough approach to the implementation at the private clinic. One factor that works with Lean Healthcare has helped with the employees' ability to identify change and implementing change. By enabling the implementation of staff changes has lead to a less stressful working environment. Consequently, Lean Healthcare results in higher efficiency and reduced stress at work. Lean Healthcare has shown to give good results in the implemented activities and the conditions for success in health care. But the work has just begun and for the entire operation to be considered to be steeped in "Lean" philosophy it is required a continued long-term effort and will to change.
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Helal, Débora. "Fatores críticos de sucesso para a sustentabilidade de lean healthcare: um estudo de caso." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/18/18156/tde-21122017-112518/.
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Assim como a literatura de lean, pouco se tem abordado acerca a sustentabilidade de melhorias de lean healthcare. Considerando as altas taxas de insucesso de iniciativas lean relatadas na literatura, este trabalho tem como objetivo testar, através de um estudo de caso em um hospital, os fatores críticos de sucesso para a sustentabilidade de melhorias lean healthcare apontados na literatura. Para tal, foi necessário identificar na literatura os fatores críticos de sucesso para a sustentabilidade lean e de lean healthcare, de modo que depois foram agrupados e consolidados em 17 fatores críticos. A partir deles, foram elaboradas 24 proposições teóricas para que fossem testadas no hospital utilizado como estudo de caso. Como resultado, 15 proposições puderam ser confirmadas com as evidências do caso, enquanto que 6 foram divergentes do previsto na literatura e 3 não tiveram dados suficientes para análise. As divergências foram relacionadas aos fatores críticos de alinhamento estratégico, cultura organizacional, envolvimento dos colaboradores e duração dos projetos. A partir das proposições divergentes, este trabalho contribui com novas proposições sugeridas que foram baseadas nas evidências do estudo de caso realizado.As in lean literature, little has been addressed about sustainability in healthcare settings. Considering the high failure rates of lean initiatives reported in the literature, this paper aims to test, through a case study in a hospital, the critical success factors for sustainability in healthcare settings reported in literature. To accomplish that it was necessary to identify in the literature the critical success factors for lean and lean healthcare. They were grouped and consolidated into 17 critical factors. From these, 24 theoretical propositions were prepared to be tested in the hospital used as a case study. As a result, 15 propositions could be confirmed with the evidence from the case, while 6 were divergent from that was predicted in the literature and 3 did not have enough data for analysis. The divergences were related to the critical factors strategic alignment, organizational culture, employee involvement and project duration. From the divergent propositions, this work contributes with new suggested propositions that were based on the evidence of the case study.
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Alwan, Fadjer. "Lean implementation problems in the healthcare system : A case study conducted at Torsby hospital." Thesis, Karlstads universitet, Fakulteten för ekonomi, kommunikation och IT, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-29557.
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This thesis is a case study conducted at the Torsby hospital, medicine department in Torsby, Sweden. The hospital has some financial, communication, and process standardizing problems and was aiming to solve them by implementing lean strategies. The data for this study were collected through structured interviews and observations in the hospital. A thorough discussion of the information gathered from the interviews and the observations made are presented related to the theoretical frame of the study. The findings of this study showed that the lean concept is actually applicable to the healthcare system except for some problems that may affect the success of the lean implementation process in the hospital. By removing or fixing these problems, the hospital can reap the benefits of the implementation process. This study presents and discusses problems in question and suggests some relevant solutions.
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Gimenes, Douglas Almeida. "Lean Sigma Applications to Service Departments in the Healthcare Industry." OpenSIUC, 2011. https://opensiuc.lib.siu.edu/theses/591.
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The Health Care System has struggled with many problems such as medical errors, poorly designed processes, waste, and customer dissatisfaction. The Lean Six Sigma methodology has been shown to be efficient in solving problems in the manufacturing industry and in services, as well. In this study, a framework for applying Lean Six Sigma to the health care industry is presented. The framework depicts a systematic methodology to solve problems typically found in this industry. A case study is also presented on how to apply this framework. The DMAIC Model has been conducted in an Imaging Department to identify the root causes of problems and to define a future state of the process
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Bailey, Rose. "Exploring the Process of Lean Training in the Healthcare Industry." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3082.
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Organizational leaders use lean training as a process improvement strategy to eliminate waste and inefficiencies in processes. Of the 91% of company leaders who believed lean training was important, 64% of those leaders expressed the perception that workers do not comprehend lean training and methodology. The purpose of this qualitative single case study was to explore how healthcare managers successfully implemented lean training strategies to combat escalating costs. The target population consisted of healthcare managers in a single rural care hospital located in Tennessee who had implemented lean training strategies to train staff in lean principles and lean tools. The conceptual framework for this study was the general systems theory. Data were collected through semistructured interviews with healthcare managers, document review of public hospital data, and public quality reports. Member checking of interview data was used to strengthen the credibility of the findings. Yin's 5-phase qualitative data analysis process was used consisting of compiling the data, disassembling the data, reassembling the data, interpreting the data, and concluding the data. Themes emerged resulting from the use of methodological triangulation of collected data to include improving quality of patient care, teamwork and collaboration, hands-on learning, and training the trainers. The application of the findings may contribute to social change by identifying strategies related to lean training to address inefficiencies, improve quality patient care, and provide a safer healthcare environment.
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Jansz, Robert, Per Olofsson, and Malin Johansson. "Lean inom sjukvården." Thesis, University of Gävle, Department of Technology and Built Environment, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-659.
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Det är uppenbart för alla inom sjukvården i Gävle att de ligger på gränsen till vad de kan hantera. Landstingen bestämmer inte bara vad sjukvården skall producera, utan även vad det får kosta. Det går ibland inte ihop, vilket föder frustration och vanmakt hos berörda avdelningar och personal. Behovet av sjukvård kommer troligen att öka ytterligare i framtiden, och vi verkar ha kommit till vägens ände vad gäller nuvarande arbetssätt. Syfte och mål med detta examensarbete är att genomföra en förstudie till att implementera och arbeta med lean på Gävle sjukhus och ortopedavdelningen. Arbetet innefattar även att ta fram en generell arbetsmodell för att analysera och förbättra flöden inom sjukvården utifrån ett lean perspektiv. Examensarbetets olika moment har styrts utifrån gruppen framtagna modell. Nedan sammanfattas vilka moment som ingått i varje steg.
1) Samla kunskap om lean: Första steget i arbetsmodellen handlar hur inlärning av lean i form av faktainsamling, litteraturstudier, föreläsningar och utbildning sker.
2) Kartläggning av flödet: Andra steget behandlar kartläggning av det aktuella flödet från att patienten skadas i hemmet till att denna är färdigbehandlad. Vidare har intervjuer och observationer gjorts hos de olika avdelningarna inblandade i flödet parallellt med dokumentering.
3) Analys av flödet i ett lean och kvalitetsperspektiv: Tredje steget innebär att en göra en analys av flödet med hjälp av olika metoder och verktyg inom lean.
4) Förbättringsförslag: Fjärde steget innebär att med hjälp av analysen skapa förbättringsförslag på de problem organisationen identifierat i flödet.
5) Implementering/Uppföljning: I sista steget handlar om hur en organisation inför förbättringsförslagen genom att informera och utbilda berörd personal.
Några av de problem som upptäcktes under förstudien var långa väntetider till operation, överbeläggningar, dubbelarbete, bristande rutiner och kommunikation mellan avdelningarna. Efter insamlad information och sammanställning av intervjuer och problemformuleringar har gruppen kommit fram till en rad förbättringsförslag som anses relevanta vid implementering av lean.
De olika lean och kvalitetsverktygen som gruppen främst har valt att jobba med är framtagna med hänsyn till de upptäckta problemen. Gruppens förslag till förbättringar inom det akuta höftflödet tror vi kommer förkorta vårdköerna, ge en mer kostnadseffektiv vård samt högre patient kvalitet. Lean har stor potential för sjukvården. Men att införa lean innebär inte enbart att införa en ny metod eller några verktyg. Det kräver en total förändring i synen på chefskap, på styrningen av sjukvården och på medarbetarnas roll. Förändringen sträcker sig ifrån högsta politiska nivå på landstingen till första linjens chefer som coachar sina team till dagliga förbättringar. Att införa lean är inte gjort i en handvändning, men det får inte hindra sjukvården ifrån att börja.
