Implementare il modello Lean nelle organizzazioni sanitarie: il caso dell’Ospedale Galliera

Titolo Rivista MECOSAN
Autori/Curatori Federica Centauri, Marta Marsilio, Stefano Villa, Francesco Nicosia
Anno di pubblicazione 2017 Fascicolo 2016/100
Lingua Italiano Numero pagine 29 P. 27-55 Dimensione file 23844 KB
DOI 10.3280/MESA2016-100003
Il DOI è il codice a barre della proprietà intellettuale: per saperne di più clicca qui

Qui sotto puoi vedere in anteprima la prima pagina di questo articolo.

Se questo articolo ti interessa, lo puoi acquistare (e scaricare in formato pdf) seguendo le facili indicazioni per acquistare il download credit. Acquista Download Credits per scaricare questo Articolo in formato PDF

Anteprima articolo

FrancoAngeli è membro della Publishers International Linking Association, Inc (PILA)associazione indipendente e non profit per facilitare (attraverso i servizi tecnologici implementati da CrossRef.org) l’accesso degli studiosi ai contenuti digitali nelle pubblicazioni professionali e scientifiche

La presente ricerca intende fornire un contributo alla letteratura sull’adozione del Lean management in sanità attraverso l’individuazione e la categorizzazione delle condizioni organizzative che alimentano efficaci e sostenibili applicazioni del modello di cambiamento nella realtà delle aziende sanitarie. Da una estesa revisione della letteratura scientifica e dall’analisi di un caso, è emerso come l’introduzione del Lean all’interno di un’organizzazione sanitaria richieda un’azione coordinata ed integrata su sette categorie di fattori organizzativi: integrazione tra il programma di cambiamento e la strategia aziendale; coinvolgimento dei professionisti e commitment della direzione strategica; gestione del cambiamento (change management) e cultura organizzativa; disponibilità di risorse e assetti organizzativi; organizzazione per processi; sistemi informativi; layout e organizzazione degli spazi.;

Keywords:Lean, sanità, cambiamento organizzativo, miglioramento continuo.

