Lean and safety management: a project to improve the continuity of care for chronic patients

Abstract

Enhancing the quality of care for chronic patients means guaranteeing the delivery of integrated care. Integrated health systems help overcome the fragmentation of care processes, by bridging the organisational, managerial, and informational gaps, with the final purpose of improving the access, quality, and continuity of services. Indeed, chronic patients require the assistance of multiple providers, referring to different levels of care (primary, secondary, or tertiary). However, hyper-specialised and fragmented healthcare systems hamper the achievement of these goals, resulting in suboptimal care, higher cost, and poor quality of care. The implementation of lean and safety management (L&SM) within hospitals demonstrated its ability to improve efficiency, effectiveness, and patient satisfaction, through proactive identification and reduction of risks and wastes. The novelty lies in adopting this approach to act on integration and continuity between different levels of care. With this aim, a L&SM project has been developed in a Spanish hospital. The project focuses on improving the discharge process from internal medicine to primary care, essential to prevent further patients’ readmissions. In fact, cooperation between the hospital and primary care is crucial to ensure continuity in chronic pathways, providing adequate assistance to patients’ healthcare and social needs. The first results show how this approach was instrumental to engage in the project all key actors involved in the pathways, overcoming departmental barriers, and enhancing continuity of care. Moreover, this approach facilitated the convergence of identified inefficiencies with the clinicians’ interests, focusing only on the aspects considered of primary importance, such as the communication between the hospital and primary care. The expected outcomes encompass the achievement of a better understanding of the process, the identification of the criticalities in terms of risks and waste, the proposal and implementation of improvement interventions. This project represents an innovative attempt to implement L&SM outside of hospital boundaries to improve new performance dimensions, focusing on integration and continuity of care.