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Lean health care

Shanta R Dube
Currently, in the U.S. and worldwide, childhood trauma is a public health crisis. Childhood adversities, such as abuse, neglect, and related household stressors, are common, interrelated and contribute to multiple adverse social, behavioral and health outcomes throughout the lifespan. The present article provides further discussion regarding adverse childhood experiences (ACEs) screening in healthcare utilizing the etic and emic perspectives. Screening in the healthcare system leans toward the etic view: objective observations of symptoms, which may then lead to intervention delivery...
March 16, 2018: Child Abuse & Neglect
Friedrich C Jassil, Alisia Carnemolla, Helen Kingett, Bruce Paton, Aidan G O'Keeffe, Jacqueline Doyle, Stephen Morris, Neville Lewis, Amy Kirk, Andrea Pucci, Kusuma Chaiyasoot, Rachel L Batterham
INTRODUCTION: Roux-en-Y gastric bypass and sleeve gastrectomy are the two most common bariatric surgery performed in the UK that result in comparable weight loss and remission of obesity-associated comorbidities. However, there is a paucity of studies examining the impact of these procedures on body composition, physical activity levels, sedentary behaviour, physical function and strength, dietary intake, health-related quality of life and costs. METHODS AND ANALYSIS: The BARI-LIFESTYLE observational study is a 1-year prospective, longitudinal cohort study within a real-world routine clinical care setting aiming to recruit 100 patients with severe obesity undergoing either primary Roux-en-Y gastric bypass or sleeve gastrectomy from two bariatric centres in London, UK...
March 16, 2018: BMJ Open
Eva-Maria Strasser, Marlene Hofmann, Bernhard Franzke, Barbara Schober-Halper, Stefan Oesen, Waltraud Jandrasits, Alexandra Graf, Markus Praschak, Barbara Horvath-Mechtler, Christine Krammer, Martin Ploder, Norbert Bachl, Michael Quittan, Karl-Heinz Wagner, Barbara Wessner
BACKGROUND: Age related loss of skeletal muscle mass is accompanied by changes in muscle quality leading to impairment of functional status. AIM: This study investigated the effect of resistance training and nutritional supply on muscle mass and muscle quality in very old institutionalized adults. DESIGN: Prospective, randomized, multi-arm parallel and controlled intervention study. SETTING: This study was conducted in five retirement care facilities...
March 7, 2018: European Journal of Physical and Rehabilitation Medicine
Samer Jabbour, Fouad M Fouad, Jennifer Leaning, Donna McKay, Rabie Nasser, Leonard S Rubenstein, Annie Sparrow, Paul Spiegel, Ahmad Tarakji, Ronald Waldman, Rola Hallam, Denis Mukwege, Ghanem Tayara
No abstract text is available yet for this article.
February 26, 2018: Lancet
Patrizia Calella, Giuliana Valerio, Matt Thomas, Helen McCabe, Jake Taylor, Malcolm Brodlie, Mario Siervo
OBJECTIVES: Body mass index (BMI) has significant limitations when assessing nutritional status in pediatric patients with cystic fibrosis (CF). We evaluated whether measurements of lean body mass (LBM) and fat mass (FM) are more sensitive nutritional parameters by testing their association with pulmonary function in adolescent patients with CF. METHODS: Sixty-nine male and female adolescents with CF were studied (age: 14.5 ± 2.3, BMI: 19.5 ± 2.3 kg/m2 )...
December 5, 2017: Nutrition
Robert E Van Demark, Vanessa J S Smith, Anthony Fiegen
Health care in the United States is both expensive and wasteful. The cost of health care in the United States continues to increase every year. Health care spending for 2016 is estimated at $3.35 trillion. Per capita spending ($10,345 per person) is more than twice the average of other developed countries. The United States also leads the world in solid waste production (624,700 metric tons of waste in 2011). The health care industry is second only to the food industry in annual waste production. Each year, health care facilities in the United States produce 4 billion pounds of waste (660 tons per day), with as much as 70%, or around 2...
