# A Managerial Approach to Investigate Fall Risk in a Rehabilitation Hospital
## 1 Introduction
Since a typical objective of a DES is optimizing resources, quite recently, considerable attention has even been paid to assessing the applicability of DES in the context of healthcare resource modeling [21], thus demonstrating that DES can be integrated into multidisciplinary healthcare-oriented processes such as Health Technology Assessment [22; 23]. Simultaneously, even managerially inspired approaches have been proposed as a potential solution for both improving the knowledge and proposing intervention strategies in healthcare. For instance, in the healthcare field, the Stanford Biodesign Methodology (SBM) [24] has demonstrated the ability to improve several processes in the cardiovascular [25], nephrology [26], and surgical [27] fields. In the context of fall risk, [PERSON] et al. [28] proposed a combination of translational research principles alongside a modified version of the SBM. This methodology allowed one to think about possible lacks in current fall prevention strategies, and it suggested, among other routes, that breaking down silos between different healthcare professionals and the lack of enhanced interprofessional communications is one of the most overlooked factors. In addition to the SBM, other effective frameworks for producing systematic innovation efforts in healthcare have been proposed: among those, the Lean Six Sigma (LSS) strategy could be cited, which was developed by combining lean thinking and Six Sigma methodologies. Briefly, the former deals with the improvement of processes by eliminating the causes of possible deviation from the ideal standards of processes (e.g., wastes), while the latter focuses on the reduction in the number of errors and oscillations in processes by employing statistical and management tools. The previous literature has already proved that LSS in healthcare has helped to achieve objectives like controlling the increase in costs and improving procedure quality [29; 30; 31] in several medical specialties [32]. In the context of LSS, the define, measure-analyze-improve-control (DMAIC) cycle has frequently been the main one employed in Six Sigma projects as a possible problem-solving strategy [33; 34]. Similarly to the SBM, even the DMAIC cycle proved successful to face different healthcare processes and/or aiming at better achieving multiple healthcare needs [35; 36; 37; 38; 39; 40; 41] and, as proved in a previous publication of the research group, to improve the management of healthcare associated infections in the rehabilitation hospital of Bari (southern Italy) of the _Istituti Clinici Scientifica Maugeri_[42]. On the wave of the promising results achieved in this last study, we decided to employ this managerial approach even to test the fall risk. Although in the last decade, the study of this issue has attracted much attention from research teams, and the previous literature has already analyzed and compared various aspects of the fall risk, very few publications have presented studies where the LSS paradigm was used to investigate the fall risk in the context of rehabilitation hospitals. Moreover, to the best of our knowledge, in the context of a managerial study focused on the risk of falls, little attention has been given to the study of the factors that support the recurrence of falls among those seeking inpatient care and the potential consequences (for both the hospital and the inpatients) on the designed rehabilitation programs. To evaluate these aspects, in this paper, we focus on studying the falls monitored in the rehabilitation hospitals of Bari of the _Istituti Clinici Scientifici Maugeri_.