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A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Healthcare Quality and Patient Safety".

Deadline for manuscript submissions: closed (15 November 2021) | Viewed by 52784

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Prof. Dr. Giovanni Improta

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Department of Public Health, University of Naples Federico II, 80134 Naples, Italy
Interests: bioengineering; public health; healthcare decision making; machine learning and data mining for healthcare; modeling and analysis of biomedical data; health technology assessment; quality improvement in healthcare; lean six sigma; biomedical signal processing and analysis
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Paolo Gargiulo

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Institute for Biomedical and Neural Engineering, Reykjavík University, Reykjavík, Iceland
Interests: biomedical engineering; biomechanical engineering; bioengineering; clinical engineering; medical image processing; 3D modelling for surgical planning; neuroscience; tissue engineering
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleague,

Healthcare organizations are a cost-intensive environment, and they should be managed efﬁciently. One of the principal key to increase the productivity of existing healthcare facilities is, among the others, the proper management of Operating Rooms (OR), Emergency Departments (ED), diagnostic services, therapeutic pathways, etc., by optimizing the whole process or chain of processes involved in the management and treatment of a patient. In particular, OR management is the science of how to run an operating room suite. It focuses on maximizing operational efficiency at the facility, to maximize the number of surgical cases that can be done on a given day while minimizing the required resources and related costs. Strategic operating room management deals with long-term decision-making. On the other hand, the ED management is increasingly studied to ensure appropriate access to the healthcare services in a timely manner, maximizing the efficiency of used facilities, human and material resources, decreasing delays, and enhancing satisfaction among patients and all the healthcare staff.

Moreover, the healthcare management also comprises an important fraction of hospital budget spending. Holding patient safety constant, the opportunity to increase financial gain through modifying the use of already existing resources is a prime target for managerial analysis. Clear goals for healthcare management are essential: improving productivity and efﬁciency while main-training high quality of care at all times.

This Special Issue aims to publish innovative researches related healthcare management and automation. Review articles which summarize the state of the art and recent advances in these topics are also welcome.

Potential topics include but are not limited to the following:

Technical and IT tools for healthcare management;
Reduction of healthcare costs and public health expenditure;
Improving the quality of care;
Re-engineering of care processes;
Introduction of novel diagnostic and therapeutic pathways;
Efficient human and material resource management in the hospital;
Continuous process improvement;
Monitoring of healthcare performances and appropriate access to healthcare services.

Prof. Giovanni Improta
Prof. Dr. Paolo Gargiulo
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Public Health management
Healthcare automation
Quality of care
Healthcare process re-engineering
Quality improvement
Healthcare cost savings

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Published Papers (13 papers)

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Research

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24 pages, 2114 KiB

Open AccessArticle

Using Simulation Optimization to Solve Patient Appointment Scheduling and Examination Room Assignment Problems for Patients Undergoing Ultrasound Examination

by Ping-Shun Chen, Gary Yu-Hsin Chen, Li-Wen Liu, Ching-Ping Zheng and Wen-Tso Huang

Healthcare 2022, 10(1), 164; https://doi.org/10.3390/healthcare10010164 - 15 Jan 2022

Cited by 9 | Viewed by 4282

Abstract

This study investigates patient appointment scheduling and examination room assignment problems involving patients who undergo ultrasound examination with considerations of multiple examination rooms, multiple types of patients, multiple body parts to be examined, and special restrictions. Following are the recommended time intervals based on the findings of three scenarios in this study: In Scenario 1, the time interval recommended for patients’ arrival at the radiology department on the day of the examination is 18 min. In Scenario 2, it is best to assign patients to examination rooms based on weighted cumulative examination points. In Scenario 3, we recommend that three outpatients come to the radiology department every 18 min to undergo ultrasound examinations; the number of inpatients and emergency patients arriving for ultrasound examination is consistent with the original time interval distribution. Simulation optimization may provide solutions to the problems of appointment scheduling and examination room assignment problems to balance the workload of radiological technologists, maintain high equipment utilization rates, and reduce waiting times for patients undergoing ultrasound examination. Full article

