Purpose: Healthcare environments are highly complex and full of variation and inefficiency. However, variation and inefficiency can be measured and improved, providing better quality care at a lower cost. This study aims to report the application of Lean Six Sigma (LSS) in a haematology laboratory in a university hospital in Egypt. Design/methodology/approach: The authors used case study research. Applying the define, measure, analyse, improve and control phases of the DMAIC methodology together with lean tools, the problem was identified, the process mapped, the causes analysed and improvements implemented. Findings: Results show that LSS can be successfully implemented in challenging public sector healthcare settings. Management commitment, generating and implementing ideas from frontline staff, using a variety of quality tools and previous LSS training were all key to success. This is evidence that the LSS methodology is adaptable to any process, people or place. Originality/value: There are no publications on LSS implementation in health care in Egypt. This study demonstrates the successful use of LSS in a university hospital (public sector) in a developing country, sharing insight into the facilitators and barriers in a real context with others in the healthcare field.

This paper reports on the first ICD-11 morbidity pilot for inpatient discharges in a public general hospital. We detail the pilot methodology, lessons learned in terms of facilitators and challenges, physician-reported opinion, and considerations for future implementation. The pilot included: engaging stakeholders; selecting the setting; building a common understanding of the discharge process; evaluating and preparing IT infrastructure; ICD-11 training; small-scale pre-pilot testing; implementing the pilot while providing on-site support and collecting data for analysis including a brief user-experience survey. Overall, physicians were satisfied with the experience. Facilitators for success included national health system influence, leadership commitment, a multidisciplinary team approach, physician-tailored training, using social media for training, and providing on-site support. Challenges included potential IT problems, and difficulties relating to training and engaging physicians. Issues to consider include DRG system requirements, and comparability of ICD-11 pilot results from different countries. In conclusion, ICD-11 can be successfully implemented for documenting diagnoses by physicians in a public hospital by installing the coding tool on the electronic hospital information system. Pilots can improve ICD-11 content by using the online proposal mechanism. Implementing ICD-11 requires effective change management, stakeholder-tailored communication, and innovative ideas for training to match the electronic nature of ICD-11 and its potential new users, physicians.

Understanding the risk factors responsible for the increased infection among HCWs can mitigate the transmission of COVID-19 among HCWs and patients alike. The aim of this study is to evaluate factors associated with SARS-CoV-2 infection among healthcare Workers. Healthcare workers and hospital administrators were asked to participate in this cross-sectional survey study that was conducted in Jaber Al Ahmad Hospital (JAH) between August to October 2020. Participants were invited to undergo SARS-CoV-2-specific antibody testing and to complete a questionnaire targeted to factors that may be associated with acquisition of SARS-CoV-2. Descriptive analysis and multivariate logistic regression were done. 847 healthcare workers participated in the study and 20.5% of them had previous SARS-CoV-2 infection. The average age of participants was 35.7 years (SD = 7.9); 52.4% were female, and 55.8% were doctors. Multivariate analysis showed that working as a nurse (adjusted OR 1.77, 95% CI = 1.15, 2.71), and wearing gloves (adjusted OR 2.93, 95% CI = 1.19, 7.22) were significantly associated with an increased likelihood of contracting SARS-CoV-2 infection while controlling for other factors. Most personal protective equipment (PPE) were reported to be available always or most of the time, with the least available PPE item being coveralls (74.4%). After adjusting for confounding factors, being a nurse and prolonged glove use were associated with increased likelihood of SARS-CoV-2 infection. Prospective cohort studies are required to further elucidate the reasons for our findings in order to minimize the transmission of infection among healthcare workers.

Background: Accidental falls are a major cause of morbidity placing pressure on hospital capacity and utilizing costly services. Evaluating the burden of falls is key for planning, implementation, and evaluation of prevention strategies. To date, no studies have been published on accidental falls at the population level in Kuwait. We studied the burden of accidental falls on public hospital inpatient capacity in Kuwait and identified the subgroups with the highest utilization of inpatient service days. Methods: From the national database of inpatient hospitalizations, we selected hospitalizations of patients admitted to Kuwait’s public hospitals for unintentional injury caused by an accidental fall from 1 January through 31 December 2016. We studied the number of inpatient service days (bed days), length of stay (LOS), and number of hospitalizations by age group, gender, and nationality. Mann–Whitney, Kruskal-Wallis, and Chi square tests were used for comparison. Logistic regression was used to quantify the risk of prolonged LOS and fractures among fall-related hospitalizations. Results: Accidental falls were responsible for 2.9% of inpatient hospitalizations, 3.7% of inpatient service days (61,140 days) with an ALOS of 9.1 days in Kuwait’s public hospitals in 2016. Accidental falls were responsible for 4.6% of older adult service days, and an even higher 5.6% of older women service days. In the age group 13–64, fall-related service days for non-Kuwaitis (5.7%) were more than triple those for Kuwaitis (1.8%) with a substantial percentage among male non-Kuwaitis (8.1%). The risk factors for exceeding the national ALOS for fall-related hospitalizations were female gender (OR 1.36), age 65 and older (OR 9.72), age 13–64 (OR 5.20), being non-Kuwaiti (OR 1.39), sustaining a femur fracture (OR 11.67), and undergoing surgery (OR 2.63). Fall-related hospitalizations associated with a higher risk of fractures were females (OR 1.22), patients 65 years and older (OR 5.09), patients aged 13–64 (OR 3.65), and non-Kuwaitis (OR 1.28). Conclusions: Accidental falls impose a considerable burden on inpatient service utilization in Kuwait. This varies by age, gender, and nationality. To reduce this burden, prevention programs should target working-age non-Kuwaiti males and older females.

Background: ICD-11’s digital architecture and granularity distinguish it from previous revisions and expand its applicability beyond mortality statistics and public health. The official ICD-11 version is updated annually. However, a separate online Maintenance Platform is continuously updated and hosts the Proposal Platform: a novel online tool that enables interested parties from all over the world to contribute to ICD-11 content. Anyone can register on the Platform to propose updates, such as adding new medical terms or improving existing descriptions, helping keep the classification relevant and inclusive. As a public, transparent system, users can view or comment on other users’ proposals. Proposals are carefully reviewed by expert WHO committees through a transparent, multi-step process that ensures scientific accuracy and consistency. High-priority updates, like emerging health conditions, can be fast-tracked for quicker inclusion. Once a proposal is accepted, it becomes effective in the following update. A clear justification is provided for rejected proposals. Since ICD-11 came into effect, most suggestions from users have been successfully implemented. Objective: This article describes the proposal submission process, the rigorous proposal review process, and the roles of the WHO reference groups and committees involved. Conclusion: ICD-11 is a free, digital global health classification that anyone can help improve by submitting proposals through an open, transparent platform. Implications for health information management practice: This inclusive system empowers users worldwide to shape ICD-11 to reflect the evolving real-world medical and public health practice and emerging needs. This also prevents the need for country-specific modifications, ultimately improving the comparability of clinical data at the international level.