Implementation of Lean healthcare methodology in designing an Intravitreal Injection Center: first Italian experience
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ORIGINAL PAPER
Implementation of Lean healthcare methodology in designing an Intravitreal Injection Center: first Italian experience Maria Oliva Grassi . Claudio Furino . Nicola Recchimurzo . Fabio De Vitis . Giancarlo Sborgia . Luigi Sborgia . Arianna Meleleo . Teresa Molfetta . Marina Piepoli . Paolo Locatelli . Francesco Boscia . Giovanni Alessio
Received: 2 April 2020 / Accepted: 23 May 2020 Ó Springer Nature B.V. 2020
Abstract Purpose The principles of the Lean methodology, introduced by Toyota to improve productivity, are relevant to other settings, including healthcare. We aimed to use Lean methodology to design a new setting in our ophthalmology clinic to improve the management of patients receiving an intravitreal injection for ocular diseases. Methods The location of services, days of operation, scheduling and processing of patients, utilization of staff, data recording methods, and examination and surgical procedures were analyzed, and a new Intravitreal Injection Center was developed according to Lean principles. Results The new setting, which is confined to a single floor, in contrast to the previous system, which necessitated that patients visit various locations spread over three floors of the hospital, demonstrated benefits for patients and improved the flow and management of patients through the system with a need for fewer team
M. O. Grassi (&) C. Furino N. Recchimurzo F. De Vitis G. Sborgia L. Sborgia A. Meleleo T. Molfetta M. Piepoli F. Boscia G. Alessio Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico, University of Bari, Piazza Giulio Cesare, 11, 70124 Bari, BA, Italy e-mail: [email protected] P. Locatelli School of Management, Politecnico di Milano, Milan, Italy
members. The intravitreal injection service improved with regard to both the quality and speed of the overall procedure and the efficient use of staff. Conclusion Our aim to achieve a fast and one-way route to move patients through intravitreal injection administration was achieved, limiting any waste of time and space and improving the capacity management of the center. The system is of relevance to other ophthalmology clinic settings and facilitates the collection of valuable epidemiological and clinical information on the response of patients to different drugs and treatment regimens. Keywords Lean methodology Intravitreal injection Anti-VEGF Quality improvement Clinic management Patient care management
Introduction The intravitreal route has been the key issue for the use, in chorioretinal diseases, of a new category of molecules borrowed from the oncology field (i.e., antivascular endothelial growth factor [VEGF] agents), and has become an efficient approach for the delivery of drugs at therapeutic levels into the retina and choroid in order to limit systemic side effects [1, 2]. These drugs have a short half-life in the vitreous cavity; in order to obtain a significant functional and anatomical outcome, repeated administrations,
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