Enhancing chronic care pathways with Health Lean Management: a case study in a Spanish hospital

Purpose – Facing the burden of chronic diseases has become a priority for health-care systems’ economic and social sustainability. To this end, this paper aims to focus on adopting Health Lean Management (HLM), a widely used managerial approach, to improve the performance and quality of care provided in chronic care pathways. HLM addresses not only efficiency and timeliness issues but also care effectiveness and integration. Indeed, the lack of continuity and co-ordination of care constitutes a major challenge for chronic pathways. This research provides an innovative contribution, by extending the implementation of HLM to chronic pathways developed across hospital and territorial care. Indeed, HLM scope typically regards hospital units and departments; hence, analysing the interaction between different levels of care represents a novelty from an academic and practical perspective. Design/methodology/approach – With the aim of understanding how to extend the adoption of HLM towards the territory, an action research project has been developed. In particular, an improvement project focused on breast cancer care pathways has been launched in a Spanish hospital. The research investigates which HLM activities, tools and practices need to be accomplished in this kind of project, grasping insights into emerging wastes. To this end, the HLM project followed the Define, Measure, Analyse, Improve and Control (DMAIC) cycle, supporting the project team in effectively conducting a preliminary context analysis, qualitative and quantitative data collection, the current state analysis and the countermeasure proposals. Findings – The analysis conducted on the breast cancer care pathway highlighted major criticalities in managing the diagnosis of new patients. In particular, waiting times to obtain diagnostic imaging and breast specialist consultations highly impacted the care pathway effectiveness and efficiency. Specific wastes that caused these delays have been investigated, leading to the definition of specific ...