A lean case study in an oncological hospital: implementation of a telephone triage system in the emergency service

Abstract

Lean practices and thinking have increased substantially in the last few years. Applications of lean practices to health care are found worldwide. Despite that, new contributions are required because the application of lean thinking to hospitals has a long way to go. Lean practices and thinking do not include, in the literature or practice programs, any references to triage systems in health care units. The common triage systems require physical presence, but there are alternative methods to avoid the need to move patients: these alternative triage systems, given their characteristics, may be included in the spectrum of lean practices. Currently, patients that are already known to suffer from cancer are encouraged to go to hospital (public or private, with an oncological focus) when facing side effects from chemotherapy or radiation treatments; they are then submitted to a triage system (present themselves to the hospital for examination). The authors of this paper propose the introduction of telephone or email triage for impaired patients as a valid substitute for moving them physically, thereby often avoiding several unnecessary moves. This approach has, in fact, characteristics similar to a lean practice in that it reduces costs and maintains, if done properly, the overall service offered. The proposed ‘remote’ triage emerged from the results of a large survey sent to patients and also as the outcome of a set of semistructured interviews conducted with hospital nurses. With the results they obtained, the authors felt comfortable proposing this approach both to public and private hospitals, because the study was conducted in the most important, largest, and best-known oncological unit in Spain. As a final result, the health care unit studied is now taking the first steps to implement a remote triage system by telephone, and has begun to reduce the previously necessary movement of impaired patients.

Implementation of lean thinking in healthcare services: Why is it importance

“…The implementation of lean healthcare basically focuses on patient's value and preferences of the services. As shown in the Oncological Portuguese Institute Lisbon, which adopting lean thinking in the use of Telephone Triage System, they acquired 82.3% patient satisfaction regarding telephone care and resolution of the problem (14). Applying lean thinking to develop Triage system can decrease both arrivals to physician start time from 62.2 minutes to 41.9 minutes and also the admission waiting time from 54.76 minutes to 24.45 minutes (15,16).…”

Proceedings of III South Florida Congress of Development

“…care and the lean thinking of the Lean model of automotive production was recognized in health by the term Lean Healthcare (SUÁREZ-BARRAZA, SMITH, & DAHLGAARD-PARK, 2012), but in Brazil is a sector that is still developing(SOLIMAN et al 2017).According toDickson et al (2009) showed how to use Lean to improve emergency care in a hospital andCarvalho et al (2013) highlighted the potential of Lean Healthcare to improve the screening process of an oncology hospital.For Mazzocato et al (2010) Lean interventions in the health context triggers four mechanisms of change: Shared understanding of processes; the organization and design for efficiency and effectiveness; increased error detection and awareness of process reliability; and finally, collaboration for systematic problem solving and continuous improvement.…”

Uma análise das barreiras e dificuldades em lean healthcare

“…Especialmente a partir dos anos 2000, diversas organizações de saúde vêm buscando adaptar os conceitos do Lean à realidade de suas operações, o que na literatura ficou conhecido como Lean healthcare. As recentes publicações de Andreamatteo et al (2015); Holden et al (2015); Al-Balushi et al (2014);Drotz;Poksinska (2014) ;De Carvalho et al (2014);Teich;Faddoul (2013); Rinehart (2013); Burgess; Radnor (2013); Radnor et al (2012) demonstram este fato. O Lean Healthcare é tido como uma abordagem promissora para a solução de problemas que, há muito tempo, o setor vem tentando superar, especialmente em setores de alta complexidade como cirurgia e emergência (CASTALDI et al, 2016).…”