Keywords
Hospital efficiency; Healthcare; Lean management, Nosocomial infections
Abstract
Introduction: Lean is largely applied to the health sector and on the healthcare-associated infections (HAI). However, a few results on the improvement of the outcome have been reported in literature. The purpose of this study is to analyze if the lean application can reduce the HAI rate.
Methods: A comprehensive search was performed on PubMed/Medline, Scopus, CINAHL, Cochrane, Embase, and Google Scholar databases using various combinations of the following keywords: "lean" and "infection". Inclusion criteria were: 1) research articles with quantitative data and relevant information on lean methodology and its impact on healthcare infections; 2) prospective studies. The risk of bias and the study quality was independently assessed by two researchers using the “The National Institutes of Health (NIH) quality assessment tool for before-after (Pre-Post) study with no control group”. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines has been used. 22 studies were included in the present meta-analysis.
Results: Lean application demonstrated a significant protective role on healthcare-associated infections rate (RR 0.50 [0.38-0.66]) with significant impact on central line-associated bloodstream infections (CLABSIs) (RR 0.47 [0.28-0.82]).
Conclusions: Lean has a positive impact on the decreasing of HAIs and on the improvement of compliance and satisfaction of the staff.
References
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3. Goff SL, Kleppel R, Lindenauer PK, Rothberg MB. Hospital workers' perceptions of waste: a qualitative study involving photo-elicitation. BMJ Qual Saf. 2013;22(10):826-835. doi:10.1136/bmjqs-2012-001683
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5. Terra JDR, Berssaneti FT. Application of lean healthcare in hospital services: a review of the literature (2007 to 2017). Production 2018;28:e20180009.
6. Antony J, Sunder MV, Sreedharan R, Chakraborty A, Gunasekaran AA. systematic review of Lean in healthcare: a global prospective. Int J Qual Reliab Management 2018,36:1370-1391.
7. Ankrum AL, Neogi S, Morckel MA, Wilhite AW, Li Z, Schaffzin JK. Reduced isolation room turnover time using Lean methodology. Infect Control Hosp Epidemiol. 2019;40(10):1151-1156. doi:10.1017/ice.2019.199.
8. Joubert B, Bam W. Review and classification of Lean project aims in hospitals. IEEE International Conference on Engineering; Technology and Innovation (ICE/ITMC). 2019, pp.1-11.
9. Farrokhi FR, Gunther M, Williams B, Blackmore CC. Application of Lean Methodology for Improved Quality and Efficiency in Operating Room Instrument Availability. J Healthc Qual. 2015;37(5):277-286. doi:10.1111/jhq.12053.
10. Halm MA, Alway A, Bunn S, et al. Intersecting Evidence-Based Practice With a Lean Improvement Model. J Nurs Care Qual. 2018;33(4):309-315. doi:10.1097/NCQ.0000000000000313.
11. Mazzocato P, Holden RJ, Brommels M, Aronsson H, Bäckman U, Elg M, Thor J. How does lean work in emergency care? A case study of a lean-inspired intervention at the Astrid Lindgren Children's hospital, Stockholm, Sweden. BMC Health Serv Res. 2012 Feb 1;12:28. doi: 10.1186/1472-6963-12-28. PMID: 22296919; PMCID: PMC3298466.
12. van Vliet EJ, Sermeus W, van Gaalen CM, Sol JC, Vissers JM. Efficacy and efficiency of a lean cataract pathway: a comparative study. Qual Saf Health Care. 2010;19(6):e13. doi:10.1136/qshc.2008.028738.
13. Lawal AK, Rotter T, Kinsman L, Sari N, Harrison L, Jeffery C, Kutz M, Khan MF, Flynn R. Lean management in health care: definition, concepts, methodology and effects reported (systematic review protocol). Syst Rev. 2014 Sep 19;3:103. doi: 10.1186/2046-4053-3-103.
