Effects of Lean Healthcare on Patient Flow: A Systematic Review.

OBJECTIVES: To assess the effects of lean healthcare (LH) on patient flow in ambulatory care and determine whether waiting time and length of stay (LOS) decrease after LH interventions. METHODS: A systematic review was performed with close adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched for studies of healthcare organizations applying LH interventions within ambulatory care published between 2002 and 2018. Six databases and grey literature sources were used. Two reviewers independently screened and assessed each study. When consensus was difficult to reach, a third reviewer intervened. Finally, a summary of findings was generated. RESULTS: Out of 5627 studies, 40 were included. Regarding LOS for all patients, 19 out of 22 studies reported a decrease. LOS for discharged patients decreased in 11 out of 13 studies, whereas LOS for admitted patients was reduced in 6 out of 7 studies. Waiting time for patients before seeing a healthcare professional decreased in 24 out of 26 studies. Waiting time to treatment and waiting time for appointments were minimized in 4 and 2 studies, respectively. Patients who left without being seen by a doctor decreased in 9 out of 12 studies. Finally, patient and staff satisfaction were measured in 8 and 2 studies, respectively, with each reporting improvements. CONCLUSIONS: According to our findings, LH helped to reduce waiting time and LOS in ambulatory care, mainly owing to its focus on identifying and minimizing non-value added (NVA) activities. Nevertheless, evidence of the impact of LH on patient/staff satisfaction and the translation of the obtained benefits into savings is scarce among studies.

Structural and Dimensional Analysis by Computed Tomography of a Multi Geometric Template Manufactured by Fused Deposition Modeling.

As a consequence of the development of AM, strategies have been developed to optimize the printing process, which focuses on reducing manufacturing time, such as using genetic algorithms (GAs), among others. The effect caused by the modification of path patterns is an effect of interest in two aspects: dimensional assurance focused on the compliance of the dimensions of the components in comparison with the digital design of the components, and the structural composition and resistance that the printing process itself can generate. This paper aims to present the effect of optimizing the path of fused filament fabrication (FFF) equipment on the dimensional finish and structural quality of a multi-geometric component using computed tomography. For this purpose, a template composed of 23 geometric elements, printed using FFF technology and PLA as the base material, is used. The results show an 11% reduction in the total process time required to print the component. The effect on the dimensional precision of different geometric elements was identified. In addition, it was possible to ensure that the structural quality of the multi-geometric component was not affected by the modification of the path required by the printing process.

Effects of mental workload on manufacturing systems employees: A mediation causal model.

BACKGROUND: Although some research has been done in the Mexican manufacturing industry regarding mental workload, none has explored its association with physical fatigue, body weight gain, and human error simultaneously. OBJECTIVE: This research examines the association between mental workload and physical fatigue, body weight gain, and human error in employees from the Mexican manufacturing systems through a mediation analysis approach. METHODS: A survey named Mental Workload Questionnaire was developed by merging the NASA-TLX with a questionnaire containing the mental workload variables mentioned above. The Mental Workload Questionnaire was applied to 167 participants in 63 manufacturing companies. In addition, the mental workload was used as an independent variable, while physical fatigue and body weight gain were mediator variables, and human error was a dependent variable. Six hypotheses were used to measure the relationships among variables and tested using the ordinary least squares regression algorithm. RESULTS: Findings indicated that mental workload significantly correlates with physical fatigue and human error. Also, the mental workload had a significant total association with human error. The highest direct association with body weight gain was provided by physical fatigue, and body weight gain had an insignificant direct association with human error. Finally, all indirect associations were insignificant. CONCLUSION: Mental workload directly affects human error, which physical fatigue does not; however, it does affect body weight gain. Managers should reduce their employees' mental workload and physical fatigue to avoid further problems associated with their health.

Effects of Lean Interventions Supported by Digital Technologies on Healthcare Services: A Systematic Review.