  1. Womack J.P., Jones D.T., Roos D. (1990). The machine that changed the world. New York: Rawson Associates.
  2. Womack J.P., Jones D.T. (1996). Beyond Toyota: how to root out waste and pursue perfection. Harvard Business Review, 74 (5): 140-158.
  3. Edmondson A.C., McManus S.E. (2007). Methodological fit in management field research. The Academy of management review, 32 (4): 1155-1179.
  4. Yin R.K. (2003). Case study research: Design and methods (3rd ed.). Thousand Oaks, CA: Sage.
  5. Young T., Brailsford S., Connell C., Davies R., Harper P., Klein J.H. (2004). Using industrial processes to improve patient care. British Medical Journal, 328 (7432): 162-164.
  6. Young T.P., McClean S.I. (2008). A critical look at Lean thinking in healthcare. Quality & Safety in Health Care, 17: 382-386.
  7. Fillingham D. (2007). Can lean save lives? Leadership in Health Services, 20 (4): 231-241. DOI: 10.1108/17511870710829346
  8. Graban M., Swartz J.E. (2012). Change for health. Management services, 56 (2): 35-39.
  9. Grant D., Wilcox D. (2008). Uncorking bottlenecks. Health management technology, 29 (10): 32-35.
  10. Aherne J. (2007). Think Lean. Nursing management, 13 (10): 13-15.
  11. Al-Balushi S., Sohal A.S., Singh P.J., Al Hajri A., Al Farsi Y.M. (2014). Readiness factors for lean implementation in healthcare settings – a literature review. Journal of Health Organization and Management, 28 (2): 135-153. DOI: 10.1108/JHOM-04-2013-0083
  12. Altea P. (2011). Lean healthcare: in viaggio con il paziente. Tecnica ospedaliera, 8: 66-68.
  13. Barlow R.D. (2009a). Efficiency dieting in supply chain operations. Healthcare Purchasing News, 2009 HPN Industry Guide, 8-11.
  14. Barlow R.D. (2009b). Performance improvement programs fighting a loss cause. Healthcare Purchasing News, 33 (11): 8-10.
  15. Baumgart A., Schüpfer G., Welker A., Bender H.J., Schleppers A. (2010). Status quo and current trends of operating room management in Germany. Current Opinion in Anesthesiology, 23: 193-200.
  16. Benneyan J. (2011). Reduce process variation to drive improvements in quality. Hospitals & Health Networks, 85 (8): 16-17.
  17. Bensa G., Prenestini A., Villa S. (2008). La logistica del paziente in ospedale: aspetti concettuali, strumenti di analisi e leve di cambiamento. In: Anessi Pessina E., Cantù E. (a cura di). L’aziendalizzazione della sanità in Italia. Rapporto OASI 2008. Egea: Milano.
  18. Bhasin S., Burcher P. (2006). Lean viewed as a philosophy. Journal of Manufacturing Technology Management, 17: 56-72. DOI: 10.1108/17410380610639506
  19. Bliss D. (2009). Lean in healthcare – wow. Frontiers of health services management, 26 (1): 39-42.
  20. Brandao de Souza L. (2009). Trends and approaches in Lean healthcare. Leadership in Health Services, 22 (2): 121-139. DOI: 10.1108/17511870910953788
  21. Burgess N., Radnor Z.J., Davies R. (2009). Taxonomy of lean in health care: a framework for evaluating activity and impact. In: 16th International Annual EurOMA Conference, Göteborg, Sweden, 14-17 Jun 2009.
  22. Carbone C., Lega F., Marsilio M., Mazzocato P. (2013). Lean on lean? Indagine sul perché e come il lean management si sta diffondendo nelle aziende sanitarie italiane. In: Anessi Pessina R., Cantù E. (a cura di). L’Aziendalizzazione della Sanità Italiana. Rapporto Oasi 2013. Milano: Egea.
  23. Centauri F., Villa S. (2016). Introdurre la gestione operativa nel cuore pulsante dell’ospedale: l’attenzione all’efficienza e appropriatezza di uso della sala operatoria. In: Lega F., Trinchero E. (a cura di). Governare la sala operatoria nell’ospedale del XXI secolo: qualità, sicurezza, efficienza. Milano: Egea.
  24. Chan H., Lo S., Lee L. et al.(2014). Lean techniques for the improvement of patients’ flow in emergency department. World Journal of Emergency Medicine, 5(1): 24-28.
  25. D’Andreamatteo A., Ianni L., Lega F., Sargiacomo M. (2015). Lean in healthcare: A comprehensive review. Health Policy, 119(9): 1197-209.
  26. Denzin N. (1984). The research act. Englewood Cliffs, NJ: Prentice Hall.
  27. Dickson E.W., Singh S., Cheung D.S., Wyatt C.C., Nugent A.S. (2009). Application of lean manufacturing techniques in the emergency department. The journal of emergency medicine, 37(2): 177-182.
  28. Grunden N. (2009). Lean at the front line: all hands on deck. Frontiers of health services management, 26 (1): 33-37.
  29. Hines P., Holweg M., Rich N. (2004). Learning to evolve: a review of contemporary lean thinking. International Journal of Operations & Production Management, 24 (10): 994-1011. DOI: 10.1108/01443570410558049
  30. Holden R.J. (2011). Lean thinking in emergency departments: a critical review. Annals of emergency medicine, 57 (3): 265-78.
  31. Holweg M. (2007). The genealogy of lean production. Journal of Operations Management, 25 (2): 420-437.
  32. Hsieh H.F., Shannon S.E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15 (9): 1277-1288. DOI: 10.1177/1049732305276687
  33. Joosten T., Bongers I., Janssen R. (2009). Application of lean thinking to health care: issues and observations. International journal for quality in health care, 21 (5): 341-347.
  34. Kim C. S., Spahlinger D.A., Kin J.M., Billi J. (2006). Lean health care: what can hospitals learn from a world-class automaker? Journal of Hospital Medicine, 1 (3): 191-199.
  35. Kollberg B., Dahlgaard J.J., Brehemer P. (2007). Measuring lean initiatives in health care services: issues and findings. International journal of productivity and performance management, 56 (1): 7-24. DOI: 10.1108/17410400710717064
  36. Lagostena A., Nicosia F. (2008). Il Galliera opera in Toyota. Il Sole 24 Ore Sanità, 5-11 Febbraio 2008.
  37. Lee T.W. (1999). Using Qualitative Methods in Organizational Research. Thousand Oaks, CA: Sage.
  38. Lodge A., Bamford D. (2007). Health service improvement through diagnostic waiting list management. Leadership in Health Services, 20: 254-265. DOI: 10.1108/17511870710829364