February 2018: Journal of Hand Surgery
Maria L Steele, Brenda Talley, Karen H Frith
PURPOSE: Medication safety and error reduction has been studied in acute and long-term care settings, but little research is found in the literature regarding mental health settings. Because mental health settings are complex, medication administration is vulnerable to a variety of errors from transcription to administration. The purpose of this study was to analyze critical factors related to a mental health work system structure and processes that threaten safe medication administration practices...
February 2018: Archives of Psychiatric Nursing
Susanna Hihnala, Lilja Kettunen, Marjo Suhonen, Hanna Tiirinki
Purpose The purpose of this paper is to discuss health services managers' experiences of management in a special health-care unit and development efforts from the point of view of the Lean method. Additionally, the aim is to deepen the knowledge of the managers' work and nature of the Lean method development processes in the workplace. The research focuses on those aspects and results of Lean method that are currently being used in health-care environments. Design/methodology/approach These data were collected through a number of thematic interviews...
February 5, 2018: Leadership in Health Services
L Dellve, M Strömgren, A Williamsson, R J Holden, A Eriksson
The Swedish health care system is reorienting towards horizontal organization for care processes. A main challenge is to engage health care clinicians in the process. The aim of this study was to assess engagement (i.e. attitudes and beliefs, the cognitive state and clinical engagement behaviour) among health care clinicians, and to investigate how engagement was related to work resources and demands during organizational redesign. A cohort study was conducted, using a questionnaire distributed to clinicians at five hospitals working with care process improvement approaches, two of them having implemented Lean production...
April 2018: Applied Ergonomics
Jessie Williams
What does it take to light a fire to create cultural change about the way we do death, dying and bereavement in Australia? The GroundSwell Project set out to embark on a bold journey to create cultural change in the death and dying space in Australia. For 7 years we have delivered over 55 arts/health projects and have punched well above our weight. What have we learned about change and innovation? We've learned that we had to set up a fiercely independent organisation, drawing on short term funding so that we were never locked into delivering results that perpetuated 'systemic malaise'...
January 2018: Annals of Palliative Medicine
Haniel J Hernandez, Gideon Obamwonyi, Michael O Harris-Love
Chronic kidney disease (CKD) is a progressive condition that may negatively affect musculoskeletal health. These comorbidities may include malnutrition, osteoporosis, and decreased lean body mass. Secondary sarcopenia due to CKD may be associated with mobility limitations and elevated fall risk. Physical therapists are well-positioned among the health care team to screen for secondary sarcopenia in those with CKD and for the treatment of musculoskeletal comorbid conditions that may affect functional performance...
January 5, 2018: Journal of functional morphology and kinesiology
Alain Antierens, Dimitri Beeckman, Sofie Verhaeghe, Dries Myny, Ann Van Hecke
AIMS: Identify which of Toyota's principles are reported in health care institutions at the organisational level and to identify the type of reported outcomes related to the effectiveness of lean production reported in these studies. BACKGROUND: No scientific research has been conducted to determine which of Toyota's principles are embedded in health care systems. This knowledge is needed to perform targeted adjustments in health care. EVALUATION: Sixty studies were identified for the final analysis...
January 22, 2018: Journal of Nursing Management
Charles L Briggs
This article analyzes a contradiction facing efforts by left-leaning governments in Latin America to transform health into a fundamental social right. Policies and practices that confront health inequities generally fail to address health/communicative inequities, hierarchical distributions of rights to shape what counts as legitimate knowledge of health. This ethnographic analysis focuses on an epidemic of a mysterious disease - identified clinically as bat-transmitted rabies - in the Delta Amacuro rainforest of Venezuela in 2007-2008, tracing how parents who lost 1-3 children faced acute health/communicative inequities in clinical settings, epidemiological investigations, work with healers, news coverage, health policy, and health communication...
