Abstract:

The ageing population poses a significant challenge to the sustainability of healthcare systems, especially considering the increasing cost and the organizational efforts to coordinate the provision of health care services. At the same time, the quality of care provided is perceived by patients as not always satisfactory, with difficulties in accessing the health services, gaps between territorial and hospital services, lack of continuity of care, high waiting times, and lists. Hence, the need to intervene in this sphere of healthcare emerges, focusing on the most committed setting in the health care of the aged and chronic population: territorial ambulatory healthcare (TAH). The TAH encompasses primary ambulatory care and low-complexity secondary care, serving as the first point of contact for patients entering national care systems and ensuring continuous, comprehensive, and coordinated patient-centered care.

The current research investigates the implementation of Lean and Safety Management (L&SM) within the TAH setting to sustain care quality improvements addressing the ageing population and chronic patients’ needs. In particular, through a systematic literature review, the quality goals pursued, and the performance measurement indicators adopted in L&SM projects are analyzed.

L&SM combines Healthcare Lean Management (HLM) and Clinical Risk Management (CRM) to proactive reduce risks and wastes. Despite its success in the healthcare context, there is still limited evidence on the adopted performance measurement systems, especially considering the territorial context. Preliminary analyzes highlight a prevalent focus on timeliness and efficiency goals and performance measurement indicators, with limited attention to other care quality aspects. Future research opportunities suggest exploring L&SM impact on care integration and equitability, patient safety and satisfaction, employee work-balance, and care clinical outcomes. Investigating and enhancing the performance measurement system could have a significant impact on both the academic and managerial realms. Expanding knowledge in this field may result in a standardized tool to monitor the progress status of L&SM projects and measure the improvement results achieved. Moreover, it could contribute to improve the sustainability of L&SM projects, particularly in addressing the needs of the ageing population.

Keywords:

Lean healthcare, healthcare management, ageing population, quality management.