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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. [ABSTRACT FROM AUTHOR]

The primary care sector is globally recognised as the pillar of an efficient and patient-centred care model. Despite its importance, many countries fail to ensure equitable access and individualised care. This problem significantly impacts the most vulnerable part of the population, such as chronic and elderly patients. In this context, considering the large number of people affected by multiple diseases, multidisciplinary and multi-organisation teamwork has become fundamental to guarantee high levels of quality, increasing patient satisfaction, and continuity of care. Furthermore, working in a multidisciplinary primary care team can improve information exchange between care providers and patients, positively impacting on clinical performance. Despite these opportunities, the primary care workforce is often overloaded in its daily activities and not adequately organised and coordinated to avoid burnout experiences and inefficient skills deployment. In this context, implementing Lean and Safety Management (L&SM) as a process improvement methodology can increase care pathways performance and integration, patient safety and satisfaction through the reduction of wastes and risks. The current study aims to implement L&SM in a primary care centre in Italy, with the final goal of increasing productivity and effectiveness in daily activities performed by primary care physicians. This project is carried out following the DMAIC cycle; a managerial approach that combines qualitative and quantitative techniques to support process improvement. The implementation roadmap will combine HLM and CRM, planning to achieve the main steps listed as follows: mapping the care demand and the available resources to define the focus of the study; identifying the most representative and critical patients; mapping the target care pathway; identifying wastes and risk and their root causes; identifying critical aspects and improvement events; implementing countermeasures; evaluating and monitoring results. The expected results of the forthcoming months consist of measurable improvements within the healthcare pathway, supporting the optimisation of the primary care centre. Moreover, this initiative may represent a pilot case for other similar projects, contributing to spread L&SM culture throughout primary care centres with benefits for both patients and clinical staff. [ABSTRACT FROM AUTHOR]

The project regards the adoption of LH in primary care, and particularly in chronic pathways, with the final aim of building a model based on best practices to improve the efficiency, efficacy, safety and continuity of care for frail patients. The project will follow a multiple case study approach, analysing and comparing different practices and models, with the purpose of identifying guidelines to create an integrated healthcare system based on a "lean and safety" perspective. From an academic perspective, the project enriches the current scientific literature, introducing a structured methodology to proactively manage risks and wastes in the new setting of chronic pathways in primary care. From a managerial perspective, the project contributes to identify guidelines to improve their coordination and integration, guaranteeing the sustainability, equity and accessibility of health services. [ABSTRACT FROM AUTHOR]