14. Cima RR, Brown MJ, Hebl JR, Moore R, Rogers JC, Kollengode A, Amstutz GJ, Weisbrod CA, Narr BJ, Deschamps C; Surgical Process Improvement Team, Mayo Clinic, Rochester. Use of lean and six sigma methodology to improve operating room efficiency in a high-volume tertiary-care academic medical center. J Am Coll Surg. 2011 Jul;213(1):83-92; discussion 93-4. doi: 10.1016/j.jamcollsurg.2011.02.009.
15. Ponsiglione AM, Ricciardi C, Scala A, Fiorillo A, Sorrentino A, Triassi M, Dell'Aversana Orabona G, Improta G. Application of DMAIC Cycle and Modeling as Tools for Health Technology Assessment in a University Hospital. J Healthc Eng. 2021 Aug 17;2021:8826048. doi: 10.1155/2021/8826048.
16. Vaishnavi V, Suresh M. Modelling of readiness factors for the implementation of Lean Six Sigma in healthcare organizations. Int J Lean Six Sigma 2020. doi:10. 1108/IJLSS-12-2017-0146.
17. Scala A, Ponsiglione AM, Loperto I, Della Vecchia A, Borrelli A, Russo G, Triassi M, Improta G. Lean Six Sigma Approach for Reducing Length of Hospital Stay for Patients with Femur Fracture in a University Hospital. Int J Environ Res Public Health. 2021 Mar 11;18(6):2843. doi: 10.3390/ijerph18062843.
18. Rathi R, Vakharia A, Shadab M. Lean six sigma in the healthcare sector: A systematic literature review. Mater Today Proc. 2022;50:773-781. doi:10.1016/j.matpr.2021.05.534.
19. Ponsiglione AM, Ricciardi C, Improta G, Orabona GD, Sorrentino A, Amato F, Romano M. A Six Sigma DMAIC methodology as a support tool for Health Technology Assessment of two antibiotics. Math Biosci Eng. 2021 Apr 19;18(4):3469-3490. doi: 10.3934/mbe.2021174.
20. Kuiper A, Lee RH, van Ham VJ, Does RJ. A reconsideration of Lean Six Sigma in healthcare after the COVID-19 crisis. International Journal of Lean Six Sigma 2021. doi: 10.1108/IJLSS-01-2021-0013.
21. Hundal GS, Thiyagarajan S, Alduraibi M, Laux CM, Furterer SL, Cudney EA, Antony J. Lean Six Sigma as an organizational resilience mechanism in health care during the era of COVID-19. International Journal of Lean Six Sigma 2021. doi: 10.1108/IJLSS-11-2020-0204.
22. Cassini A, Plachouras D, Eckmanns T, Abu Sin M, Blank HP, Ducomble T, Haller S, Harder T, Klingeberg A, Sixtensson M, Velasco E, Weiß B, Kramarz P, Monnet DL, Kretzschmar ME, Suetens C. Burden of Six Healthcare-Associated Infections on European Population Health: Estimating Incidence-Based Disability-Adjusted Life Years through a Population Prevalence-Based Modelling Study. PLoS Med. 2016 Oct 18;13(10):e1002150. doi: 10.1371/journal.pmed.1002150.
23. Haque M, Sartelli M, McKimm J, Abu Bakar M. Health care-associated infections - an overview. Infect Drug Resist. 2018;11:2321-2333. Published 2018 Nov 15. doi:10.2147/IDR.S177247.
24. Sticchi C, Alberti M, Artioli S, Assensi M, Baldelli I, Battistini A, Boni S, Cassola G, Castagnola E, Cattaneo M, Cenderello N, Cristina ML, De Mite AM, Fabbri P, Federa F, Giacobbe DR, La Masa D, Lorusso C, Marioni K, Masi VM, Mentore B, Montoro S, Orsi A, Raiteri D, Riente R, Samengo I, Viscoli C, Carloni R; Collaborative Group for the Point Prevalence Survey of healthcare-associated infections in Liguria. Regional point prevalence study of healthcare-associated infections and antimicrobial use in acute care hospitals in Liguria, Italy. J Hosp Infect. 2018 May;99(1):8-16. doi: 10.1016/j.jhin.2017.12.008.
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