![]() Pursuing perfection is the point to which we must strive through continual improvement and eliminating wastes. LT is implemented according to five principles: ( Cruz and Leitner, 2010 Abdallah, 2020 Amaro et al., 2020): ![]() (1990) to describe TPS, which involves a series of methods and tools to continuously improve the efficiency and effectiveness of a system by eliminating waste. The term “lean” was first used by Womack et al. Toyota Production System (TPS) is based on the concept of eliminating waste or unnecessary interventions on the entire industrial process ( Ohno, 1988 Costa and Filho, 2016 Östlund, 2020). Lean Thinking (LT) emerged in the 1940s in the Japanese automotive industry, Toyota. Several methodologies have been used in the healthcare sector: health technology assessment between technologies ( Ricciardi et al., 2020a), machine learning algorithms to analyse data and improve clinical decision making ( Ricciardi et al., 2020b, c Improta et al., 2020 D'Addio et al., 2019) and Six Sigma (SS) to introduce and analyse new clinical pathway ( Improta et al., 2019a, b). However, there are several excellence-oriented management models based on the use of methodologies developed in the industrial and manufacturing sectors ( Nicolay et al., 2012 Antony and Kumar, 2012 Amrani and Ducq, 2020) but also spread in the transactional and services sector, with the aim of assisting, supporting and advising health policymakers ( Converso et al., 2012 Ran et al., 2020). The significant increase in healthcare costs has prompted hospital services to reinvent themselves to increase productivity, ensure quality of care and patient safety ( Costa et al., 2017 Lucchese et al., 2020 Cabrera et al., 2020). Healthcare spending has grown less than inflation, but the cuts have been justified with the need to maintain a balanced budget and to eliminate wastes and inefficiencies ( Report GIMBE Observatory n. The incidence of health expenditure on the Italian economy is relevant in this context at first glance, in absolute terms it has been growing steadily in recent years, in 2019 health expenditure of 118.560 billion is expected, equal to 6.6% of gross domestic product (Nota di aggiornamento del Documento di Economia e Finanza 2019). It is often needed to operate and reconstruct to restore the anatomy and the function of the tissues affected ( Wong and Wiesenfeld, 2018).ĭata from the AIOM/AIRTUM Report “I numeri del cancro in Italia 2019” indicate that around 9,400 new cases of head-neck cancer (lips, oral cavity, pharynx) are expected in 2019, 7.200 among men and 2.200 among women: they represent approximately 3% and 1% of all incident cancers respectively. The mouth also has an important aesthetic and communicative function that may be affected in case of big tumours and important surgical removal. Squamous cell carcinoma alone represents the 90% of all the malignancies of the oral cavity ( Chaturvedi et al., 2013). There are a lot of oral cancers depending on the histology: minor salivary gland cancers, odontogenic tumours, sarcomas, lymphomas and melanomas represent the 10% of the oral cancers ( Kumar et al., 2016). Oral cancer represents the sixth most common malignancy in the world. ![]() The full terms of this licence may be seen at Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Copyright © 2021, Antonella Fiorillo, Alfonso Sorrentino, Arianna Scala, Vincenzo Abbate and Giovanni Dell'aversana Orabona License ![]()
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