Lean management in healthcare

Process management in Emergency Room

The main purpose of value stream mapping is process improvement. If in current process are present mistakes, long waiting time for example: patient waits for medical counsel or wait for results of laboratory tests, it should be analyzed in order to find out root causes of that situation. Main output will be lists of process improvement ideas and implement it. It is called future state map. To collect all relevant data you should be in GEMBA, in place where everything works. It could be Emergency Department, operating theatre, physician room.

All activities the patinet undergoes during the hospital stay were measured in order to present actual process including time duration of each stage. Analysis were conducted from patient point of view. The patient is main initiator every activities and medical services, for patient demand process starts. Process mapping is lean management healthcare element.

Process of realization of medical services in emergency department

Process has steps as follow:

  1. Patient notification in emergency department. Waiting for register in register point.
  2. Patient goes from register point to waiting room. Waiting for physician counsel.
  3. Enter to physician room and describe symptoms of illness. Conduct interview and physical examination. Conduct USG.
  4. Refer patient for RTG examination. Patient goes to another floor, to another room in hospital building.
  5. Patient waiting for RTG examination. Patient signs documents and is being examined by radiology technician.
  6. Patient goes to another floor and waiting for blood tests.
  7. Blood specimen collection. Syringe had to be re-insert in another place. (MISTAKE-MUDA)
  8. Patient comes back to waiting room next to physician room. Waiting for medical counsel.
  9. Patient enters to physician room and receive refferal to next USG examination.
  10. Patient goes to another floor, to USG room.
  11. Conduct USG examination by specialist
  12. Patient comes back to waiting room. Waiting for medical counsel.
  13. Patient enters physician room, analysis blood, USG, RTG analysis. Discussion about results, recommendation and prescription. Patient monitors symptoms, if needed comes back to hospital.
  14. Patient goes to hospital reception desk.
  15. Patient receives authorized documents- medical records and prescription.
  16. Exit emergency department.

Based on above list we created current state map. Between described activities patient moved from one room to another to be examined. From lean healthcare point of view, patient moving is defined as waste – muda. Next identified wastes were waiting and mistake.

Total lead time equals to 164 minutes. The time identified as value added equals to 65 minutes, time as non value added equals to 99 minutes.

Healthcare approach

In order to make process more smoothly, proposed to implement lean healthcare approach, reducing wastes. All rooms could be located next to each other on the same floor as physician room in emergency department. It causes that time dedicated for moving would be shorter. Also work in physicial room could be improved. The purspose it to make lead time shorter.

Results are presented on photo below.

Value Stream Mapping table

Total lead time is shorter from 164 minutes to 68 minutes. Time dedicated for non value added activities – muda was reduced about 94%! Process optimization relates to use lean healthcare tools:

  • 5S
  • visual management
  • leveling work (heijunka)
  • spaghetti diagram and layout analysis
  • Kanban system

If you are interested in value stream mapping contact us!