  39. Mazzocato P., Holden R.J., Brommels M., Aronsson H., Bäckman U., Elg M., Thor J. (2012). 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 Services Research, 12 (1): 28. DOI: 10.1186/1472-6963-12-28
  40. Mazzocato P., Savage C., Brommels M., Aronsson H., Thor J. (2010). Lean thinking in healthcare: a realist review of the literature. Quality & safety in health care, 19 (5): 376-382.
  41. Mintzberg H. (1979). The structuring of organization. Prentice Hall: Englewood Cliffs.
  42. Nicosia F. (2008). Flussi sotto controllo nell’ospedale snello e per intensità di cure. Management della sanità, settembre: 34-38.
  43. Nicosia F. (2009). Galliera: caccia agli sprechi con Lean. Il Sole 24 Ore Sanità, 3-9 novembre 2009.
  44. Nicosia F. (2010). Il nuovo ospedale è snello. Far funzionare gli ospedali con il Lean Healthcare: consigli pratici e sostenibilità, Milano: FrancoAngeli.
  45. Nicosia F. (2011). Così Lean taglia gli sprechi. Il Sole 24 Ore Sanità, 26 aprile-2 maggio 2011.
  46. Nicosia P.G., Nicosia F. (2008). Tecniche Lean in sanità: più valore, meno spreco, meno errori col sistema Toyota. Milano: FrancoAngeli.
  47. Noble D., Lee A. (2010). Just right: designing for hospital efficiency and flexibility. Health Facilities Management, 23(10): 23-28.
  48. Ohno T. (1988). Toyota Production System: beyond large-scale production. OR: Productivity Press.
  49. Pedersen E.R.G., Huniche M. (2011). Determinants of lean success and failure in the Danish public sector: A negotiated order perspective. International Journal of Public Sector Management, 24 (5): 403-420. DOI: 10.1108/09513551111147141
  50. Piercy N., Rich N. (2009). High quality and low cost: the lean service center. European Journal of Marketing, 43 (11-12): 1477-1497. DOI: 10.1108/03090560910989993
  51. Poksinska B. (2010). The current state of Lean implementation in health care: a literature review. Quality Management in Health Care, 19 (4): 319-329.
  52. Radnor Z., Walley P., Stephens A., Bucci G. (2006). Evaluation of the lean approach to business management and its use in the public sector. Edimburgh: Scottish executive social research.
  53. Radnor Z., Bucci G. (2007). Evaluation of Pacesetter, Lean, Senior Leadership and Operational Management within HMRC Processing. London: HMRC.
  54. Radnor Z., Bucci G. (2010). Evaluation of the Lean Programme in HMCS. London: HMCS.
  55. Radnor Z., Boaden R. (2008). Lean in public services - Panacea or Paradox? Public Money and Management, 28 (1): 3-7.
  56. Radnor Z., Walley P. (2008). Learning to walk before we try to run: adapting lean for the public sector. Public money & management, 28 (1): 13-20.
  57. Radnor Z. (2010). Review of business process improvement methodologies in public services. London: Advanced Institute of Management Research (AIM Research).
  58. Radnor Z. (2011). Implementing Lean in Health Care: Making the link between the approach, readiness and sustainability. International Journal of Industrial Engineering and Management, 2 (1): 1-12.
  59. Radnor Z., Holweg M., Warning J. (2012). Lean in healthcare: The Unfilled Promise? Social Science and Medicine, 74 (3): 364-371.
  60. Radnor Z., Osborne S. (2013). Lean: A failed theory for public services? Public Management Review, 15 (2): 265-287. DOI: 10.1080/14719037.2012.748820
  61. Roth A.V., Van Dierdonck R. (1995). Hospital Resource Planning: Concepts, Feasibility and Framework. Production Operations Management, 4 (1): 2-29.
  62. Sandberg W.S., Daily B., Egan M., Stahl J.E., Goldman J.M., Wiklund R.A., Rattner, D. (2005). Deliberate perioperative systems design improves operating room throughput. Anesthesiology, 103: 406-418. DOI: 10.1097/00000542-200508000-00025
  63. Drejer A., Blackmon K., Voss C. (1998). Worlds apart? A look at the operations management area in the US, UK and Scandinavia. Scandinavian Journal of Management, 16(1): 45-66.
  64. Seddon J. (2005). Watch out for the toolheads! Everything you need to know about lean manufacturing tools and why they won’t work in service organisations. --Disponibile al sito: www.triarchypress.com/pages/articles/Understanding-the-varietyof-Demand.pdf.
  65. Soriano-Meier H., Forrester P.L., Markose S., Garza-Reyes J. (2011). The role of the physical layout in the implementation of lean management initiatives. International Journal of Lean Six Sigma, 2 (3): 254-269. DOI: 10.1108/20401461111157204
  66. Spear S.J. (2005). Fixing healthcare from the inside, today. Harvard Business Review, 83 (9): 78-91.
  67. Stroupe J.M. (2012). It’s the process: how lean strategies can streamline hospital design. Health Facilities Management, 25 (2): 23-27.
  68. Toussaint J. (2009). Why are we still underperforming? Frontiers of health services management, 26 (1): 27-32.
  69. Towne J. (2010). Lean transformations: planning a Lean health care makeover. Health facilities management, 23 (10): 51-54.
  70. Villa S. (2012). L’operations management a support del sistema di operazioni aziendali: modelli di analisi e soluzioni progettuali. Padova: CEDAM.
  71. Waring J.J., Bishop S. (2010). Lean healthcare: rhetoric, ritual and resistance. Social Science & Medicine, 71: 1332-1340.
  72. Westwood N., James-Moore M., Cooke M. (2007). Going Lean in the NHS. Coventry: NHS Institute for Innovation and Improvement.

  • Strutturare il cambiamento organizzativo negli ospedali: l'esperienza dell'Ufficio Lean dell'AOU Senese Federica Centauri, Jacopo Guercini, Caterina Bianciardi, Vincenzo Mezzatesta, in MECOSAN 104/2018 pp.51
    DOI: 10.3280/MESA2017-104004

Federica Centauri, Marta Marsilio, Stefano Villa, Francesco Nicosia, Implementare il modello Lean nelle organizzazioni sanitarie: il caso dell’Ospedale Galliera in "MECOSAN" 100/2016, pp 27-55, DOI: 10.3280/MESA2016-100003