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Silva, Bruno Miguel Ribeiro Vaz. "Lean healthcare no serviço de urgência geral do Hospital Pêro da Covilhã." Master's thesis, Universidade da Beira Interior, 2012. http://hdl.handle.net/10400.6/1183.
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Na situação socioeconómica atual torna-se difícil prever o futuro do sistema nacional de
saúde, contudo uma coisa é certa se o sistema nacional de saúde quiser sobreviver terá que
custar menos ao erário público. Uma das ferramentas que poderá permitir o aumento da
eficácia e eficiência das instituições que formam o sistema nacional da saúde é o Lean
Healthcare. Este paradigma inclui princípios e ferramentas simples que visam a eliminação de
desperdício e a criação de valor.
Seguindo a linha de raciocínio, esta dissertação surge com o intuito de analisar e divulgar a
filosofia Lean, propondo-se, dessa forma, a identificar problemas que possam afectar o
funcionamento do Serviço de Urgência Geral do Hospital Pêro da Covilhã e, secundariamente,
a propor propostas de melhoria Lean para cada problema encontrado.
O estudo baseou-se em cerca de 34 horas de observação do SUG do CHCB, assim como em
entrevistas informais a colaboradores e na consulta de literatura e documentação relativa à
gestão do serviço.
Durante este estudo foram identificados 19 problemas que foram divididos em 5 categorias:
instalações do serviço, material, Recursos humanos, utente e fluxo de informação. Qualquer
um deles foi identificado como potencial causa de desperdício. Sendo que para todos foi
proposto uma melhoria Lean que visa a eliminação total ou parcial dos desperdícios
encontrados.
Concluiu-se que a implementação Lean trará muitos benefícios ao serviço, contudo é
importante referir que para uma implementação apropriada deste método será necessário
fomentar a motivação dos colaboradores para a necessidade de mudança.In the current economic situation it is difficult to predict the future of the national health system, but one thing is certain if the national health system wants to survive, it will have to mean less cost to the public treasury. One of the tools that may allow the increase of the effectiveness and efficiency of the institutions that form the national health system is Lean Healthcare. This paradigm includes principles and simple tools aimed at eliminating waste and creating value. Following the line of reasoning, this work arises in order to analyze and disclose the Lean philosophy, intending thereby to identify problems that may affect the functioning of the General Emergency Service of Hospital Pero da Covilhã and, secondarily, to propose suggestions for Lean improvements for each problem encountered. The study was based on about 34 hours of observation of the ER of CHCB, as well as informal interviews and consultation to employees and consultation of documentation and literature on the management of the service. During this study 19 problems were identified which were divided into five categories: service facilities, equipment, staff, users and information flow. Any one of them was identified as a potential cause of waste. As for every one was proposed a Lean improvement aimed at total or partial elimination of waste found. It was concluded that the Lean implementation will bring many benefits to the service, however it is important to note that for a proper implementation of this method will be necessary to promote the motivation of employees to the need for change.
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Lindskog, Pernilla. "Reaching at Sustainable Development : Lean in the Public Sector." Doctoral thesis, KTH, Ergonomi, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-191550.
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The concept of sustainable development is commonly used worldwide. In the public sector, characterized by a rationalization focus, conclusions about the sustainability of lean production (lean), as a management concept for organizational change, are contradictory. This thesis aims to identify conditions promoting sustainable development in the public sector, in particular the healthcare sector, when implementing lean. Two qualitative and one quantitative case study were conducted using longitudinal data collection: focus group interviews, semi-structured interviews, analysis seminars, steering board meetings, and a questionnaire. The empirical data was collected from national lean programs in Sweden. The results describe that socio-technical principles may be used as indicators of sustainability as well as a guide in the implementation of lean in healthcare. Active ownership among stakeholders, a developmental view in the organization, stakeholder participation, organized joint innovative learning activities, role and goal clarity may be conditions influencing the sustainability of lean in the public sector. Furthermore, when supported by a favorable lean context, the results show that the lean tools value stream mapping, standardized work and 5S (housekeeping) may promote a sustainable implementation of lean in healthcare by the promotion of employees and managers’ working conditions and/or employee individual innovation. Visual follow-up boards may inhibit employees and managers’ job satisfaction, when not supported by job resources. Personnel stability, time for development, and information to be able to participate were in this context shown to be central job resources. In conclusion, conditions which may promote sustainable development in the public sector, when implementing lean are: stakeholder values of inclusive social well-being, an implementation process including stakeholder ownership and joint innovative learning, and a favorable lean context: balancing job resources and job demands. Lean tools may empower public healthcare employees to engage in development and counteract a poor implementation process and a poor lean context but only to a limited degree. The lean contexts studied were unfavorable, i.e., a weak implementation process and job resources not balancing the job demands. Hence, the lean implementations studied could not be considered sustainable.QC 20160901
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Brüer, Michael. "Lean Healthcare på Akademiska : Analys av förändringsarbete med utgångspunkt från en utbildningsdag." Thesis, Uppsala University, Department of Business Studies, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-106295.
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I denna uppsats har jag studerat förändringsarbete i samband med införande av Lean Healthcare. Arbetet har en abduktiv ansats där jag utifrån en fallstudie på Akademiska Sjukhuset i Uppsala har studerat hur de arbetar med förändringsarbetet. För att få insikt i deras förändringsarbete har jag intervjuat delar av personalen och deltagit i två av deras utbildningsdagar.
Förutom en beskrivning av hur arbetet på Akademiska Sjukhuset är organiserat så innehåller arbetet även en stor teoridel som tar upp de grundläggande principerna i Lean-filosofin. I tillägg till detta så presenteras också en modell för förändringsarbete och jag har tagit med teorier som specifikt handlar om förändringsarbete i samband med införande av Lean Healthcare. Genom att jämföra teorierna med erfarenheterna från utbildningsdagarna har jag sedan kunnat dra slutsatser om förändringsarbetet.
För att lyckas med Lean-implementeringen är det viktigt att inse att det kan finnas ett motstånd mot förändringarna. Motståndet ska minimeras och den viktigaste åtgärden i detta är involvera medarbetarna i förändringsprocessen. Akademiska Sjukhuset använder sig av ett top-down införande där chefer får delta i utbildningsdagar för att sedan utbilda sin egen personal. Fördelen med detta är att det skapas ett gynnsamt förändringsklimat. Nackdelen är att alla inte får del av utbildningen. Arbetet med Lean-implementeringen på Akademiska Sjukhuset har ingen bestämd tidsplan, istället fokuserar de på ett smidigt förändringsarbete som börjar med små förbättringar.
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Honda, Ana Carolina. "Aplicação de ferramentas de gestão da qualidade em ambientes de serviços hospitalares: estudo de medidas de melhoria em Santa Casa de Misericórdia no interior do estado de São Paulo." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/18/18156/tde-21122017-112044/.
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Nesta dissertação foi estudada a aplicabilidade de ferramentas e técnicas da qualidade em um hospital filantrópico, através da execução de projetos de melhoria seguindo a abordagem Lean. Objetivou-se verificar a possibilidade destas de ser uma solução para problemas de gestão de recursos enfrentados por hospitais públicos e filantrópicos brasileiros. Foi feita revisão de literatura sobre o assunto e um estudo de caso foi conduzido em uma Santa Casa de Misericórdia no interior do estado de São Paulo, onde foram aplicadas ferramentas lean. Foram relatadas diversas melhorias, dentre elas uma enorme redução de estoque, eliminação de desperdícios como excesso de deslocamento/transporte e fluxo contínuo. Foi possível concluir que o Lean foi efetivo no hospital estudado e que ainda possui grande potencial de exploração no contexto da gestão da qualidade.In this master thesis presents the study of the applicability of quality tools and techniques in a philanthropic hospital, through the execution of improvement projects following the Lean approach. The objective was to verify the possibility of these as a solution to the problems of resource management, common problem faced by Brazilian public health hospitals. A literature review on the subject and a case study were conducted at a non-profit hospital in the interior of the state of São Paulo, where lean tools were applied. Several improvements have been reported, among them a huge reduction of stock, elimination of wastes such as excess displacement/transport and continuous flow. It was possible to conclude that the Lean was effective in the studied hospital and still has great potential for exploration in the context of quality management.
