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Abstract
To demonstrate the sustainability of improvements over the long term after the implementation of Lean Healthcare methodology in the urology department, a total of 19,567 clinical processes were analysed from 2011 to 2017. In 2011, the pre-surgical hospital stay was 1.07 days, and in 2018, it was 0.33 days. The average gross hospital stay was 4.25 days, and it fell progressively to 2.78 days in 2015, before increasing to 2.92 days in 2018. The risk-adjusted mean hospital stay index was 0.61 (49 per cent improvement over the standard), with a saving of 3,320 hospital stays in 2018. The risk-adjusted complications index was 0.44 (66 per cent improvement over the standard), with a saving of 37 complications in 2017 (0.65 in 2013). The risk-adjusted mortality index was 0.05 (95 per cent improvement over the standard), with a saving of 20 deaths in 2017 (0.3 in 2013). The risk-adjusted readmissions index (RARI) was 1.49 (49 per cent worse than the standard), with 26 more readmissions than expected (1.58 in 2013). Lean Healthcare methodology can be effectively applied and maintained over the long term in a department of a public tertiary hospital, but it demands a change in the mindset of the workers and an economic investment.
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Author's Biography
Alberto Budía Alba is qualified in medicine from the Literary University of Valencia, Spain, in 1994. He was a resident in urology from 1996 to 2001 and a consultant urologist from 2001 to 2012 at La Fe University Hospital, Valencia, Spain. Since 2012, he has been the head of lithotripsy and endourology at La Fe University and Polytechnic Hospital, Valencia, Spain. Budía Alba completed his doctorate in medicine and surgery in 2006 and postdoctoral studies in the field of urinary stones and oncology in Spain in 2002. He has a masters in management and organisation of hospitals and health services and is a member of the Spanish Urological Association, European Association of Urology, Endourological Society, Spanish Association of Laparoscopic Surgery and Valenciana Urological Association. He is also member of the board of Actas Urológicas Españolas and EC anesthesia and reviewer of several international journals (BMC Urology, Journal of Urology and Urologia Internationalis). He has authored over 150 scientific publications in journals and books of urology. Budía Alba frequently lectures at the national and international congresses and has participated in more than 100 courses, seminars, workshops and roundtables. He also serves as a member on the advisory board panel of several medical companies. Budía Alba has been the vice president of Valencian Urology Association since 2016.
Francisco Boronat Tormo is the head of the Urology Department at La Fe University and Polytechnic Hospital. He has a doctorate in medicine and surgery and a masters in management and organisation of hospitals and health services. Boronat Tormo is a member of the Spanish Urological Association and Valenciana Urological Association. He is a frequent speaker at the national congresses and has participated in more than 100 courses, seminars, workshops and roundtables. Boronat Tormo has authored over 200 scientific publications in journals and books of urology. He is the ex-president of Valencian Urology Association.
M. Pilar Bahílo Mateu is qualified in medicine from the Literary University of Valencia, Spain, in 2004. She was a resident in urology from 2005 to 2010 at La Fe University Hospital in Valencia, Spain and a medical specialist in urology at the Hospital Universitario y Politécnico La Fe in Valencia. Pilar Bahílo Mateu completed her doctorate in medicine and surgery by a program in clinical medicine in 2014. She is a fellow of the European Board of Urology; has received specialised training in endourology and laser holmium applications at Tenon Hospital, Paris; is professor of endourology at the Lithotripsy Unit of La Fe Hospital and in clinical teaching provided by the Department of Surgery of the University of Valencia. Pilar Bahílo Mateu is a member of the Spanish Urological Association and Valenciana Urological Association. She has authored over 40 scientific publications in journals and books of urology and is a regular speaker at international, national and local conferences..
Salvador Arlandis is a consultant urologist at La Fe University and Polytechnic Hospital in Valencia, Spain, where he has been employed for the past decade. He is currently chief of the kidney transplant team and research coordinator of the Nephrourology Department. Arlandis graduated from Valencia University, from where he also earned his doctorate, and completed further specialist training in neuro-urology, urodynamics and neuromodulation techniques at the University Hospital of Maastricht under the direction of Professor Van Kerrebroeck. He has since been a principal investigator in more than 20 phase II and III clinical trials focused mainly in functional urology. The author of more than 50 books or book chapters, Arlandis is also widely published in national and international peer-reviewed journals. He frequently presents at national and international congresses and has participated in more than 100 courses, seminars, workshops and roundtables. He is a reviewer for several peer-reviewed journals and has been member of the advisory board panel of several medical companies. Arlandis is a member of the Spanish Urological Association, the International Continence Society and the European Association of Urology. He is the actual president of the Ibero-American Society of Neurourology and Urogynecology (SINUG).
Jose Luis Pontones is qualified in medicine from the Literary University of Valencia, Spain, in 1986. He was a resident in urology from 1989 to 1993 at La Fe University Hospital in Valencia, Spain and has been a medical specialist in urology at the Hospital Universitario y Politécnico La Fe in Valencia since 1994. Pontones is a member of the Spanish Urological Association and Valenciana Urological Association and the Editorial Board of Actas Urológicas Españolas. He has authored over 100 scientific publications in journals and books of urology and is a regular speaker at national and local conferences.
David Vivas-Consuelo does research in health economics and management. His current work includes Big Data analysis in healthcare to improve quality and efficiency, real-world evidence in pharmacoeconomics and performance and productivity measurement in primary healthcare. He has undertaken 16 research projects on pharmacoeconomics, health technology assessment and health policy. The results of these projects have been published in high-impact factor journals, achieving an h-index of 6 (ORCID.org/0000-0003-2945-7525). He has also worked for the European Commission as a consultant in public health projects in Argentina, Ecuador and Bolivia.
Citation
Alba, Alberto Budía, Tormo, Francisco Boronat, Mateu, M. Pilar Bahílo, Arlandis, Salvador, Pontones, Jose Luis and Vivas-Consuelo, David (2019, December 1). Sustainability of improvements over the long term after the implementation of Lean Healthcare methodology in the Urology Department of a public hospital as a tool for improving efficiency. In the Management in Healthcare: A Peer-Reviewed Journal, Volume 4, Issue 2. https://doi.org/10.69554/RFME7737.Publications LLP