July 2017: Salud Colectiva
Mahima Ashok, Dorothy Hung, Lucia Rojas-Smith, Michael T Halpern, Michael Harrison
BACKGROUND: Complex system interventions benefit from close attention to factors affecting implementation and resultant outcomes. This article describes a framework for examining these factors in process redesign (PR) and for assessing PR outcomes. METHODS: Using literature scans and expert comment on draft frameworks based on the Consolidated Framework for Implementation Research, a team of researchers developed the PR framework for the Agency for Healthcare Research and Quality...
January 2018: Quality Management in Health Care
Elise Fields, Smriti Neogi, Pamela J Schoettker, Jennifer Lail
BACKGROUND: An improvement team from the Complex Care Center at our large pediatric medical center participated in a 60-day initiative to use Lean methodologies to standardize their processes, eliminate waste and improve the timely and reliable provision of durable medical equipment and supplies. METHODS: The team used value stream mapping to identify processes needing improvement. Improvement activities addressed the initial processing of a request, provider signature on the form, returning the form to the sender, and uploading the completed documents to the electronic medical record...
December 12, 2017: Healthcare
Wiebren A A Tjalma, Tom Van den Mooter, Tim Mertens, Valerie Bastiaens, Manon T Huizing, Konstantinos Papadimitriou
OBJECTIVE: The subcutaneous (SC) formulation of trastuzumab represents an alternative to the intravenous (IV) infusion in the treatment of patients with HER2-positive metastatic and early breast cancer. We compared the two formulations in terms of time and cost differential. STUDY DESING: We conducted a time, motion and cost assessment study in a lean operating day care oncology unit to determine and compare the time and costs of trastuzumab SC versus IV administration in patients with HER2-positive breast cancer...
December 7, 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Joshana K Goga, Antonio Depaolo, Sunil Khushalani, J Ken Walters, Robert Roca, Marc Zisselman, Christopher Borleis
OBJECTIVE: To Evaluate the Effects of Applying Lean Methodology-Improving Quality Increasing Efficiency by Eliminating Waste and Reducing Costs-An Approach To Decrease the Prescribing Frequency of Antipsychotics for The Indication of Agitation. DESIGN: Historically Controlled Study. SETTING: Bheppard Pratt Health System is the Largest Private Provider of Psychiatric Care in Maryland With a Total Bed Capacity of 300. There Were 4 337 Patient Days From November 1 2012 to October 31 2013 on the Dementia Unit...
January 1, 2017: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
Jennifer Dunsford, Laura E Reimer
Continuous improvement efforts, recognized in much literature as Lean management techniques have been used in efforts to improve efficiency in democratic health care contexts for some time to varying degrees of success. The complexity of the health care system is magnified by the sheer number of processes and sub processes required to deliver value within a bureaucratic environment, while maintaining some level of compassionate and personalized care. There is inherent tension between what is required to be efficient and what is required to be caring and this conflict presses against Lean practice at the level of delivery...
December 1, 2017: International Journal for Quality in Health Care
Rachele La Sala, Rita Bruna Dicembrino, Simona Dall'Argine, Monica Baiguera, Lorena Gazzotti, Elena Gubin, Alessia Rondini, Ilaria Mamei
BACKGROUND AND AIM: The therapeutic education and self-management carried out by nurses, are winning elements in cardiovascular secondary prevention, but because they are complex matters, they require special training by the professionals. The target of the study has been to assess the effects in clinical practice of a training program for nurses in the management of patients with cardiovascular diseases, leaning towards a self-oriented patient management and therapeutic patient education...
November 30, 2017: Acta Bio-medica: Atenei Parmensis
Kjeld Harald Aij, Maurits Teunissen
Purpose Emphasis on quality and reducing costs has led many health-care organizations to reconfigure their management, process, and quality control infrastructures. Many are lean, a management philosophy with roots in manufacturing industries that emphasizes elimination of waste. Successful lean implementation requires systemic change and strong leadership. Despite the importance of leadership to successful lean implementation, few researchers have probed the question of ideal leadership attributes to achieve lean thinking in health care...
October 9, 2017: Journal of Health Organization and Management
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