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Matteo, Marco. "Development of a sustainable Lean Six Sigma framework in healthcare sector." Thesis, Sheffield Hallam University, 2012. http://shura.shu.ac.uk/18466/.
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The healthcare sector is promoting the use of process improvement approaches resulting in several successful improvement projects. However, evidence, based on literature, points out that in a significant number of cases, healthcare organisations have failed to sustain the deployment of process improvement tools for long-term continuous improvements. Lean Six Sigma, which incorporates the speed and impact of Lean, with the quality and variation control of Six Sigma, is considered to have a high impact. Nevertheless, to reap the full benefits of LSS, it is necessary to develop a systematic approach to sustain LSS in healthcare organisations. Organisations have been shown to approach change from only three ways: functional, operational and ad hoc, neglecting a holistic or systemic analysis. Hence, the literature has not provided a systemic approach to change and improvement, which also includes the assessment of readiness for change. Therefore the objectives are to carry out an extensive literature review and survey to identify the reasons for organisations failing to sustain Lean Six Sigma. A list of factors critical for successfully sustaining Lean Six Sigma are identified and analysed using the ISM methodology. With the view to support healthcare professionals in integrating Lean Six Sigma in their organisation, this research develops a new framework (SLSS) to shift focus away from short term and towards long-term improvement. Furthermore, using a semi structured interview approach experts validate the framework. The framework will allow professionals to pay more attention on strategically important factors when integrating Lean Six Sigma in their organisation. The major outcome of this research is that the relationship between CSFs is analysed providing a distinctive view on how to handle them. Common approaches have focused on other aspects of research and were content with having identified CSFs, which led to the misconception that all CSFs are equally important. Hence, this research provides a more sophisticated view on this topic. In addition, the SLSS framework was build to fill the gap between implementation-focused and organisational culture focused frameworks. It can be used in conjunction with the organisation's preferred implementation framework in order to guarantee that the strategic component is covered.
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Patton, Michael Winston Jr. "DEVELOPING A TIME AND MOTION STUDY FOR A LEAN HEALTHCARE ENVIRONMENT." UKnowledge, 2011. http://uknowledge.uky.edu/gradschool_theses/163.
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This thesis outlines the development of a standard methodology for performing a time and motion study in a lean healthcare environment. Time and motion studies have been used in healthcare environments in the past, however they have nearly all been exclusive to a particular healthcare enterprise. To develop the time and motion study methodology, a study was designed to examine how resident doctors spend their time. This study was performed in response to coming changes in the work hours for all residents. Once the methodology was developed, trial observations were conducted. The data from these observations was analyzed to determine the effectiveness of both the time and motion study methodology and its usefulness for process improvement activities.
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Ellsworth, Samuel Blake. "A Framework for Clinical Healthcare Process Design: Investigating Applicability to Lean." TopSCHOLAR®, 2015. http://digitalcommons.wku.edu/theses/1458.
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Healthcare delivery is a process-driven sequence of patient care treatments and services. A prescribed method for process design is required in order for healthcare organizations of the future not just to innovate, but to safely provide highly-reliable patient care. Some healthcare organizations have established the utilization of lean methodologies as a tool for process improvement. Other philosophies and methods such as Six-Sigma have also been introduced into hospitals to guide quality. Many of these efforts have provided theories or perspectives of quality improvement without being firmly connected to a model of application relative to clinical process design, process formulation, or process readiness. Hospitals often fail to recognize this gap and subsequently roll out multiple overarching quality improvement initiatives. This research examines some of the methods and activities of continuous healthcare improvement that frame clinical process design. In addition to providing an overview of current activities and methods, this research will explore to what extent standardized models for process design were followed in the course of using lean or other quality improvement initiatives. The research will conclude with a recommended best practice discussion for a healthcare process design framework and future applicability to the work of code blue standardization.
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Bahaitham, Haitham Ahmed. "A framework for quantifying sustainability of lean implementation in healthcare organizations." Doctoral diss., University of Central Florida, 2011. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/4735.
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Due to the remarkable positive effect of lean adoption in various firms in the manufacturing sector, it has been adopted by several organizations within the healthcare industry. Although the rate of adopting lean by hospitals in the developed countries is slower than it should be, it proved to be effective in helping healthcare organizations maintain or even improve their quality of care while containing their related costs. However, such adoption did not take place until the beginning of the new millennium. And with such adoption, it has been accompanied with major challenges related to proper lean implementation, sustainability of achieved levels of performance, and staff engagement in infinite cycles of continuous improvement towards perfection. Thus, the purpose of this study is to develop a framework that helps healthcare organizations quantify their experience with lean. Such quantification is obtained by measuring the agreement level of hospital staff members about the degree of adopting two sets of critical factors of successful lean implementation within their hospital. These two sets of factors are classified as process factors and organizational factors. The proposed framework has been validated by determining the sustainability level of lean implementation within one of U.S. hospitals in the State of Florida. The developed framework provides a balanced assessment of both process and organizational factors essential for achieving sustainable levels of lean implementation. In order to accommodate for the observed variation in lean adoption in hospitals, individual hospital departments are considered the "analysis units" of the developed framework. In order to quantify the implementation status of lean within a hospital department, a survey-based lean sustainability assessment tool has been developed based on the defined sets of factors.; The sustainability level of lean implementation of a hospital can be obtained by combining various responses of its surveyed departments. The developed framework is the first that addresses both process and organizational factors of sustainable lean implementation in a balanced manner while fulfilling the assessment needs of all healthcare organizations regardless of their current level of lean adoption. In addition, utilizing the framework within a hospital enhances employee involvement and respect for employee which are essential for sustainable lean implementation. Finally, the developed framework provides healthcare supervising authorities (i.e. ministries of health or corporate offices of hospitals' groups) a macro-level benchmarking view regarding the progress of their hospitals towards implementing sustainable levels of lean.ID: 030646193; System requirements: World Wide Web browser and PDF reader.; Mode of access: World Wide Web.; Thesis (Ph.D.)--University of Central Florida, 2011.; Includes bibliographical references (p. 156-163).
Ph.D.
Doctorate
Industrial Engineering and Management Systems
Engineering and Computer Science
Industrial Engineering
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Oliveira, Thomás Silva. "Proposta de aplicação das ferramentas do lean healthcare à logística hospitalar." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/18/18156/tde-16062014-135630/.
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A logística representa uma importante e complexa função de apoio dentro do hospital, assegurando a correta e ótima movimentação dos fluxos de materiais, informações e pessoas, a fim de que os cuidados médicos (competência essencial) sejam prestados com eficácia aos pacientes. Pode-se perceber, no entanto, que embora as atividades logísticas possuam um caráter estratégico, tanto em relação ao custo que representam para as finanças hospitalares, quanto para o nível de serviço prestado e a consequente percepção do paciente, alguns hospitais não a possuem de maneira bem estruturada e desenvolvida, principalmente dentro do setor público. Dessa forma, considerando a relevância da logística hospitalar, afirma-se que a busca de melhorias na execução de suas atividades pode trazer benefícios diretos ao hospital e aos seus clientes internos (colaboradores) e externos (pacientes e familiares). É nesse contexto que se insere o lean healthcare, abordagem advinda do Sistema Toyota de Produção. Baseado em princípios e ferramentas voltados a eliminação de desperdícios, criação de valor para o cliente e melhoria contínua, a produção enxuta já tem sido aplicada com sucesso para otimizar as atividades no ambiente hospitalar. O objetivo desta pesquisa é, portanto, desenvolver uma proposta de aplicação das ferramentas do lean healthcare na gestão da logística hospitalar, em uma unidade laboratorial de um hospital público de ensino. Classificada como uma pesquisa exploratória e qualitativa, foi adotado o método do estudo de caso único e realizado em um hospital público de ensino, localizado no interior do estado de São Paulo. Cinco etapas foram definidas como roteiro de execução: mapeamento da situação atual, seminários de aprovação, projeção de uma situação futura, análise dos resultados esperados e estudo de viabilidade para aplicação. Ao final, a contraposição entre a literatura revisada e as informações do caso estudado permitiu subsidiar a construção da proposta de aplicação das ferramentas do lean healthcare na logística hospitalar. A principal contribuição deste trabalho é, portanto, prática, caracterizada como um roteiro de ações a serem adotadas ao longo do processo de implantação. Espera-se que tal proposta seja uma possível referência aos gestores dos hospitais que desejem implantar as ferramentas do lean healthcare na gestão logística dos fluxos de materiais, pacientes e informações.Logistics is an important and complex hospital support area that allows the correct and optimal flow of material, information and people. Its activities are part of hospital strategy, because of cost that they represent and the impact on the quality of the service perceived by the patient. Despite of these relevant characteristics, some hospitals do not have a developed and well-structured logistics area, mainly on public sector. Therefore, considering the importance of hospital logistics, looking forward improvements on its activities would benefit internal customers (workers) and external (patients and parents). In this context, lean healthcare, approach emerged from Toyota, could be presented. Based on principles and tools that eliminate waste, create value to customer and continues improvement, lean production has been successfully applied to optimize hospital activities. Thus, the goal of this research is develop an application proposal of lean healthcare tools in hospital logistics, into a laboratory of a public teaching hospital. Classified like an exploratory and qualitative research, the single case method was adopted and executed into a public teaching hospital, located in São Paulo state. Five steps were defined like a sequence of execution: current state mapping, approval seminars, prediction of a future state, analysis of expected results and study of viability to do the application. In the end, the comparison between the reviewed literature and the case informations allowed the construction of an application proposal of lean healthcare tools in hospital logistics. Therefore, the main contribution of this research is practical, described like a sequence of prescribed actions to be adopted during the process of implantation. It is expected that this proposal could be a reference for hospital managers who want to apply lean healthcare tools on logistics\' management of material, patient and information flow.
