Abstract:

Reducing the burden of chronic diseases has become a priority for healthcare systems. The application of lean and safety management within hospitals demonstrated its potential to leverage quality of care; however, the lack of continuity and integration with territorial care still represents a challenge for chronic pathways.

With the aim of testing a new methodology for implementing lean and safety management in chronic care, two different improvement projects have been developed in a Spanish hospital, in collaboration with the University of Padova and Comillas University. This paper reports the holistic analysis and reorganization of two chronic pathways (COPD and breast cancer), considering the process inside and outside hospital boundaries.

The methodology mentioned above guided the project development through each phase and activity, suggesting the tools and the hard and soft practices to be adopted. The healthcare workforce and all key actors involved in the pathways have been engaged in the project, providing interesting contributions to the study. From the first results, this collaboration was shown to be essential to overcome departmental barriers and enhance the integration of care. Moreover, the preliminary outcomes highlight the achievement of a better understanding of the process, the identification of the criticalities in terms of risks and waste, and the proposal of improvement interventions.

These projects, which constitute the first attempts to implement a new integrated methodology to improve chronic pathways also in territorial care, provide an innovative contribution with scientific, managerial, and social impacts.

Keywords:

Lean healthcare, healthcare management, chronic care pathways, care integration.