(This article belongs to the Special Issue Management and Automation of Health Organizations)

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15 pages, 781 KiB

Open AccessArticle

Comparing Two Approaches for Thyroidectomy: A Health Technology Assessment through DMAIC Cycle

by Carlo Ricciardi, Adelmo Gubitosi, Donatella Vecchione, Giuseppe Cesarelli, Francesco De Nola, Roberto Ruggiero, Ludovico Docimo and Giovanni Improta

Healthcare 2022, 10(1), 124; https://doi.org/10.3390/healthcare10010124 - 8 Jan 2022

Cited by 3 | Viewed by 1978

Abstract

Total thyroidectomy is very common in endocrine surgery and the haemostasis can be obtained in different ways across surgery; recently, some devices have been developed to support this surgical phase. In this paper, a health technology assessment is conducted through the define, measure, analyse, improve, and control cycle of the Six Sigma methodology to compare traditional total thyroidectomy with the surgical operation performed through a new device in an overall population of 104 patients. Length of hospital stay, drain output, and time for surgery were considered the critical to qualities in order to compare the surgical approaches which can be considered equal regarding the organizational, ethical, and security impact. Statistical tests (Kolmogorov–Smirnov, t test, ANOVA, Mann–Whitney, and Kruskal–Wallis tests) and visual management diagrams were employed to compare the approaches, but no statistically significant difference was found between them. Considering these results, this study shows that the introduction of the device to perform total thyroidectomy does not guarantee appreciable clinical advantages. A cost analysis to quantify the economic impact of the device into the practice could be a future development. Healthy policy leaders and clinicians who are requested to make decisions regarding the supply of biomedical technologies could benefit from this research. Full article

(This article belongs to the Special Issue Management and Automation of Health Organizations)

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12 pages, 1167 KiB

Open AccessArticle

Reducing the Healthcare-Associated Infections in a Rehabilitation Hospital under the Guidance of Lean Six Sigma and DMAIC

by Giuseppe Cesarelli, Rita Petrelli, Carlo Ricciardi, Giovanni D’Addio, Orjela Monce, Maria Ruccia and Mario Cesarelli

Healthcare 2021, 9(12), 1667; https://doi.org/10.3390/healthcare9121667 - 1 Dec 2021

Cited by 10 | Viewed by 3664

Abstract

The reduction of healthcare-associated infections (HAIs) is one of the most important issues in the healthcare context for every type of hospital. In three operational units of the Scientific Clinical Institutes Maugeri SpA SB, a rehabilitation hospital in Cassano delle Murge (Italy), some corrective measures were introduced in 2017 to reduce the occurrence of HAIs. Lean Six Sigma was used together with the Define, Measure, Analyze, Improve, Control (DMAIC) roadmap to analyze both the impact of such measures on HAIs and the length of hospital stay (LOS) in the Rehabilitative Cardiology, Rehabilitative Neurology, Functional Recovery and Rehabilitation units in the Medical Center for Intensive Rehabilitation. The data of 2415 patients were analyzed, considering the phases both before and after the introduction of the measures. The hospital experienced a LOS reduction in both patients with and without HAIs; in particular, Cardiology had the greatest reduction for patients with infections (−7 days). The overall decrease in HAIs in the hospital was 3.44%, going from 169 to 121 cases of infections. The noteworthy decrease in LOS implies an increase in admissions and in the turnover indicator of the hospital, which has a positive impact on the hospital management as well as on costs. Full article

(This article belongs to the Special Issue Management and Automation of Health Organizations)

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17 pages, 845 KiB

Open AccessArticle

‘Stolen Time’—Delivering Nursing at the Bottom of a Hierarchy: An Ethnographic Study of Barriers and Facilitators for Evidence-Based Nursing for Patients with Community-Acquired Pneumonia

by Signe Eekholm, Karin Samuelson, Gerd Ahlström and Tove Lindhardt

Healthcare 2021, 9(11), 1524; https://doi.org/10.3390/healthcare9111524 - 9 Nov 2021