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Apte, Uday M., and Keebom Kang. "Lean Six Sigma in healthcare: combating the military's escalating pharmacy costs." Monterey, California: Naval Postgraduate School, 2009. http://hdl.handle.net/10945/11064.
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Approved for public release, distribution unlimitedApproved for public release; distribution unlimited.
Healthcare costs throughout the United States are on the rise, drawing increased scrutiny from government officials and Congress. The cost of pharmacy operations and pharmaceuticals is growing at a rate that is alarmingly higher than that of the total cost of military healthcare itself. Recent congressional legislation has essentially given the Department of Defense the ultimatum to cut costs for beneficiaries wherever possible, or risk having benefits arbitrarily cut by Congress. In the face of this possibility, cutting costs through better business practices must be explored, particularly within the area of pharmacy operations. This project explores the potential cost savings that can be realized by implementing Lean Six Sigma (LSS) methodology in the pharmacy operations of the DoD Medical Treatment Facilities (MTF). This research proves that implementing Lean Six Sigma methodology will improve military pharmacy operations, often at little cost, while realizing significant savings and increased customer satisfaction.
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Fong, Jessica, and Johanna Öjerstav. "Hur passar Lean i vården?" Thesis, Karlstads universitet, Fakulteten för ekonomi, kommunikation och IT, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-14444.
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Syfte: Syftet med studien är att ta reda på hur Lean passar i vården genom att studera framgångsfaktorer och kartlägga eventuella utmaningar samt att ge en ökad förståelse för vårdens Leanarbete. Metod: För att uppnå syftet med studien lämpar sig en kvalitativ metodinriktning bäst. För att öka förståelsen för hur Lean passar i vården har en fallstudie genomförts, där tio verksamheter inom Landstinget i Värmland har studerats. Ett sätt att samla in data för denna studie har varit att genomföra semistrukturerade intervjuer med respondenter inom varje verksamhet och detta ligger till grund för empirin. Referensramen har arbetats fram med hjälp av vetenskapliga artiklar och böcker. Slutsats: Studien visar, att Lean som ursprungligen konstruerades för den japanska bilindustrin, mycket väl kan användas i vården, men måste anpassas till vårdens behov. Gammal ledningsstruktur, invanda roller och oförutsägbarhet är hinder som måste överbryggas för att Leanarbetet ska fungera optimalt. Genom att ta ett steg i taget kan helheten till slut förändras.
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Jonsson, Christian, and Anna Randefelt. "What is Lean? : -A case study of how Akademiska Hospital’s departments work with Lean." Thesis, Uppsala universitet, Företagsekonomiska institutionen, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-202259.
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The main purpose of this thesis is to examine how Lean is applied at the Akademiska hospital in Uppsala, Sweden. Lean is regarded as a solution for many issues connected to healthcare. We consider it interesting to examine to what extent Lean is applicable to healthcare in regard with that Lean is initially created for the production industry. We have conducted interviews with leaders and employees at the head division and at four different departments to see if there exists a difference in how they work Lean. From our study we can see that Lean is manifested differently at the departments based on which typology of technology they belong to and how the leaders communicate Lean to its employees. We hope that this study has clarified both difficulties and opportunities with implementing Lean at a hospital. Suggestions for further studies would be to examine what implications there could be with combining Lean with other management philosophies.
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Svensson, Ivan, and Elin Berglund. "At the heart of it all : A value stream mapping of the heart emergency at Danderyds Sjukhus AB." Thesis, KTH, Industriell ekonomi och organisation (Inst.), 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-170535.
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Dagens situation med en åldrande befolkning som leder till en större förekomst av allvarliga kroniska sjukdomar gör att sjukvården står inför nya utmaningar. Då de flesta vårdinrättningar har en mycket hög beläggning och begränsade resurser har man börjat använda sig av produktionsstrategier som traditionellt använts i mer industrinära miljöer, exempelvis Lean production. I denna studie har värdeflödet kartlagts och analyserats för besök vid hjärtakuten på Danderyds Sjukhus AB. Detta har genomförts med hjälp av fältstudieobservationer och intervjuer, för att undersöka verksamheten på en vårdinstitution som arbetar enligt Lean healthcare. Studien har genomförts för att identifiera potentiella förbättringsområden och förändringar inom dessa, som kan leda till effektivare patientflöde. Resultaten av vår fallstudie tyder på att det förekommer icke-värdeskapande inslag relaterade till Transport, Motion, Waiting, Overproduction & Over processing, Defects, Confusion och People på hjärtakuten. Den vanligaste orsaken till slöseri har upptäckts vara kopplad till arbetsrutiner och hur väl dessa rutiner följs, även om problem relaterade till kommunikation och arbetsplatskultur också har upptäckts. Vår främsta rekommendation för att effektivisera verksamheten på akuten är att skapa standardiserade rutiner som är lätta för personalen att följa. Studien och dess resultat kan ses som ett bidrag till den generella diskursen på områdena Lean healthcare, kartläggning samt analys av värdeflöden. Den kan även användas av vårdinrättningar liknande fallkliniken som är i stånd att genomföra en värdeflödesanalys.The aging population and higher occurrence of chronic diseases today has healthcare facing a very high occupancy and limited resources. To meet rising demands, many healthcare institutions have adapted operational strategies traditionally used in more industrial settings such as Lean production. In this study, the value flow during emergency visits to the heart emergency at Danderyds hospital (Danderyds Sjukhus AB) was mapped and analysed through observations and interviews. The aim was to identify potential changes that might render a more efficient patient flow and improve the operations at a healthcare institution working in accordance with Lean healthcare. The findings from the study show that waste related to Transport, Motion, Waiting, Overproduction & Over processing, Defects, Confusion and People exists at the heart emergency. The most common source of waste is related to routines and compliance to them among the staff, all though some issues related to communication and workplace culture were also discovered. Our main suggestion is therefore to establish standardised routines that are easy to follow for the staff at the clinic, to make emergency visits and patient flow more efficient. The study and its findings can be seen as a general contribution to the discourse regarding Lean healthcare, value stream mapping and analysing. It can also be used by healthcare institutions similar to the case clinic, about to perform an analysis of the value stream.
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Forzelius, Anna, and Maria Skogeryd. "Kan Lean Healthcare vara den bit som saknas i den svenska sjukvårdens pussel? : En studie av kommersiella modeller i svensk sjukvård." Thesis, Linköping University, Department of Management and Engineering, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-12131.
