Introduction: The basic postulate of the lean concept is that greater efficiency of the work process can be achieved through a process of continuous improvement,which aims to eliminate waste and maximize activities that add value.The Netherlands, Great Britain, Italy and the United States were examples of healthcare systems that implemented the lean concept.Aim: To examine the opinion of health workers of a public hospital in the Sarajevo area about the possibilities of improving business processes by implementing thelean concept.Method: The cross-sectional study was conducted using a questionnaire. The questionnaire was sent to the e-mail addresses of health workers of public health organizations. 91 respondents of both sexes (doctors ofmedicine, residents, registered nurses, nurses and administrative staff) were included.Results: A positive correlation was establishedin the attitude toward the effectiveness and efficiency of business processes. According to the participant’s opinion, the greater effectiveness of business processes contributes to greater efficiency (r=0.846; p<0,05). Spearman’s coefficient rs=0.81 shows a strong connection between the effectiveness and efficiency of business processes.Conclusion: The study showed that there is a positive attitude towards the impact of the lean concept on improving the efficiency of business processes. The reducexpected positive effects of the implementation of the lean concept are manifested through faster provision of services to patients, reduction of service waiting times and general improvement of business processes.

Introduction. Lean principles have been successfully adapted to the healthcare environment, enabling hospitals and clinics to streamline their operations and focus on value as perceived by their patients. Many healthcare facilities have implemented lean principles to improve their efficiency. The subject of this paper is the lean concept, the essence of which is implementation of methods that affect the efficiency and quality of providing health services. Our aim was to point out the necessity of applying modern concepts in healthcare. Material and Methods. The primary sources of data were obtained through research on the opinions and possibility of applying the lean concept in hospitals in Bosnia and Herzegovina. We presented the results on the effectiveness of the lean concept in hospitals that apply it. Results. After implementation of the lean concept in an Italian hospital, the results showed a positive impact on the waiting time for admission, faster discharge, and faster flow of information. The results of the research in Bosnia and Herzegovina showed that there were positive attitudes towards the effects that would be achieved by implementing the lean concept. Conclusion. The implementation of the lean concept would reduce medical waste, which would positively affect the quality of health care services.

: Introduction Th e concept of the quality of healthcare services is constantly evolving and transforming depending on the interest in it and the level of involvement of medical sta ff and patients. Aim To assess patient satisfaction with the quality of health services in private practice condition. Methods 105 (n=105) subjects participated in the study, and it was conducted by an anonymous survey of the clinic which o ff ers medical services, tests, and diagnostic procedures in the fi elds of gynecology, internal medicine, surgery, radiology, urology, and neurology. Th e research was conducted among patients who used the health services of a private practice institution from January to September 2022. Th e patient questionnaire consisted of 14 questions. Five questions related to identifying the sociodemographic characteristics of the respondents, and 9 questions were research questions of the Lickert type. For this purpose, the standardized Laschinger HCAHPS ( Hospital Consumer Assessment of Healthcare Providers and Systems ) questionnaire on patient satisfaction with the quality of healthcare services was used. Di ff erences in numerical variables were tested by Student’s t-test or analysis of variance (ANOVA). All P values are two-sided (p<0.05). Th e statistical program MedCalc Statistical Software version 18.2.1 was used for statistical analysis. Results Th e research was conducted on 105 patients, 28% of whom were male and 72% female. Most patients were in the age group of 61 to 70 years (30%). Patients are satis fi ed with the quality of healthcare services. Th e highest average score for reception and waiting time (4.9), the lowest score for being informed about upcoming interventions and treatments and professional approach (4.68). Conclusion Patients show a high degree of satisfaction with the general services provided.

Introduction: Emergency cerclage in the second trimester is aestablished treatment for a dilated cervix. Aim: To report a case of a successful cerclage performed in a 33-year old woman in her secondpregnancy, after 5 years of non-successfulpregnancy outcomes. Case report: In her fourth month of pregnancy, the patient was hospitalized because of suprapubic pressure. After complete laboratory results, ultrasound and vaginal examination the patient was diagnosed with cervical shortening, cervical canal was opened 3cm, with prolapse and bulging of the fetal membranes in vagina. An amount of 120 ml of clear amniotic fluid was removed transabdominally under ultrasound guidance, and sent to the microbiological and genetical analysis. McDonald emergency cerclage of the cervical canal was performed. Patient was monitored few days on department and released home with advice of strict reduction of activity to minimum, and prescribed therapy due to that: antithrombotic, progesterone and antibiotic therapy. Conclusion: Amnioreduction at the time of emergency cerclage placement is associated with a lower rate of extreme prematurity and related neonatal morbidity. Successful outcome is not impossible, along with adequate antibiotic regimen, bed rest and regular obstetrical control/checkup.