Cited by 4 | Viewed by 3022

Abstract

The research has reported a high prevalence of low-quality and missed care for patients with community-acquired pneumonia (CAP). Optimised nursing treatment and care will benefit CAP patients. The aim of this study was to describe the barriers and facilitators influencing registered nurses’ (RNs’) adherence to evidence-based guideline (EBG) recommendations for nursing care (NC) for older patients admitted with CAP. Semi-structured focus group interviews (n = 2), field observations (n = 14), and individual follow-up interviews (n = 10) were conducted in three medical units and analysed by a qualitative content analysis. We found a main theme: ‘‘stolen time’—delivering nursing at the bottom of a hierarchy’, and three themes: (1) ‘under the dominance of stronger paradigms’, (2) ‘the loss of professional identity’, and (3) ‘the power of leadership’. These themes, each comprising two to three subthemes, illustrated that RNs’ adherence to EBG recommendations was strongly influenced by the individual RN’s professionalism and professional identity; contextual barriers, including the interdisciplinary team, organisational structure, culture, and evaluation of the NC; and the nurse manager’s leadership skills. This study identified central factors that may help RNs to understand the underlying dynamics in a healthcare setting hindering and facilitating the performance of NC and make them better equipped for changing practices. Full article

(This article belongs to the Special Issue Management and Automation of Health Organizations)

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12 pages, 1122 KiB

Open AccessArticle

Healthcare Quality Improvement Analytics: An Example Using Computerized Provider Order Entry

by Jungwon Cho, Sangmi Shin, Youngmi Jeong, Eunsook Lee, Soyeon Ahn, Seunghyun Won and Euni Lee

Healthcare 2021, 9(9), 1187; https://doi.org/10.3390/healthcare9091187 - 9 Sep 2021

Cited by 1 | Viewed by 2560

Abstract

Evaluation of sustainability after quality improvement (QI) projects in healthcare settings is an essential part of monitoring and future QI planning. With limitations in adopting quasi-experimental study design in real-world practice, healthcare professionals find it challenging to present the sustained effect of QI changes effectively. To provide quantitative methodological approaches for demonstrating the sustainability of QI projects for healthcare professionals, we conducted data analyses based on a QI project to improve the computerized provider order entry system to reduce patients’ dosing frequencies in Korea. Data were collected for 5 years: 24-month pre-intervention, 12-month intervention, and 24-month post-intervention. Then, analytic approaches including control chart, Analysis of Variance (ANOVA), and segmented regression were performed. The control chart intuitively displayed how the outcomes changed over the entire period, and ANOVA was used to test whether the outcomes differed between groups. Last, segmented regression analysis was conducted to evaluate longitudinal effects of interventions over time. We found that the impact of QI projects in healthcare settings should be initiated following the Plan–Do–Study–Act cycle and evaluated long-term effects while widening the scope of QI evaluation with sustainability. This study can serve as a guide for healthcare professionals to use a number of statistical methodologies in their QI evaluations. Full article

(This article belongs to the Special Issue Management and Automation of Health Organizations)

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12 pages, 837 KiB

Open AccessArticle

Effects of Automation on Sustainability of Immunohistochemistry Laboratory

by Marija Đorđević, Maja Životić, Sanja Radojević Škodrić, Jelena Nešović Ostojić, Jasmina Marković Lipkovski, Jelena Filipović, Sanja Ćirović, Sanjin Kovačević and Duško Dunđerović

Healthcare 2021, 9(7), 866; https://doi.org/10.3390/healthcare9070866 - 8 Jul 2021