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Bakgrund
Svensk sjukvård har idag bland de bästa behandlingsresultaten i Europa, men trots det förs diskussionen om sjukvården ofta i negativa ordalag. I ett försök att förbättra synen på verksamheten och bli mer effektiva har sjukvården i Sverige ofta använt sig av kommersiella
modeller, modellerna har dock behövt anpassas för att fungera i sjukvårdens miljö. En av de senaste kommersiella modellerna som nu införs i den svenska sjukvården är Lean Healthcare,som är sjukvårdens version av Toyotas produktionsfilosofi Lean Production. En stor del av
tidigare forskning på området har behandlat Lean Production men lite finns att tillgå som handlar om Lean Healthcare. Den här studien är ett bidrag till att utöka kunskapen om Lean Healthcare i Sverige.
Syfte
Syftet med den här studien är att beskriva hur Lean-filosofin fungerar i den svenska sjukvården samt att göra en jämförelse mellan Lean Production och andra kommersiella modeller som tidigare har införts i den svenska sjukvården.
Genomförande
Med hjälp av intervjuer på tre svenska sjukvårdsenheter har en fallstudie med fokus på Lean Production och Lean Healthcare genomförts.
Resultat
Resultatet av studien visar att Lean Healthcare, i likhet med tidigare modeller, har krävt anpassningar för att fungera i sjukvårdens kontext. Det har bland annat visat sig i att de undersökta enheterna endast har infört vissa delar av filosofin.
Background
Swedish healthcare has today among the best treatment results in Europe, despite that the discussion about healthcare in Sweden is often pursued in negative terms. In an attempt to enhance the opinion about the organization and try to become more efficient, Swedish
healthcare has often used commercial models, however, the models has needed adjustments to function in the healthcare environment. One of the latest models that now are implemented in Swedish healthcare is Lean Healthcare which is the healthcare version of Toyota´s production
philosophy Lean Production. Much of the previous research has focused on Lean Production but little is to be found about Lean Healthcare. This study is a contribution to extend the knowledge about Lean Healthcare in Sweden.
Aim
The aim with this study is to describe how the Lean philosophy functions in Swedish healthcare and to compare Lean Production with other commercial models that earlier have been implemented in Swedish healthcare.
Completion
Through interviews on three healthcare units in Sweden a case study has been conducted with focus on Lean Production and Lean Healthcare.
Findings
The findings of this study show that Lean Healthcare, in resemblance with earlier commercial models, has needed adjustments to function in the healthcare context. It has also shown that the examined units only have implemented some of the parts of the philosophy.
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Turati, Ricardo de Carvalho. "Desenvolvimento de uma abordagem estatística dos tempos para o Lean Healthcare: uma proposta para análise dos tempos nos processos hospitalares." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/18/18156/tde-29012016-133521/.
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Os hospitais são grandes organizações de serviços responsáveis pelo bem estar da população. Desempenham um papel importante na sociedade e também são responsáveis por boa parte dos recursos financeiros destinados a saúde. Diante deste cenário, os hospitais tem demandado um aumento no uso de ferramentas de gestão e melhoria de seus processos de negócio. Uma proposta para auxiliar neste processo, tem sido reportada na literatura como Lean Healthcare. Desse modo, o objetivo deste trabalho constituiu na proposição de uma abordagem estatística dos tempos para a análise das atividades nos processos hospitalares, de modo a identificar as variações existentes e contribuir com o gerenciamento do processo. A proposta foi desenvolvida utilizando a pesquisa teórica. Este método orientou o processo de desenvolvimento da AET- Abordagem Estatística dos Tempos, uma vez que a motivação para a sua elaboração estava alicerçada em uma proposta que pudesse contribuir com o aprimoramento do Lean Healthcare em hospitais. Os resultados teóricos da AET foram apresentados em três simulações (cenários I, II e III) para dois setores do hospital. Essas simulações atestaram que a variabilidade existente pode afetar diretamente os esforços de melhoria envolvidos, principalmente quando realizada a comparação de tempos de atividade em plantões diferentes Foi também realizada uma aplicação piloto em um processo de atendimento ambulatorial de um hospital regional no Estado de Mato Grosso do Sul. Na aplicação piloto foram utilizados os parâmetros comparativos, que ilustraram, de forma quantitativa, a influência que a variabilidade dos tempos pode desencadear na dinâmica do processo. Esta aplicação ocorreu em um pronto socorro, onde foi possível observar a variabilidade dos tempos em uma situação real. Essa aplicação demonstrou uma melhora na quantificação da variabilidade, pois analisou a variabilidade com base no comportamento dos dados, e não apenas pela média dos tempos ou pelos valores inferiores e superiores de uma amostra de tempos. Dessa aplicação resultou também a identificação de que a padronização do trabalho em ambientes hospitalares pode demandar mais esforços do que em ambientes de manufatura. Isto pode ser observado quanto ao distanciamento no atendimento da demanda, identificado pelo parâmetro LMV - Limite Máximo da Variação. Assim, a AET contribuiu para avaliar melhor a capacidade em atividade que agregam valor, e em relação as atividades que não agregam valor, ela auxiliou na identificação das possíveis causas dos desperdícios. A AET pode ajudar no planejamento das ações de melhoria, pois trouxe para a discussão um importante aspecto de o processo hospitalar: a variação existente nos tempos das atividades.Hospitals are big organizations services responsible for the welfare of the population. They play an important role in society and are also responsible for much of the financial resources for health. In this scenario, the hospital has demanded an increase in the use of management tools and improves their business processes. A proposal to assist in this process has been reported in the literature as Lean Healthcare. Thus, the objective of this work consisted in proposing a statistical approach of the times for the analysis of activities in the hospital processes in order to identify existing variations and contribute to the management of the process. The proposal was developed using theoretical research. This method guided the development process of SAT- Statistical Approach of the Times, since the motivation for its development was founded on a proposal that could contribute to the improvement of Lean Healthcare in hospitals. The theoretical results of SAT were presented in three simulations (scenarios I, II and III) for two hospital sectors. These simulations testified that the variability can directly affect the improvement efforts involved, especially when performed comparing activity times in different shifts. A pilot application was also performed in an outpatient service process of a regional hospital in the state of Mato Grosso do Sul. In the pilot application were used comparative parameters, which illustrated, in a quantitative manner, the influence of the variability of time may initiate the dynamics of the process. This application was in an emergency room, where it was observed in real situation. This application showed an improvement in quantification of variability because analyzed the variability based on data behavior, and not just the average of the time or the lower and upper values of a sample times. This application also resulted in the identification of the standardization work in hospital settings may require more effort than in manufacturing environments. This can be seen as the distance in meeting demand, identified by MLV parameter - Maximum Limit Variation. Thus, the SAT contributed to better assess the capacity of activity that add value, and in relation to activities that do not add value, it assisted in the identification of possible causes of waste. The SAT can help in the planning of improvement actions, as brought to the discussion an important aspect of the hospital process: the variation in the times of activities.
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Gabassa, Valéria Cristina. "Lean healthcare: estratégia para a qualificação da gestão em saúde e enfermagem." Universidade Federal de São Carlos, 2014. https://repositorio.ufscar.br/handle/ufscar/3276.
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Previous issue date: 2014-02-24The dissertation presented here is entitled Lean Healthcare: strategy for qualifying management in healthcare and nursing, and it was aimed at implementing and evaluating the application of the lean methodology principles to improve both the managerial work process of nurses and healthcare quality. It all started from the idea that managers of healthcare organizations need to apply management tools which enable the assessment of their organizational processes, thus ensuring that the services rendered to the population have the best possible quality. In this sense, the lean healthcare system is presented as a philosophy, a management method with a set of tools which come from lean production and were introduced in healthcare scenarios as a possible alternative to change the way these organizations are managed. Given this context, nurses are presented as central professionals who seek to articulate management and assistance dimensions in healthcare, which makes maintaining the quality of services rendered dependent basically on remaining close to patients. Bringing the nursing management practice and lean methodology into focus as potential tools for process improvement led to the implementation of such methodology practices and tools in this investigation. This is an applied research, exploratory and the case study type. It is divided into three stages: 1) mapping of processes, 2) modeling of processes, and 3) practical application of lean tools and practices. In order to achieve the proposed objectives and confirm the hypothesis, the theoretical and methodological framework of Lean Healthcare was used in all stages of the research, as well as the supporting methods Business Process Modeler Notation and the Bizagi® software in the second stage and the management improvement tool Plan-Do-Check-Act in the third stage. Data analysis proceeded with a qualitative and quantitative approach. The results of the first two stages indicated that the work management process of nurses Management in Nursing Personnel Schedule should be studied in depth in the third stage. Lean principles guided the analysis of the situation encountered and the proposition of the future situation. Its practices and applied tools led to a reduction of 94% in the amount of time nurses spend on activities that were not worthwhile as well as to reducing waste inherent in their management work process. It was concluded that nurses can act effectively to promote best practices and contribute substantially to the change process in healthcare. The results are promising as they indicate a path to implement lean practices in healthcare, starting with small problems. However, the research suggests that the motivation to seek improvements must be systemic and therefore lean healthcare can be adopted as a management strategy focused on creating value for patients, improving healthcare management and assistance essentially.