Despite the increasing utilization of lean practices and digital technologies (DTs) related to Industry 4.0, the impact of such dual interventions on healthcare services remains unclear. This study aims to assess the effects of those interventions and provide a comprehensive understanding of their dynamics in healthcare settings. The methodology comprised a systematic review following the PRISMA guidelines, searching for lean interventions supported by DTs. Previous studies reporting outcomes related to patient health, patient flow, quality of care, and efficiency were included. Results show that most of the improvement interventions relied on lean methodology followed by lean combined with Six Sigma. The main supporting technologies were simulation and automation, while emergency departments and laboratories were the main settings. Most interventions focus on patient flow outcomes, reporting positive effects on outcomes related to access to service and utilization of services, including reductions in turnaround time, length of stay, waiting time, and turnover time. Notably, we found scarce outcomes regarding patient health, staff wellbeing, resource use, and savings. This paper, the first to investigate the dual intervention of DTs with lean or lean-Six Sigma in healthcare, summarizes the technical and organizational challenges associated with similar interventions, encourages further research, and promotes practical applications.

Light pollution as a factor in breast and prostate cancer.

Light pollution is a global environmental issue that affects photosensitive organisms. For instance, several researchers have recognized melatonin suppression in humans as a direct cause of long-term exposure to high artificial light levels at night. Others have identified low melatonin levels as a risk factor for a higher prevalence of hormone-sensitive cancer. This paper analyzes the association between light pollution, estimated as the emission analysis of satellite worldwide nighttime light collections from 1999 to 2012, and 25,025 breast and 16,119 prostate cancer events from 2003 to 2012. Both types of cancer increased during the study period, but light pollution increased in urban and peri-urban areas and decreased in rural areas. Cumulative light pollution during 5 years showed a positive association with breast cancer but not with prostate cancer. The association between light pollution and breast cancer persisted when adjusted to age-standardized rates with a mean increase of 10.9 events per 100,000 population-year (95% confidence interval 7.0 to 14.8). We conclude that exposure to elevated light pollution levels could be a risk factor for breast cancer in Slovakia. This work can interest researchers who study relationships between atmospheric pollutants and the growing cancer epidemic. The results and the methodology can be extrapolated to any country in the world if data is available.

Impact of job strain and being overweight on middle and senior managers from the manufacturing sector in the Mexican industry.

BACKGROUND: This research work establishes the relationship between job strain and being overweight among Mexican managers. Recently in Mexico, there has been a sharp increase in work-related diseases and mental health disorders. Furthermore, evidence shows that Mexicans rank top among employees who suffer from stress, yet research on the impact of job strain on the phenomena of obesity and being overweight among such vulnerable job positions in the industrial field is scarce. METHODS: The sample included 170 overweight middle and senior managers from six companies in the Mexican Manufacturing Industry. Cedillo's Spanish version of the Job Content Questionnaire by Karasek was used, and the Body Mass Index (BMI) was used to characterize an overweight condition. Structural Equations Modelling studied the relationships among variables. RESULTS: Even though, the model shows a power of explanation of 6%(R2 = 0.06), the variable showing the greatest direct effect on the overweight variable is social support, with 21%(p < 0.01, ß= -0.21). Regarding the total effects, only two of the four variables studied contributed directly to the overweight variation: the social support variable and the job demand variable. CONCLUSIONS: The results of the model hold a relatively low explanatory power; however, they do show a relationship between the studied variables. Also, the importance of the supervisor and co-workers' support should be considered when developing organizational strategies for the prevention of work stress and an overweight condition.

ZnO Semiconductor Nanoparticles and Their Application in Photocatalytic Degradation of Various Organic Dyes.