Cited by 4 | Viewed by 2986

Abstract

The COVID-19 pandemic that hit the world recently caused numerous changes affecting the health system in every department. Reduced staff numbers, mostly due to illness, led to an increase in automation at every stage of laboratory work. The immunohistochemistry (IHC) laboratory conducts a high volume of slide staining every day. Therefore, we analyzed time and total costs required to obtain IHC slides in both the manual and automated way, comparing their efficiency by processing the same sample volume (48 microscope slides—the maximum capacity that an automated immunostainer—DAKO, Autostainer Link 48, Part No AS48030—can process over a single cycle). The total IHC procedure time to run 48 slides manually by one technician was 460 min, while the automated process finished a cycle within 390 min (15.22% less time). The final cost of a single manual IHC slide was 12.26 EUR and 7.69 EUR for slides labeled in the automated immunostainer, which reduced final costs by 37.27%. Thus, automation of the IHC procedure reduces the time and costs of the IHC process, contributing significantly to the sustainability of the healthcare system during the COVID-19 pandemic, overcoming insufficient human resources. Full article

(This article belongs to the Special Issue Management and Automation of Health Organizations)

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11 pages, 2519 KiB

Open AccessArticle

Using Design Thinking Principles to Improve Outpatients’ Experiences in Hospital Pharmacies: A Case Study of Two Hospitals in Asir Region, Saudi Arabia

by Dalia Almaghaslah, Abdulrhman Alsayari, Saleh Ali Alyahya, Rana Alshehri, Khawlah Alqadi and Sumiah Alasmari

Healthcare 2021, 9(7), 854; https://doi.org/10.3390/healthcare9070854 - 6 Jul 2021

Cited by 6 | Viewed by 4323

Abstract

Introduction: Design thinking, an innovative problem-solving approach, has gained wide popularity in healthcare disciplines. The aim of this work is to improve outpatients’ experiences in hospital pharmacies in two hospitals in Asir region, Saudi Arabia. Methods: The design thinking approach, adopted from Stanford University’s D-School, was used in this study. Results: Several problems were identified: lack of comfortable environment in the pharmacies’ waiting area, lack of a queue management system, and workflow inefficiencies related to ordering and supplies of medicines. A prototype was proposed to overcome these challenges. Discussion and Conclusion: The design thinking approach helped in identifying end-user (patients visiting outpatient pharmacies) values and desires and provided an understanding of their struggles. It also proposed tailored solutions that could improve patients’ experiences while using the services of the outpatient pharmacies. Full article

(This article belongs to the Special Issue Management and Automation of Health Organizations)

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11 pages, 316 KiB

Open AccessArticle

Scheduling of Anaesthesia Operations in Operating Rooms

by Pi-Yu Hsu, Shao-Hua Lo, Hsin-Gin Hwang and Bertrand M. T. Lin

Healthcare 2021, 9(6), 640; https://doi.org/10.3390/healthcare9060640 - 28 May 2021

Cited by 5 | Viewed by 3489

Abstract

This paper considers scheduling of surgical operations across multiple operating rooms subject to the limited availability of anaesthetists. The objective is to construct a feasible operations schedule that has the minimum makespan, i.e., the completion time of all operations. We abstract the problem into a theoretical server scheduling problem and formulate it in a mathematical form by proposing an integer programming model. Due to the intractability of its computing time, we circumvent the exact approaches and develop two approximation methods. Then, the steepest descent search is adopted for improving the solutions. Computational study suggests that the proposed methods can produce quality solutions in a few seconds. Full article

(This article belongs to the Special Issue Management and Automation of Health Organizations)

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13 pages, 741 KiB

Open AccessArticle

Integrating Quality Tools and Methods to Analyze and Improve a Hospital Sterilization Process

by Amira Kammoun, Wafik Hachicha and Awad M. Aljuaid

Healthcare 2021, 9(5), 544; https://doi.org/10.3390/healthcare9050544 - 7 May 2021

