Management engineer, Kasper Edwards (right) of the Technical University of Denmark in Lyngby andhis colleagues reviewed research literature on lean practices, which based on "preserving value with less work."

The team hoped to discover whether the same value and efficiency might be applied to healthcare systems. Findings within the Danish public healthcare system, demonstrates "lean" can work very effectively for some parts of healthcare provision, such as surgical wards, but not necessarily for others.

A 'lean' approach could help address not only financial constraints on public health services, but cope with a lack of doctors, nurses and healthcare professionals in general. Lean projects in healthcare have focused on peripheral activities to improve patient flow through wards and reduce turnover times. Administrative procedures have also benefited from a lean approach. 

A major hospital outside Copenhagen with 200 employees and 10 operating rooms was studied. The surgery was split into two streams: one following normal procedures, the other running "lean" for elective operations.

The programme was initiated to create more effective working procedures, and ensure a total continuity of care to the benefit of both staff and patients in the light of absenteeism and morale problems at the hospital.

In the lean approach, two "turbo" rooms were set up to carry out only elective and routine surgical procedures, staffed by only senior employees, with no educational functions. Teamwork was encouraged with a fixed team, where the anaesthetist might assist the surgeon by holding a patient's arm when required.

Results were overwhelming. Edwards and his colleagues report: "What was previously done in three operating rooms can now be done in two and the teams are finished within their shift." This has had a significant effect on employee morale as well as increasing patient turnover by a third, eliminating waiting times for the routine procedures carried out in the turbo rooms.

The researchers point out in the International Journal of Technology Management that the remaining 'non-lean' operating theatres at the hospital no change has been experienced other than fewer, efficient senior staff being available. Staff morale in non-lean rooms may also be compromised, highlighting need to investigate the benefits for patients of a lean approach to surgery, and to consider the overall impact on a hospital should lean be implemented only in certain areas.

The team concludes that 'Lean' works in healthcare. Mixing lean and normal mode surgery in the same ward is not recommended.

Bio-chipping: sepsis, dope testing and food quality

The more quickly and directly doctors recognise and treat sepsis, or blood poisoning, the greater the patient’s chances of survival.

With the help of a new biochip, physicians will now be able to analyse blood in their own practice and have the results in 20 minutes.

A biochip for this has been developed by scientists at the Fraunhofer Institute for Physical Measurement Techniques IPM in Freiburg.

The biochip is analyzed in a fully automatic portable device: CourtesyFraunhofer IPM.

“To analyse the biochip we have also designed a fully automatic device to carry out all the examination steps,” explains Dr. Albrecht Brandenburg, (right) group manager at the IPM. “All the doctor has to do is place the sample in the apparatus and wait for the results.”



"The device prepares the blood sample, separating red blood cells from the blood and the plasma that remains is guided onto the biochip. Immune systems of sepsis sufferers 
reacts by producing certain proteins. The biochip uses these in its diagnosis: antibodies positioned on the chip fit these proteins like a key fits a lock. If the proteins are present in the blood, the antibodies fish them out of the fluid and bind them to the chip.

But how does the apparatus know if proteins have been caught? “The chip is rinsed with a solution containing the appropriate antibodies, which have in turn been marked with a fluorescent dye,” explains IPM scientist  (left) Dr. Manuel Kemmler. “These bind to the proteins – meaning antibodies, protein and marked antibodies are all firmly linked to each other 
and to the chip’s surface. When the chip is illuminated, the dye lights up.”

The apparatus sees lots of little illuminated dots that show the protein was in the blood. For a healthy patient, the chip remains dark.

Researchers can even test for different proteins at the same time in one cycle done by placing various different catcher molecules on the chip, to which specific molecules in the blood attach themselves. A selection of proven protein markers allows scientists to obtain additional important information about severity and cause of illness.

Together with colleagues from a university hospital, the researchers have already successfully 
tested prototypes of the device and biochip. As each biochip can only be used once they have to be affordable.

“We predict that in the long run, with production on a large enough scale, each chip will cost no more than €1,” says Brandenburg. There are various possible applications: other conditions such as heart attacks or cancers can also be investigated this way. What’s more, the chip facilitates doping and urine testing as well as the quality assessment of foodstuffs."