A dissertação que aqui se apresenta intitula-se Lean Healthcare: estratégia para a qualificação da gestão em saúde e enfermagem e teve como principal objetivo implementar e avaliar a aplicação dos princípios da metodologia lean para a melhoria do processo de trabalho gerencial do enfermeiro e da qualidade da assistência em saúde. Partiu-se da concepção de que os gestores das organizações de saúde necessitam aplicar ferramentas gerenciais que possibilitem a avaliação dos seus processos organizacionais, garantindo que os serviços prestados à população tenham a melhor qualidade possível. Nessa direção, o sistema lean healthcare é apresentado enquanto uma filosofia, um método de gestão com um conjunto de ferramentas provenientes da produção enxuta e introduzidas nos cenários da saúde como um possível caminho para mudar a forma com que essas organizações são gerenciadas. Diante deste contexto, o enfermeiro é apresentado como um profissional central, que busca articular as dimensões gerencial e assistencial do cuidado, o que faz com que a manutenção da qualidade do serviço prestado dependa basicamente da sua permanência junto ao paciente. Focalizando a prática gerencial do enfermeiro e a metodologia lean como ferramenta potencial para a melhoria de processo é que se procurou implementar práticas e ferramentas dessa metodologia nesta investigação. Trata-se de uma pesquisa aplicada, exploratória e do tipo estudo de caso. Encontra-se dividida em três etapas: 1) mapeamento de processos; 2) modelagem de processos e; 3) aplicação prática de ferramentas e práticas lean. Para alcançar os objetivos propostos e confirmar a hipótese levantada utilizou-se do referencial teórico-metodológico Lean Healthcare em todas as etapas da pesquisa, os métodos apoiadores Business Process Modeler Notation e software Bizagi® na segunda etapa, e a ferramenta de gestão de melhoria Plan-Do-Check-Act na terceira etapa. A análise dos dados procedeu com abordagem qualitativa e quantitativa. Os resultados das duas primeiras etapas apontaram para o processo gerencial do trabalho do enfermeiro Gestão da Escala de Pessoal de Enfermagem para ser estudado em profundidade na terceira etapa. Os princípios lean nortearam a análise da situação encontrada e a proposição da situação futura. Suas práticas e ferramentas aplicadas levaram à redução de 94% do tempo do enfermeiro gasto com atividades que não agregavam valor e redução dos desperdícios inerentes ao seu processo de trabalho gerencial. Concluiu-se que o enfermeiro pode agir efetivamente em prol das melhores práticas e contribuir substancialmente para o processo de mudança na saúde. Os resultados são promissores ao indicar um caminho para implementar a prática lean na saúde, começando por pequenos problemas. Contudo, a pesquisa aponta que a motivação para buscar melhorias deve ser sistêmica e, assim, o lean healthcare pode ser adotado como uma estratégia de gestão centrada na criação de valor para o paciente, melhorando essencialmente a gestão e a assistência à saúde.
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Deguirmendjian, Samira Candalaft. "Lean healthcare : aplicação do diagrama de espaguete em uma unidade de emergência." Universidade Federal de São Carlos, 2016. https://repositorio.ufscar.br/handle/ufscar/7405.
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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
Every day we are faced with constant waste and activities that do not add any value in hospitals. Aspects related to communication, unnecessary movement of professionals, patients, materials and information, useless protocols although well written are increasingly observed in health services. For improvements related to handling flow and continuous elimination of waste and activities that do not add value in the hospital, this study aimed to assess the implementation of spaghetti diagram tool in an emergency room of a small hospital in the state of São Paulo. The healthcare lean methodology and spaghetti diagram tool was used. It was identified the current situation and opportunities for improvement, relating to proposition good spaghetti diagram practices in hospitals. The main movement of wastes were mentioned and it was noted that the application of the tool was successful. The importance of the method for reducing the waste stream related to movement flow in a hospital environment has been proved. It is expected that the flow of tasks become efficient, always seeking less time to perform activities using less effort, less cost and reducing the waiting time of the patients in the unit by reorganizing the movement flow in the workplace.
A cada dia percebem-se constantes desperdícios e atividades que não agregam valor algum nos hospitais. Aspectos relacionados à comunicação, movimentação desnecessária de profissionais, pacientes, materiais e informações, protocolos inúteis, apesar de bem escritos, são cada vez mais observados nos serviços de saúde. Visando melhorias relacionadas ao fluxo de movimentação e a eliminação contínua de desperdícios e atividades que não acrescentam valor no ambiente hospitalar, esta pesquisa teve como objetivo a avaliação da aplicação da ferramenta diagrama de espaguete em uma unidade de emergência de um hospital de pequeno porte do interior do estado de São Paulo. Foi utilizada a metodologia lean healthcare e a ferramenta diagrama de espaguete. Identificou-se a situação atual e as oportunidades de melhorias, relacionando-se a proposição de boas práticas de diagrama de espaguete em ambiente hospitalar. Foram apontados os principais desperdícios de movimentação encontrados e percebeu-se que a aplicação da ferramenta pôde ser realizada com êxito. Comprovou-se a importância do método para a redução dos desperdícios relacionados ao fluxo de movimentação em ambiente hospitalar. Espera-se que o fluxo de tarefas torne-se eficiente, buscando sempre menor tempo para realização das atividades, utilizando menos esforços, com menor custo e diminuindo o tempo de espera do paciente na unidade por meio da reorganização dos fluxos de movimentação do ambiente de trabalho.
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Rust, Tom. "Dynamic Analysis of Healthcare Service Delivery: Application of Lean and Agile Concepts." Digital WPI, 2013. https://digitalcommons.wpi.edu/etd-dissertations/456.
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Hospitals are looking to industry for proven tools to manage increasingly complex operations and reduce costs simultaneously with improving quality of care. Currently, €˜lean€™ is the preferred system redesign paradigm, which focuses on removing process waste and variation. However, the high level of complexity and uncertainty inherent to healthcare make it incredibly challenging to remove variability and achieve the stable process rates necessary for lean redesign efforts to be effective. This research explores the use of an alternative redesign paradigm €“ €˜agile€™ €“ which was developed in manufacturing to optimize product delivery in volatile demand environments with highly variable customer requirements. €˜Agile€™ redesign focuses on increasing system responsiveness to customers through improved resource coordination and flexibility. System dynamics simulation and empirical case study are used to explore the impact of following an agile redesign approach in healthcare on service access, care quality, and cost; determine the comparative effectiveness of individual agile redesign strategies; and identify opportunities where lean methods can contribute to the creation of responsive, agile enterprises by analyzing hybrid lean-agile approaches. This dissertation contributes to the emerging literature on applying supply chain management concepts in healthcare, and opens a new path for designing healthcare systems that provide the right care, at the right time, to the right patient, at the lowest price.
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Souza, Thiago Antonio. "Lean healthcare: aplicação dos conceitos de gestão de operações em centros cirúrgicos." Universidade do Vale do Rio dos Sinos, 2015. http://www.repositorio.jesuita.org.br/handle/UNISINOS/5157.
