Clicca qui per scaricare

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:  2016 Fascicolo: 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 


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. Yin R.K. (2003). Case study research: Design and methods (3rd ed.). Thousand Oaks, CA: Sage.
  4. 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.
  5. Young T.P., McClean S.I. (2008). A critical look at Lean thinking in healthcare. Quality & Safety in Health Care, 17: 382-386.
  6. Edmondson A.C., McManus S.E. (2007). Methodological fit in management field research. The Academy of management review, 32 (4): 1155-1179.
  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. 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.
  64. 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
  65. Spear S.J. (2005). Fixing healthcare from the inside, today. Harvard Business Review, 83 (9): 78-91.
  66. Stroupe J.M. (2012). It’s the process: how lean strategies can streamline hospital design. Health Facilities Management, 25 (2): 23-27.
  67. Toussaint J. (2009). Why are we still underperforming? Frontiers of health services management, 26 (1): 27-32.
  68. Towne J. (2010). Lean transformations: planning a Lean health care makeover. Health facilities management, 23 (10): 51-54.
  69. Villa S. (2012). L’operations management a support del sistema di operazioni aziendali: modelli di analisi e soluzioni progettuali. Padova: CEDAM.
  70. Waring J.J., Bishop S. (2010). Lean healthcare: rhetoric, ritual and resistance. Social Science & Medicine, 71: 1332-1340.
  71. Westwood N., James-Moore M., Cooke M. (2007). Going Lean in the NHS. Coventry: NHS Institute for Innovation and Improvement.
  72. 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.



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

Federica Centauri, Marta Marsilio, Stefano Villa, Francesco Nicosia, in "MECOSAN" 100/2016, pp. 27-55, DOI:10.3280/MESA2016-100003

   

FrancoAngeli è membro della Publishers International Linking Association associazione indipendente e no profit per facilitare l'accesso degli studiosi ai contenuti digitali nelle pubblicazioni professionali e scientifiche