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Cited by 105Healthcare Quality and ManagementHealthcare Operations and Scheduling OptimizationQuality and Supply Management

The DOI matches its Crossref record; 30 of the 31 references it cites were found in a registry or an index.

Improving performances of the knee replacement surgery process by applying DMAIC principles

Open access
Improta, Giovanni, Balato, Giovanni, Romano, Maria, Ponsiglione, Alfonso Maria, Raiola, Eliana, Russo, Mario Alessandro, Cuccaro, Patrizia, Santillo, Liberatina Carmela, Cesarelli, Mario·2017·Journal of Evaluation in Clinical Practice
DOI 10.1111/jep.12810PMC PMC6585639
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Abstract

Rationale, Aims, and Objectives: The work is a part of a project about the application of the Lean Six Sigma to improve health care processes. A previously published work regarding the hip replacement surgery has shown promising results. Here, we propose an application of the DMAIC (Define, Measure, Analyse, Improve, and Control) cycle to improve quality and reduce costs related to the prosthetic knee replacement surgery by decreasing patients' length of hospital stay (LOS) Methods: The DMAIC cycle has been adopted to decrease the patients' LOS. The University Hospital “Federico II” of Naples, one of the most important university hospitals in Southern Italy, participated in this study. Data on 148 patients who underwent prosthetic knee replacement between 2010 and 2013 were used. Process mapping, statistical measures, brainstorming activities, and comparative analysis were performed to identify factors influencing LOS and improvement strategies. Results: The study allowed the identification of variables influencing the prolongation of the LOS and the implementation of corrective actions to improve the process of care. The adopted actions reduced the LOS by 42%, from a mean value of 14.2 to 8.3 days (standard deviation also decreased from 5.2 to 2.3 days). Conclusions: The DMAIC approach has proven to be a helpful strategy ensuring a significant decreasing of the LOS. Furthermore, through its implementation, a significant reduction of the average costs of hospital stay can be achieved. Such a versatile approach could be applied to improve a wide range of health care processes.

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Crossref · 10.1111/jep.12810

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Figures

Figure 1 Brief description of the typical lean Six Sigma DMAIC (Define, Measure, Analyze, Improve and Control) phases
Figure 1 Brief description of the typical lean Six Sigma DMAIC (Define, Measure, Analyze, Improve and Control) phasesCC BY · PubMed Central
Figure 2 Gantt diagram
Figure 2 Gantt diagramCC BY · PubMed Central
Figure 3 Value Stream Map of the care process for patient undergoing prosthetic knee replacement
Figure 3 Value Stream Map of the care process for patient undergoing prosthetic knee replacementCC BY · PubMed Central
Figure 4 Length of hospital stay (LOS) run chart before (left) and after (right) the improvement actions
Figure 4 Length of hospital stay (LOS) run chart before (left) and after (right) the improvement actionsCC BY · PubMed Central

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Citations

Cites

Research works printed but not linked: 6

  1. ConversoG De CarliniR SantilloLC ImprotaG.Project management implementation for healthcare activities organization. Paper presented at: Advances in Computer Science Proceedings of the 6th WSEAS European Computing Conference (ECC '12) 2012; Prague Czech Republic.
  2. ImprotaG De RosaG VerdolivaC et al.Appropriate indicators to evaluate the technology managed by the functional direction GAT of AORN. “A. Cardarelli” in Naples. Paper presented at: 15th International Conference on Industrial Engineering and Management Science (ICIEMS)2013.
  3. ImprotaG ParenteG TriassiM et al.Evaluation of a set of indicators devoted to the service of health education: the case of the Biotechnology Centre of the AORN Hospital “A. Cardarelli” in Naples. Paper presented at: 15th International Conference on Industrial Engineering and Management Science (ICIEMS)2013.
  4. Womack JP, 2005, Going Lean in Health Care
  5. ImprotaG GiangrandeP MontellaE et al.An appropriate methodology for hospital management: Six Sigma at AOU “Federico II” of Naples. Paper presented at: 15th International Conference on Industrial Engineering and Management Science (ICIEMS)2013.
  6. Cimmino MA, 2004, Pain patterns in Italian patients with osteoarthritis: preliminary results of the MIDA Study, Reumatismo, 56, 253

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Metadata

Authors
Improta, G., Balato, G., Romano, M., Ponsiglione, A. M., Raiola, E., Russo, M. A., Cuccaro, P., Santillo, L. C., & Cesarelli, M.
Affiliations
  • University of Naples Federico II (IT)
  • Magna Graecia University (IT)
  • Federico II University Hospital (IT)
  • Fondazione Salvatore Maugeri (IT)
Corresponding author
Improta, Giovanni
ORCID
Venue
Journal of Evaluation in Clinical Practice
Publisher
Wiley
Published
2017-09-26
Volume
23
Issue
6
Pages
1401-1407
ISSN
  • 1356-1294 (ISSN-L)
  • 1365-2753
DOI
10.1111/jep.12810
PMC
PMC6585639
OpenAlex
W2758975722
Cited by
105
References
31
Citations by year
2026: 1 · 2025: 3 · 2024: 5 · 2023: 9 · 2022: 14 · 2021: 36 · 2020: 22 · 2019: 10 · 2018: 3 · 2017: 2
FWCI
13.89
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Evaluation in Clinical Practice (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Quality and Management
  • Social Sciences › Decision Sciences › Management Science and Operations Research › Healthcare Operations and Scheduling Optimization
  • Social Sciences › Business, Management and Accounting › Management Information Systems › Quality and Supply Management
Keywords
knee arthroplasty, length of hospital stay, DMAIC, Lean Six Sigma, process improvement, hospital costs, surgical process, process mapping, healthcare quality improvement
MeSH terms
Aged, Aged, 80 and over, Cost-Benefit Analysis, Female, Humans, Interprofessional Relations, Italy, Length of Stay, Male, Middle Aged, Patient Care Team, Efficiency, Organizational, Total Quality Management, Arthroplasty, Replacement, Knee, Quality Improvement

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