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CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
CNPQ – Conselho Nacional de Desenvolvimento Científico e Tecnológico
Hospitais brasileiros tipicamente convivem com um desnivelamento entre capacidade e demanda. Os subsistemas público e privado são incapazes de coordenar situações de falta e excesso de capacidade identificados, de forma concomitante, em suas respectivas estruturas. Custos tornam-se um elemento focal em ambos os casos, quer visando qualidade e segurança quer visando incremento de capacidade, enfocando áreas chave do serviço hospitalar: serviços cirúrgicos, de internação, de emergência e de diagnóstico. O Lean Healthcare, neste contexto, se torna uma filosofia possível para a mudança organizacional dos processos hospitalares visando o incremento de sua eficiência. Este estudo discute a aplicação de conceitos do Lean Healthcare em serviços cirúrgicos, com base em evidências coletadas de três estudos realizados integradamente em um hospital universitário de grande porte, pertencente ao subsistema de saúde público brasileiro. O primeiro estudo enfoca a análise de eficiência do centro cirúrgico, propondo e aplicando o indicador Operating Room Effectiveness (ORE). O segundo, analisa e propõe formas de nivelar a produção (Heijunka) de cirurgias de diferentes demandas competindo pelo mesmo centro cirúrgico, em um contexto de capacidade inferior à demanda. O terceiro estudo desenvolve o conceito de Planejamento, Programação e Controle do Fluxo de Pacientes (PPCFP), com vistas ao planejamento integrado de consultas, cirurgias, pré-operatórios e aquisição de materiais. A aplicação dos modelos conceituais propostos revela potenciais vantagens, ainda a serem estudadas em amplitude e longitude como alternativa para outras organizações do setor. Como resultados locais, além do aporte de conceitos de Engenharia de Produção aplicada ao contexto de saúde, foram identificados: ganho operacional médio de 12% de eficiência nas salas de cirurgia; redução em 40% do tempo médio de espera para cirurgias eletivas; redução média de filas para consultas em 50%; melhor planejamento e controle de eficiência e produção; e economia de cerca de R$ 5.000.000,00 resultante dos três casos.
Brazilian hospitals typically work with a depression between capacity and demand. The public and private subsystems are unable to coordinate situations of shortage and excess capacity identified in their respective structures, concomitantly. Costs become a focal element in both cases, aiming to quality and safety or to increase capacity, focusing on key areas of hospital service: surgical services, admission, emergency and diagnostic. In this context, Lean Healthcare becomes an attractive philosophy for organizational change of hospital processes aiming at increasing its efficiency. This study discusses the application of Lean Healthcare concepts in surgical services, based on evidence collected from three studies integrally in a large University Hospital, part of the Brazilian public health subsystem. The first study focuses on the operating room efficiency analysis, proposing and applying the indicator Operating Room Effectiveness (ORE). The second study analyzes and proposes alternatives to level the production of surgeries (Heijunka) of different brands, competing for the same operating room, at a low capacity context. The third study develops the concept of Planning, Programming and Control of Patient Flow (PPCPF), to establish integrated planning consultations, surgeries, preoperative and acquisition of materials. The application of the proposed conceptual models reveals potential advantages, yet to be studied in amplitude and longitude as an alternative to other industry organizations. As local gains, in addition to the approximation of Industrial Engineering concepts to the health context, it have been identified: 12% increase in the surgical center’s average efficiency; 40% reduction in the average waiting time for elective surgery; 50% reduction in the number of queued consultations; better planning and control efficiency and production; and savings of about R$ 5,000,000.00 resulting from the three cases.
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CAMPOS, Afonso Teberga. "Contribuições para a melhoria na condução de Projetos de Lean Healthcare Simulation." reponame:Repositório Institucional da UNIFEI, 2018. http://repositorio.unifei.edu.br/xmlui/handle/123456789/1135.
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Muitos países têm enfrentado o desafio de melhorar os serviços de saúde oferecidos aos cidadãos em um cenário de austeridade. Para enfrentar esse desafio, a Engenharia de Produção pode oferecer respostas, como o Lean, a Simulação a Eventos Discretos e sua integração: o Lean Healthcare Simulation (LHS). Entretanto, apesar dos divulgados benefícios da integração LHS, ainda existem poucos estudos que orientem a condução de seus projetos. Por essa razão, o presente estudo tem como objetivo reunir, por meio de uma revisão da literatura, as principais recomendações para a condução de projetos de LHS, que visem evitar a ocorrência de falhas em sua condução. Assim, objetiva-se desenvolver um checklist com as principais recomendações, de modo que futuros projetos sejam orientados e possam apresentar maiores chances de sucesso. O checklist foi adotado em um projeto de LHS desenvolvido em um pronto atendimento. Com isso, o projeto logrou êxito em demonstrar resultados positivos, que foram aceitos pela equipe. Por outro lado, dois projetos desenvolvidos sem a utilização do checklist apresentaram graves falhas, como atrasos e resultados não confiáveis. Tais fatos demonstraram que a utilização do checklist pode apoiar significativamente futuros projetos em sua condução, evitando a ocorrência de falhas e aumentando suas chances de sucesso. Além disso, uma Revisão Sistemática da Literatura sobre projetos de LHS demonstrou que em todos os projetos publicados houve o não atendimento a, ao menos, uma das recomendações, o que colocou em dúvida, na maioria dos projetos, seus declarados sucessos. Esse fato demonstra, complementarmente, o potencial de contribuição do checklist a futuros projetos de LHS. Assim, o presente trabalho contribui ao trazer à tona a discussão quanto à qualidade dos projetos de LHS, indicando falhas que precisam ser evitadas e definindo recomendações que podem auxiliar futuros projetos a se tornarem bem-sucedidos.
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Conislla-Murquia, Teresa, Anait Saico-Sulla, Claudia León-Chavarri, Jose Maria Alvarez, and Carlos Raymundo-Ibañez. "Lean healthcare model for increasing the availability of products in pharmaceutical SMEs." Association for Computing Machinery, 2019. http://hdl.handle.net/10757/656252.
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El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.Nowadays, retailers in the trade industry are focused on meeting customers’ needs, as their priority is to make as many sales per day as possible. Stockouts lead to unattended sales, which mean loss of income. This endangers the place of the MSBs in the industry. This paper aims to prove that proposing a supply management model will reduce the number of lost sales due to stockouts. For this study, we analyzed three key processes (purchasing, storage and distribution), where we identified problems such as incomplete shipments and unfulfilled POs and replacement requests. To prove the viability of our proposal, a pilot was carried out in a pharmacy that has five dispensing premises and a central warehouse, which improved its stock availability from 82% to 89.5%.
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Wahlberg, Samuel, and Sofia Sundberg. "Implementering av Lean Healthcare inom Svensk sjukvård : En fallstudie inom Region Västerbotten." Thesis, Luleå tekniska universitet, Institutionen för ekonomi, teknik, konst och samhälle, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-85226.
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Inom den svenska offentliga sjukvården har det under en längre tid implementerats ett antal olika styrmedel som i grunden är skapade för den privata industrin. Dessa styrmedel går under samlingsnamnet New Public Management (NPM) och riktar in sig på att rationalisera bort icke värdeskapande aktiviteter i verksamheten. Under de senaste åren är det framförallt Lean som har varit det populäraste NPM-styrmedlet inom svensk sjukvård. Det finns idag forskning kring Lean Healthcare ur ett globalt perspektiv, främst från USA och England, men relativt lite forskning finns kring hur Lean Healthcare har påverkat den svenska offentliga sjukvården. Vi har i denna studie valt att genom en fallstudie på Region Västerbotten undersöka hur implementeringen av Lean Healthcare har påverkat organisationen, och hur denna process har upplevts av tjänstemän i organisationen. Åtta personer med koppling till Region Västerbotten har genom semi-strukturerade intervjuer fått redogöra för hur de upplever att deras vardag påverkats av implementeringen av Lean, samt om de upplever att arbetet med Lean hittills kan anses ha varit framgångsrikt. Dessa åtta intervjupersoner är tjänstemän i chefsställning inom Region Västerbotten som på olika sätt har varit en del av processen från det att beslutet om att en implementering ska ske, till att nu idag kunna följa det dagliga arbetet med Lean på ett flertal avdelningar inom Region Västerbotten. Det visade sig under arbetets gång att intervjupersonerna är eniga om att implementeringen av Lean har haft en positiv inverkan på arbetet inom kärnverksamheten. Här nämns framför allt att det är positivt att nya tankar och idéer kring hur vården ska bedrivas är av godo, och på så vis undvika att hämma utvecklingen av vårdarbetet. Den kritik som riktats mot Lean menar de medverkande intervjupersoner främst brukar framkomma initialt i implementeringsprocessen för att sedan avta i takt med att Lean etablerats inom verksamheten. Den kritik som idag ännu finns inom organisationen är vanligast på de avdelningar som ännu inte helt har kommit ur implementeringsfasen.