Cited by 9 | Viewed by 3850

Abstract

Healthcare facilities are facing major issues and challenges. Hospitals continuously search approaches to improve operations quality, optimize performance, and minimize costs. Specifically, an efficient hospital sterilization process (HSP) allows reusable medical devices (RMDs) to be more quickly available for healthcare activities. In this context, this paper describes an integrated approach developed to analyze HSP and to identify the most critical improvement actions. This proposed approach integrates four quality tools and techniques. Firstly, a structured analysis and design technique (SADT) methodology is applied to describe HSP as a hierarchy of activities and functions. Secondly, the failure modes and effects analysis (FMEA) method is used as a risk assessment step to determine which activity processes need careful attention. Thirdly, a cause–effect analysis technique is used as a tool to help identify all the possible improvement actions. Finally, priority improvement actions are proposed using the quality function deployment (QFD) method. To validate the proposed approach, a real sterilization process used at the maternity services of Hedi-Cheker Hospital in the governorate of Sfax, Tunisia, was fully studied. For this specific HSP, the proposed approach results showed that the two most critical activities were (1) improving the coordination between the sterilization service and the surgery block and (2) minimizing the average duration of the sterilization process to ensure the availability of RMDs in time. Full article

(This article belongs to the Special Issue Management and Automation of Health Organizations)

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Review

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11 pages, 557 KiB

Open AccessReview

User Perception of Automated Dose Dispensed Medicine in Home Care: A Scoping Review

by Lasse Mertz, Kristina Tornbjerg and Christian Nøhr

Healthcare 2021, 9(10), 1381; https://doi.org/10.3390/healthcare9101381 - 15 Oct 2021

Cited by 4 | Viewed by 3464

Abstract

(1) Background: Automated dose dispensing (ADD) systems are today used around the world. The ADD robots are placed in patients’ homes to increase medication safety as well as medication adherence; however, little is known about how ADD robots affect the patient’s day-to-day lives, receiving the daily doses of medicine from a machine rather than from a human healthcare professional. The aim of this study is to review the available literature on users’ perceptions of having an ADD robot and collect evidence on how they perceive having less human contact after implementing this technology in their homes. (2) Methods: References were searched for in Embase and PubMed. Literature investigating ADD robots in primary healthcare was included in this study and literature in a hospital setting was excluded. After screening processes, eleven publications were included in this review. (3) Results: The literature reported high medication adherence when using ADD robots and general satisfaction in terms of user experiences with the acceptability and functionality of ADD. (4) Conclusion: The review is the first focusing on user experience and perceptions regarding ADD robots. General satisfaction was shown towards ADD robots as an intervention, but the review indicates that research is missing on healthcare professionals and patient perceptions on how ADD affects their routines, both in relation to work and daily life. Full article

(This article belongs to the Special Issue Management and Automation of Health Organizations)

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20 pages, 1909 KiB

Open AccessReview

Digital Management Systems in Academic Health Sciences Laboratories: A Scoping Review

by Margareth Timóteo, Emanuelle Lourenço, Ana Carolina Brochado, Luciana Domenico, Joice da Silva, Bruna Oliveira, Renata Barbosa, Pietro Montemezzi, Carlos Fernando de Almeida Barros Mourão, Beni Olej and Gutemberg Alves

Healthcare 2021, 9(6), 739; https://doi.org/10.3390/healthcare9060739 - 16 Jun 2021

Cited by 2 | Viewed by 3315

Abstract

Good laboratory practices (GLP) increase the quality and traceability of results in health sciences research. However, factors such as high staff turnover, insufficient resources, and a lack of training for managers may limit their implementation in research and academic laboratories. This Scoping Review aimed to identify digital tools for managing academic health sciences and experimental medicine laboratories and their relationship with good practices. Following the PRISMA-ScR 2018 criteria, a search strategy was conducted until April 2021 in the databases PUBMED, Web of Sciences, and Health Virtual Library. A critical appraisal of the selected references was conducted, followed by data charting. The search identified twenty-one eligible articles, mainly originated from high-income countries, describing the development and/or implementation of thirty-two electronic management systems. Most studies described software functionalities, while nine evaluated and discussed impacts on management, reporting both improvements in the workflow and system limitations during implementation. In general, the studies point to a contribution to different management issues related to GLP principles. In conclusion, this review identified evolving evidence that digital laboratory management systems may represent important tools in compliance with the principles of good practices in experimental medicine and health sciences research. Full article