The biosynthesis of oxide semiconductor nanoparticles (NPs) using materials found in nature opens a wide field of study focused on sustainability and environmental protection. Biosynthesized NPs have the capacity to eliminate organic dyes, which pollute water and cause severe damage to the environment. In the present work, the green synthesis of zinc oxide (ZnO) NPs was carried out using Capsicum annuum var. Anaheim extract. The photocatalytic elimination of methylene blue (MB), methyl orange (MO), and Rhodamine B (RhB) in UV radiation was evaluated. The materials were characterized by scanning and transmission electron microscopy (SEM and TEM) and SEM-coupled energy dispersive spectroscopy (EDS), attenuated total reflectance-infrared (ATR-IR), X-ray photoelectron spectroscopy (XPS), X-ray diffraction (XRD), Photoluminescence (PL), and ultraviolet-visible spectroscopy (UV-Vis). The TEM analysis showed the NPs have an average size of 40 nm and quasi-spherical shape. ATR-IR showed the ZnO NPs contained functional groups from the extract. The analysis through XRD indicated that the NPs have a hexagonal zincite crystal structure with an average crystallite size of approximately 17 nm. The photoluminescence spectrum (PL) presented an emission band at 402 nm. From the UV-Vis spectra and TAUC model, the band-gap value was found to be 2.93 eV. Finally, the photocatalytic assessment proved the ZnO NPs achieved 100% elimination of MB at 60 min exposure, and 85 and 92% degradation of MO and RhB, respectively, at 180 min. This indicates that ZnO NPs, in addition to using a friendly method for their synthesis, manage to have excellent photocatalytic activity in the degradation of various organic pollutants.

The Relationship Between the Burnout Syndrome Dimensions and Body Mass Index as a Moderator Variable on Obese Managers in the Mexican Maquiladora Industry.

Burnout syndrome (BS) and obesity are two growing conditions that affect employees' health and company productivity. Recently, several studies have pointed to a possible relationship between both phenomena. However, such a relationship has not been clearly defined. This research analyzes the relationship between BS dimensions and body mass index (BMI), the latter being treated as a moderator variable among obese senior and middle managers in the Mexican maquiladora industry through a structural equation model. A total of 361 senior and middle managers (124 of them classified as obese under the World Health Organization's criteria) completed both the Maslach Burnout Inventory-General Survey [with emotional exhaustion (EE), cynicism, and professional efficacy (PE) as subscale dimensions] and a sociodemographic questionnaire (which included BMI). The results showed a statistically significant relationship between EE and PE (P < 0.001; ß = -0.320), with BMI acting as a moderator variable. The results showed that when BMI increases as a moderator variable, the strength of the relationship between EE and PE also changes. For example, although PE had a negative value of 0.14 before the moderator effect, the value increased up to 0.32 when the BMI was factored into the relationship. Therefore, maquiladora industries are being advised to increase their investments on the identification and prevention of employees' EE and obesity. Such interventions would promote a better quality of life and could prevent economic losses resulting from poor employee performance.

Improvement project in higher education institutions: A BPEP-based model.

Improvement projects (IPs) are a fundamental element in any quality management system from any organization. In Higher Education Institutions (HEIs), IPs are constantly implemented to maintain excellence in academic and administrative processes. In this study, we propose a model for IP implementation that is based on the Baldrige Performance Excellence Program (BPEP). As a part of the model, we propose a series of research hypotheses to be tested. The data used to test the hypotheses were gathered from a questionnaire that was developed after an extensive literature review. The survey was administered to Mexican public HEIs, and more than 700 responses were collected. The data were assessed in terms of convergent and discriminant validity, obtaining satisfactory results. To test the proposed relationships between the model constructs, we utilized Structural Equation Modeling (SEM) using the software IBM SPSS Amos. The analysis confirmed the statistical validity of both the model and the hypotheses. In conclusion, our model for IP implementation is a useful tool for HEIs that seek to attain excellence in their processes through IPs.

Assessing the Impact of Lean Healthcare on Inpatient Care: A Systematic Review.

Healthcare services are facing challenges in increasing their efficiency, quality of care, and coping with surges in demand. To this end, some hospitals have implemented lean healthcare. The aim of this systematic review is to evaluate the effects of lean healthcare (LH) interventions on inpatient care and determine whether patient flow and efficiency outcomes improve. The review was performed according to PRISMA. We used six databases to search for studies published from 2002 to 2019. Out of 5732 studies, 39 measuring one or more defined outcomes were included. Hospital length of stay (LOS) was measured in 23 studies, 16 of which reported a reduction, turnover time (TOT) decreased in six out of eight studies, while the turnaround time (TAT) and on-time starts (OTS) improved in all five and seven studies, respectively. Moreover, eight out of nine studies reported an earlier discharge time, and the boarding time decreased in all four cases. Meanwhile, the readmission rate did not increase in all nine studies. Lastly, staff and patient satisfaction improved in all eight studies. Our findings show that by focusing on reducing non-value-added activities, LH contributed to improving patient flow and efficiency within inpatient care.