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Grimmeiss, Andrea, and KATHERINE WANG. "Value Creation in Healthcare through Secondary Activities : A Case study investigating food processes." Thesis, KTH, Industriell Management, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-237247.
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The world is facing the challenge of an increasingly growing and aging population which leads to increasing requirements on the healthcare system. This has led to higher financial pressure on operational managers to do more with less resources. Hospitals are characterised by rigid routines, strict hierarchical structures and lack of consistent definitions of value which creates challenges for improvement projects and implementation. To explore an alternative perspective of how to increase value in healthcare, the concept of secondary activities is introduced. Secondary activities are defined as activities that are indirectly related to healthcare and medical processes in hospitals. Presently, secondary activities are not prioritised in healthcare since the distinction has not been made before and therefore is the value-gain interesting to investigate. The purpose of this report is to investigate how to increase value in healthcare through improved secondary activities and the following research questions are used to fulfill the purpose: What are the challenges of defining value in healthcare? 2. What process improvement strategy is suitable for improving secondary activities? 3. What implementation strategy is suitable when improving secondary activities? The method used to conduct this study consisted of a literature study covering the fields of value creation, Lean in healthcare and change management in hospital management, followed by a case study at Norrtälje Sjukhus where the food process was investigated. Results of the study showed that the challenges of defining value in healthcare are the different mindsets between professions operating in hospitals and the required balance between ethical and financial aspects. II At Norrtälje Sjukhus, the assistant nurses valued time spent with patients. In order to free more time for them, secondary activities have great potential of increasing value through improvement projects. The combination of Lean and Biodesign based on comprehensive observations proved to be a suitable process improvement strategy for improving secondary activities. Moreover, secondary activities lag well behind primary activities regarding digitalisation which can increase the value of secondary activities through improved workflows. When value is defined as time spent with patients this process improvement strategy proved to be successful. Results of improving the food process in the case study showed that the total annual savings for the hospital were 3212 work hours which corresponds to 761 244 kr. Prerequisites for a successful implementation strategy are awareness of problems, needs and to have an improvement strategy that fits the situation. Introduction of changes should made together with the personnel and be incremental to minimise disturbances to other healthcare activities. A remaining challenge is the lack of responsibility and managerial competence in the regular hospital organisation that is needed for future, continuous and sustainable improvements for secondary activities.Världen står inför en stor utmaning med en växande och åldrande befolkning vilket ställer högre krav på sjukvårdssystemet. Detta har lett till ökat finansiellt tryck på verksamhetsansvariga att prestera mer med mindre resurser. Sjukhus karaktäriseras ofta av oflexibla rutiner, strikt hierarkiska strukturer och inkonsekvent definition av värde vilket innebär utmaningar för förbättringsarbeten och implementation. Konceptet sekundära aktiviteter introduceras för att utforska ett alternativt perspektiv av hur man ökar värde i sjukvården. Sekundära aktiviteter definieras som indirekt sjukvårdsrelaterade aktiviteter som stöttar medicinska processer. I nuläget prioriteras inte sekundära aktiviteter i sjukvården eftersom denna särskiljning inte tidigare gjorts och därför blir den potentiella värdeökningen intressant att undersöka. Syftet med denna rapport är att undersöka hur värdet kan öka i sjukvården genom förbättring av sekundära aktiviteter. Följande forskningsfrågor bidrar till att uppfylla syftet med rapporten: 1. Vilka är utmaningarna med att definiera värde i sjukvården? 2. Vilken processförbättringsstrategi är lämpligast för att förbättra sekundära aktiviteter? 3. Vilken implementationsstrategi är lämpligast för att förbättra sekundära aktiviteter? Metoden som användes i denna studie bestod av en litteraturstudie som behandlade områdena värdeskapande, Lean i sjukvården och förändringsarbete inom sjukhusledningen, följt av en fallstudie på Norrtälje Sjukhus för att undersöka matprocessen. Resultat från studien visade att utmaningarna med att definiera värde inom sjukvården är skillnader mellan professioner och en avvägning mellan etiska och finansiella faktorer. Undersköterskorna på Norrtälje Sjukhus värderar tiden med patienterna högst. Sekundära aktiviteter har stor potential att öka i värde genom förbättringsarbeten för att kunna frigöra mer tid för undersköterskorna. IV Kombinationen av Lean och Biodesign baserat på omfattande observationer visade sig vara en lämplig processförbättringsstrategi för att förbättra sekundära aktiviteter. Sekundära aktiviteter ligger efter primära aktiviteter vad gäller digitalisering som kan öka värdet av sekundära aktiviteter genom förbättrat arbetsflöde. När värde definieras som tid spenderad med patienter är den här processförbättringsstrategin framgångsrik. När matprocessen förbättrades i fallstudien resulterade det i en årlig besparing för hela sjukhuset på 3212 arbetstimmar vilket motsvarar 761 244 kr. Förutsättningar för en framgångsrik implementationsstrategi är medvetenhet kring problemen, behoven samt att anpassa strategin efter situationen. Introduktion av förändringarna bör ske stegvis i samarbete med personalen för att minimera störningsmoment gentemot andra vårdaktiviteter. En kvarstående utmaning är bristen på ansvar och chefskompetens i sjukhusorganisationen för framtida, kontinuerliga och hållbara förbättringar av sekundära aktiviteter.
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Falenius, Erik, and Mikael Jarl. "Lean – En utveckling från produktion till välfärd och service : En litteraturstudie av hur Lean utvecklats från produktion till välfärds- och servicebranschen." Thesis, Mittuniversitetet, Institutionen för informationssystem och –teknologi, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:miun:diva-36335.
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This study consists of two studies around Lean. The studies are limited to two databases and three different sectors, the industry sector where Lean originated from, and the welfare and service sectors. The first study is a quantitative pilot study on published articles. The purpose was to get an understanding of what extent the different sectors get published, compared to each other. The result was illustrated in a graph where 40 articles per year were proportionally divided between the three sectors. The main study is a literature review where a scoring matrix was used to cull the selected articles. The remaining articles where compared to the “Toyota house” to answer the research questions: In what way has the definition of Lean changed from the manufacturing-based improvement philosophy it originated as, to the concept that is used in different sectors today? How does the specific sector affect the implementation of Lean, is there a difference in the Lean that is described in the literature compared to the Lean that is used in the welfare or service sectors? The study found in the chosen literature is that the sectors that are new at using Lean are using less of the tools available and in a smaller part of the organization, instead of using it on the whole organization. Many case studies where found that describes what tool was used, but not how they were used. One sector with many published articles was the construction sector, but they were overlooked due to the limitations of the study.Denna studie består av två undersökningar kring Lean. Undersökningarna är begränsade till två databaser samt tre branscher, industribranschen där Lean grundades samt välfärds- och tjänstebranschen. Först gjordes en kvantitativ förstudie av publicerade artiklar för att få en uppfattning kring hur många andelar av de olika branscherna artiklarna bestod av. Resultatet visades i form av en graf där 40 artiklar från varje år delades upp i de tre branscherna. Efter det gjordes en litteraturstudie med en bedömningsmatris för en utgallring av artiklar. Utvalda artiklar jämfördes därefter mot ”toyotahuset” för att svara på forskningsfrågorna: På vilket sätt har definitionen av Lean förändrats från den produktionsbaserade förbättringsfilosofin det ursprungligen var, till det uttryck som används i flera olika branscher idag? Hur påverkar branschen implementeringen av Lean, skiljer sig det Lean som beskrivs i litteraturen mot det Lean som används i välfärds- eller tjänstesektorn? Det vi kunde hitta i den utvalda litteraturen var att de branscher som är nya med Lean använder färre verktyg och på mindre delar av sin organisation istället för att göra implementeringen på hela organisationen. Vi hittade många ”case studies” som berättar att det använt verktyg men inte hur verktygen har använts. En bransch som det hittades mycket artiklar om men som sållades bort på grund av avgränsningen var Lean construction.