LEAN AND SAFETY MANAGEMENT FOR CHRONIC PATHWAYS IN LOCAL HEALTH NETWORKS

Globally, the healthcare sector presents a multitude of challenges characterized by escalating costs, inadequate quality of care, and disparities in healthcare access. One of the recognized causes of these challenges is the fragmentation of healthcare delivery, resulting in suboptimal care, unfavorable patient outcomes, and the provision of unnecessary or even harmful services. Indeed, the typical health compartmentalization results in barriers between levels of care, hindering the delivery of an integrated assistance across primary, secondary and tertiary care. The absence of care continuity constitutes a particular concern especially in the context of chronic diseases, becoming a global threat that needs to be promptly addressed. Hence, new managerial tools are needed to solve these issues. Lean and safety management (L&SM), approach deriving from the combination of Lean Healthcare (LH) and Clinical Risk Management (CRM), has been recently embraced by hospitals as a means to enhance multiple goals – such as efficiency, effectiveness, and patient safety – through the proactive management of wastes and risks simultaneously. The current project responds to the dual necessity: on one hand, the improvement of the quality of care provided in chronic pathways, focusing also on integration of care; on the other hand, the theoretical contribution to the current knowledge about L&SM, extending its implementation outside the hospital boundaries, toward the Local Health Network (LHN). A systematic literature review (SLR) on L&SM in LHNs was conducted to synthesize all the existing knowledge in a theoretical framework. The emerging gaps led to the formulation of the research objective: to understand how L&SM can be implemented in LHNs to improve the quality of care of chronic. In particular, the research focused on the definition of the activities, tools, organizational practices, and enablers needed to perform L&SM projects: a Lean & Safety Chronic Care (L&SCC) methodology collecting these elements was designed and tested in an operational project in a real-life context. Given the nature of the objectives, action research (AR) was conducted. The AR cycles encompassed the L&SCC development, testing and refinement. The results provide a methodology to guide L&SM projects that have been tested and refined according to the experience gained in the operational projects. The outcomes achieved in the operational projects validated the effectiveness of the L&SCC methodology, demonstrating positive results in terms of improved performances and of benefits on innovation and learning. The research offers academic and managerial contributions. From an academic point of view, it enriches the L&SM literature with a theoretical framework emerging from the SLR, and a L&SCC methodology, which standardizes the L&SM implementation in chronic pathways in the LHNs, extending the typical field of application. From a managerial point of view, the research support healthcare providers with practical guidelines. Finally, it has implications also for the economic and social sustainability of the healthcare system, addressing the burden of chronic disease and the access to care.