A Systematic Review and Meta-Analysis of the Effects of Food Safety and Hygiene Training on Food Handlers.

Foodborne diseases are a significant cause of morbidity and mortality worldwide. Studies have shown that the knowledge, attitude, and practices of food handlers are important factors in preventing foodborne illness. The purpose of this research is to assess the effects of training interventions on knowledge, attitude, and practice on food safety and hygiene among food handlers at different stages of the food supply chain. To this end, we conducted a systematic review and meta-analysis with close adherence to the PRISMA guidelines. We searched for training interventions among food handlers in five databases. Randomized control trials (RCT), quasi-RCTs, controlled before-after, and nonrandomized designs, including pre-post studies, were analyzed to allow a more comprehensive assessment. The meta-analysis was conducted using the random-effects model to calculate the effect sizes (Hedges's g) and 95% confidence interval (CI). Out of 1094 studies, 31 were included. Results showed an effect size of 1.24 (CI = 0.89-1.58) for knowledge, an attitude effect size of 0.28 (CI = 0.07-0.48), and an overall practice effect size of 0.65 (CI = 0.24-1.06). In addition, subgroups of self-reported practices and observed practices presented effect sizes of 0.80 (CI = 0.13-1.48) and 0.45 (CI = 0.15-0.76) respectively.

Effects of Job Content and Physical Activity on Body Mass Index among Obese Managers of the Mexican Manufacturing Industry.

Mental health disorders resulting from work stressors are increasing in the Mexican manufacturing industry and worldwide. Managerial positions in these contexts are highly stressful, and although physical activity may reduce the negative effects of work stress, the relationships between these two aspects regarding their effects on the body mass index (BMI) of obese managers are scarcely studied. This article aims to study such relationships by using the Job Content Questionnaire (JCQ) dimensions with the Baecke's physical activity questionnaire dimensions and analyzing their effects on the BMI. A sample of 255 managers from the Mexican industry, with a (BMI > 30) participated by answering the surveys and providing their weight, their height, and certain sociodemographic information. The research hypotheses were tested using WarpPLS® 6.0 for structural equation modeling. The results for three models featuring acceptable reliability to estimate the direct, indirect, and total effects are presented. The first model showed a medium explanatory power, the variable of job decision-making authority having the greatest direct effect on BMI. The second model showed a medium explanatory power, and the variable of physical activity during leisure-time observed the unique direct effect on BMI. Finally, although the integrating model showed a small explanatory power, both work stress and the physical activity exerted observed direct effects on BMI reduction.

Burnout Syndrome in Middle and Senior Management in the Industrial Manufacturing Sector of Mexico.

Due to globalization and the accelerated growth of technology, ever more employees of companies are affected by burnout syndrome, the psychological nature of which requires a prolonged response to chronic interpersonal stressors in work environments. The present research aims to validate the operability of the Maslach Burnout Inventory-General Survey (MBI-GS) using a sample of 378 professionals belonging to middle and senior management working in companies within the IMMEX sector (comprising the industrial-manufacturing, maquiladora and export services) located in the state of Baja California, Mexico. Firstly, an exploratory factor analysis using the principal components method and Varimax rotation was performed and the results revealed the existence of three factors representing more than 67 percent of the total variance. Secondly, a confirmatory factorial analysis was carried out performing appropriate results for the indices Chi-square goodness-of-fit model, Root Mean Square Error of Approximation (RMSEA), Normed Fit Index (NFI), Comparative Fit Index (CFI), Relative Fit Index (RFI), Parsimony Ratio (PRATIO) and Parsimony Normed Fit Index (PNFI), which are highly recommended by literature in these types of studies. Additionally, construct validity was satisfactorily verified. The factorial solution coincided with the Maslach Burnout Inventory original proposal so that this instrument can be considered a valid and reliable option to analyze the burnout levels in people pertaining to middle and senior management in these types of industries.