The streaming of patients into groups of patients cared for by a specific team of doctors and nurses, and the minimizing of complex queues in this ED by altering the practices in relation to the function of the Australasian Triage Scale improved patient flow, thereby decreasing potential for overcrowding.
Lean thinking is a method for organising complex
production processes so as to encourage flow
and reduce waste. While the principles of lean
thinking were developed in the manufacturing
sector, there is increasing interest in its application
in health care. This case history documents
the introduction and development of Redesigning
Care, a lean thinking-based program to redesign
care processes across a teaching general hospital.
Redesigning Care has produced substantial
benefits over the first two-and-a-half years of its
implementation, making care both safer and
more accessible. Redesigning Care has not been
aimed at changing the specifics of clinical practice.
Rather, it has been concerned with improving
the flow of patients through clinical and other
systems. Concepts that emerged in the manufacturing
sector have been readily translatable into
health care. Lean thinking may play an important
role in the reform of health care in Australia and
elsewhere.
Abstract. Flinders Medical Centre was experiencing issues with timely discharge and knowing the potential discharges and in-patient bed capacity for the next day. This case study describes the application of 'visual management' theory to discharge processes. The solutions developed were 'patient journey boards' and 'discharge traffic lights'. The implementation of these visual management systems has enabled the hospital to improve its discharge processes.What is known about the topic? Communication is critical to the delivery of safe patient care. There is little in the literature on the use of visual management principles and techniques in healthcare. What does the paper add? This paper provides a brief overview of visual management principles and gives two case study examples showing the development and implementation of visual management systems in an acute hospital setting to promote safe and efficient patient care. What are the implications for practitioners? Practitioners can learn visual management principles and how these have been applied to an acute healthcare context.
Despite good quality evidence for benefits with its use, challenges have been encountered in the correct and consistent implementation of the surgical safety checklist (SSC). Previous studies of the SSC have reported a discrepancy between what is documented and what is observed in real time. A baseline observational audit at our institution demonstrated compliance of only 3.5% despite a documented compliance of 100%. This project used quality improvement principles of identifying the problem and designing strategies to improve staff compliance with the SSC. These included changing the SSC from paper-based to a reusable laminated form, a broad multidisciplinary education and marketing campaign, targeted coaching and modifying the implementation in response to ongoing staff feedback. Five direct observational audits were undertaken over four Plan–Do–Study–Act cycles to capture real-time information on staff compliance. Two staff surveys were also undertaken. Compliance with the SSC improved from 3.5% to 63% during this study. Staff reported they felt the new process improved patient safety and that the new SSC was easily incorporated into their workflow. Improving compliance with the SSC requires deep engagement with and cooperation of surgical, anaesthesia and nursing teams and understanding of their work practices and culture. The prospective observational audit highlighted an initial 3.5% compliance rate compared with 100% based on an audit of the patient notes. Relying solely on a retrospective paper-based model can lead to hospitals being unaware of significant safety and quality issues. While in-person prospective observations are more time-consuming and resource-consuming than retrospective audits, this study highlights their potential utility to gain a clear picture of actual events. The significant variation between documented and observed data may have considerable implications for other retrospective studies which rely on human-entered data for their results.
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