The available literature on capacity management in health care focuses on improvementstrategies when demand exceeds capacity and queues are formed in various part of thesystem. This paper deals with a different problem: the studied units do not have apparentaccessibility problems and the demand and capacity patterns show an ideal match, but theproductivity is low, and personnel resources are not used efficiently. The capacitymanagement is disrupted by unclear demand and uncertain process to meet the patient’sneeds. The paper aims to contribute to the knowledge on capacity management in patientflows characterised by high variability and where care pathways are customised to eachindividual patient and require coordinated efforts from various professions.

The literature emphasizes the importance of creating more responsive health care systems that can quickly adapt to evolving needs of patinets and can mobilise capacity promptly to avoid delays and queues. The paper contributes with a holistic process-oriented model for demand driven capacity planning and management, which is aimed to serve a wide range of outpatient units in a specialized care. The preliminary findings from the development and implementation work show that not a lack of capacity, but the need to properly understanding demand and managing patient flows is one of the major issue of capacity management in health care.

Care for older people must often be provided across health and community settings. The fragmentation of care processes and lack of continuity are common problems. Better and more efficient care models need to be developed to meet the needs of the growing population of older people. Based on case studies in the Swedish health care system this paper focuses on identifying strategies for achieving integrated care for older people. Five key strategies are described: integration of care processes, development of targeted care services, establishing home-based care services, coordination of care services, and use of technology to streamline care.

Purpose

The Swedish health-care system currently implements cancer care pathways (CCPs) for better and more timely cancer diagnostics. The purpose of this paper is to elucidate and define “crowding out” effects associated with the CCP implementation.

Design/methodology/approach

A document study based on implementation reports and action plans from Swedish county councils (n = 21) and a case study in one county council were conducted. Qualitative data collection and analysis were used to acquire more knowledge about the “crowding out” effects associated with the CCP implementation.

Findings

Three effects discussed under “crowding out” were defined. The first effect, called the push-out effect, occurs when other patients have to wait for care longer in favour of CCP patients. Another effect is the inclusion effect, whereby “crowding out” is reduced for vulnerable patients due to the standardised procedures and criteria in the referral process. The final effect is the exclusion effect, where patients in need of cancer diagnostics are, for some reason, not referred to CCP. These patients are either not diagnosed at all or diagnosed outside CCP by a non-standard process, with the risk of longer waiting times.

Originality/value

“Crowding out” effects are an urgent topic related to CCP implementation. While these effects have been reported in international research studies, no shared definition has been established to describe them. The present paper creates a common base to measure the “crowding out” effects and support further development of CCPs to avoid the negative effects on waiting times.

The purpose of this paper is to outline pros and cons of cancer care pathway (CCP) components perceived by health care professionals involved in the diagnostic process. The results are based on a comprehensive national survey. The biggest pros follow from the component of care pathway description, which make cancer diagnostics more process-oriented and standardised and thereby contribute to more timely, safe and patient-centred for the CCP patients. The component of standardised criteria for referral are associated with most cons. The biggest cons are the perceived “crowding out” effects, which imply impaired access and longer waiting times for non-CCP patients.

The purpose of this paper is to outline pros and cons of cancer care pathway (CCP)components perceived by health care professionals involved in the diagnostic process.The results are based on a comprehensive national survey. The biggest pros follow from the component of care pathway description, which make cancer diagnostics more processoriented and standardised and thereby contribute to more timely, safe and patient-centred for the CCP patients. The component of standardised criteria for referral are associated with most cons. The biggest cons are the perceived “crowding out” effects, which imply impaired access and longer waiting times for non-CCP patients. 

Industrial improvement approaches such as Lean management are increasingly being adopted in health care. Synthesis is necessary to ensure these approaches are evidence based and requires operationalization of concepts to ensure all relevant studies are included. This article outlines the process utilized to develop an operational definition of Lean in health care. The literature search, screening, data extraction, and data synthesis processes followed the recommendations outlined by the Cochrane Collaboration. Development of the operational definition utilized the methods prescribed by Kinsman et al. and Wieland et al. This involved extracting characteristics of Lean, synthesizing similar components to establish an operational definition, applying this definition, and updating the definition to address shortcomings. We identified two defining characteristics of Lean health-care management: (1) Lean philosophy, consisting of Lean principles and continuous improvement, and (2) Lean activities, which include Lean assessment activities and Lean improvement activities. The resulting operational definition requires that an organization or subunit of an organization had integrated Lean philosophy into the organization?s mandate, guidelines, or policies and utilized at least one Lean assessment activity or Lean improvement activity. This operational definition of Lean management in health care will act as an objective screening criterion for our systematic review. To our knowledge, this is the first evidence-based operational definition of Lean management in health care.

Many improvement programmes often fail to sustain over an extended period of time. Previous research suggests that a similar set of factors influence the success and sustainability of an improvement programme. The purpose of this paper is to make a distinction between the success and sustainability of improvement programmes, and to identify mechanisms that specifically contribute to the sustainability. In this paper, we study a sustainable improvement programme from the perspective of complexity theories that stress the importance of studying change as a dynamic process of interacting elements and events unfolding in time. We conducted a longitudinal, in-depth case study of a Swedish Lean Prize Award Winner where a Lean improvement programme was studied over 9 years. An improvement programme is successful if goals are achieved and the targeted problems are resolved. Furthermore, the first-order sustainability means the ability to sustain results and the second-order sustainability means the ability to keep an improvement programme alive. The lessons identified from complexity theories, such as destabilising the organisation, ensuring novelty and constant flow of change or self-organisation at the team level, are examples of mechanisms important to achieve the sustainability of the improvement programme.

Background Lean healthcare is claimed to contribute to improved patient satisfaction, but there is limited evidence to support this notion. This study investigates how primary-care centres working with Lean define and improve value from the patient's perspective, and how the application of Lean healthcare influences patient satisfaction.

Methods This paper contains two qualitative case studies and a quantitative study based on results from the Swedish National Patient Survey. Through the case studies, we investigated how primary-care organisations realised the principle of defining and improving value from the patient's perspective. In the quantitative study, we compared results from the patient satisfaction survey for 23 primary-care centres working with Lean with a control group of 23 care centres not working with Lean. We also analysed changes in patient satisfaction over time.

Results Our case studies reveal that Lean healthcare implementations primarily target efficiency and little attention is paid to the patient's perspective. The quantitative study shows no significantly better results in patient satisfaction for primary-care centres working with Lean healthcare compared with those not working with Lean. Further, care centres working with Lean show no significant improvements in patient satisfaction over time.

Conclusions Lean healthcare implementations seem to have a limited impact on improving patient satisfaction. Care providers need to pay more attention to integrating the patient's perspective in the application of Lean healthcare. Value needs to be defined and value streams need to be improved based on both the knowledge and clinical expertise of care providers, and the preferences and needs of patients.