(This article belongs to the Special Issue Management and Automation of Health Organizations)

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Other

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15 pages, 586 KiB

Open AccessPerspective

Healthcare Digitalisation and the Changing Nature of Work and Society

by Henrik Skaug Sætra and Eduard Fosch-Villaronga

Healthcare 2021, 9(8), 1007; https://doi.org/10.3390/healthcare9081007 - 6 Aug 2021

Cited by 17 | Viewed by 6261

Abstract

Digital technologies have profound effects on all areas of modern life, including the workplace. Certain forms of digitalisation entail simply exchanging digital files for paper, while more complex instances involve machines performing a wide variety of tasks on behalf of humans. While some are wary of the displacement of humans that occurs when, for example, robots perform tasks previously performed by humans, others argue that robots only perform the tasks that robots should have carried out in the very first place and never by humans. Understanding the impacts of digitalisation in the workplace requires an understanding of the effects of digital technology on the tasks we perform, and these effects are often not foreseeable. In this article, the changing nature of work in the health care sector is used as a case to analyse such change and its implications on three levels: the societal (macro), organisational (meso), and individual level (micro). Analysing these transformations by using a layered approach is helpful for understanding the actual magnitude of the changes that are occurring and creates the foundation for an informed regulatory and societal response. We argue that, while artificial intelligence, big data, and robotics are revolutionary technologies, most of the changes we see involve technological substitution and not infrastructural change. Even though this undermines the assumption that these new technologies constitute a fourth industrial revolution, their effects on the micro and meso level still require both political awareness and proportional regulatory responses. Full article

(This article belongs to the Special Issue Management and Automation of Health Organizations)

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19 pages, 618 KiB

Open AccessSystematic Review

A Systematic Review on Lean Applications’ in Emergency Departments

by Davenilcio Luiz Souza, André Luis Korzenowski, Michelle McGaha Alvarado, João Henrique Sperafico, Andres Eberhard Friedl Ackermann, Taciana Mareth and Annibal José Scavarda

Healthcare 2021, 9(6), 763; https://doi.org/10.3390/healthcare9060763 - 19 Jun 2021

Cited by 28 | Viewed by 7826

Abstract

This article presents the state of the art of Lean principles applied in Emergency Departments through a systematic literature review. Our article extends previous work found in the literature to respond to the following questions: (i) What research problems in emergency departments can Lean principles help overcome? (ii) What Lean approaches and tools are used most often in this environment? (iii) What are the results and benefits obtained by these practices? and (iv) What research opportunities appear as gaps in the current state of the art on the subject? A six-step systematic review was performed following the guidance of the PRISMA method. The review analysis identified six main research problems where Lean was applied in Emergency Departments: (i) High Waiting Time and High Length of Hospital Stay; (ii) Health Safety; (iii) Process redesign; (iv) Management and Lessons Learned; (v) High Patient Flow; (vi) Cost Analysis. The six research problems’ main approaches identified were Lean Thinking, Multidisciplinary, Statistics, and Six Sigma. The leading Lean tools and methodologies were VSM, Teamwork, DMAIC, and Kaizen. The main benefits of applying Lean Principles were (a) reductions in waiting time, costs, length of hospital stay, patient flow, and procedure times; and (b) improvements in patient satisfaction, efficiency, productivity, standardization, relationships, safety, quality, and cost savings. Multidisciplinary integration of managers and work teams often yields good results. Finally, this study identifies knowledge gaps and new opportunities to study Lean best practices in healthcare organizations. Full article

(This article belongs to the Special Issue Management and Automation of Health Organizations)

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