Improving Patient Flow Using Lean Methodology: an Emergency Medicine Experience

Abstract

Lean I Quality improvement I Patient flow I Emergency medicine I Pediatrics I Continuous performance improvement I Process I Waste I Value Opinion statement In today's rapidly changing health care milieu, organizations are expected to continuously improve the quality of care delivered to an expanding population of patients. To do so, they need a framework for developing, testing and implementing changes. Lean provides a methodology to engage workers and leaders to identify waste in a process, develop standards, implement a change, assess the results of that change, review next steps, and repeat the process. This can be successfully accomplished in the highly variable world of emergency medicine and can help health care providers be more productive, engaged, and satisfied while enabling patients to receive the value-added care they want and expect. Successful implementation of Lean or any other improvement framework requires that the hospital and medical leadership are all strong supporters of the methodology, speak the same process improvement language and are able to generate support and resources for operation-wide forward movement.

Effects of Lean Healthcare on Patient Flow: A Systematic Review

“…In contrast, if the goal is to maximize quality improvements and cost savings, then LH interventions or similar methodologies (eg, the Virginia Mason Production System) must occur throughout the institution (ie, in both ambulatory care and inpatient settings). 20 Most of the reviewed studies that involved professionals from different areas in the lean team-whether multidisciplinary teams, 93 improvement teams, 85 cross-functional teams, 101 or Kaizen teams 89 -reported better performance in patient flow indicators. In fact, lean teams are vital in getting "buy in" from all the stakeholders involved, 116 mainly because lean continues to support a multidisciplinary problem-solving approach, as evidenced by the joint ownership of performance measures.…”

Purpose-orientated stocking of procedure trolleys saves time in busy emergency centres

“…[1] In today's rapidly changing healthcare environment, ECs are expected to continuously improve the quality of care delivered to an expanding population of patients. [2] This is also true in underresourced settings such as public facilities in South Africa (SA), where high patient volumes and acuity combine with overworked staff to lead to multiple quality challenges. [1] One of the most visible challenges relates to long waiting times, a common cause of patient dissatisfaction.…”

“…[5] Lean thinking begins with driving out waste so that all work adds value and serves the client's needs. [2,5] Identifying value-added and non-value-added steps in every process is the beginning of the journey towards Lean operations. [5] Substantial improvements in waiting times and patient outcomes have been achieved and sustained following Lean thinking-inspired changes to employee roles, staffing and scheduling, communication, workspace layout and problem solving.…”

“…[4] Lean practices can be successfully achieved in emergency care, and can help healthcare providers be more productive, engaged and satisfied while enabling patients to receive the quality of care they want and expect. [2] Numerous EC processes can be improved through Lean thinking, such as separate patient streams, structural changes, staffing changes and reorganisation of physical space; a recent review found that patient care improved after the implementation of Lean, with decreases in waiting times, length of stay, and proportion of patients leaving the EC without being seen. [4] A high proportion of EC patients need medical procedures, from intravenous (IV) line placement to lumbar puncture.…”

“…Inefficient storage and sourcing of routinely required consumables located on procedure trolleys result in time wasted when preparing for procedures, and this effect is magnified for tasks performed multiple times each day. [2] Procedure trolleys are clinical resource trolleys equipped with the essential equipment necessary to perform specific procedures in the EC. Following the principles of Lean thinking, a simple intervention that changes the way these trolleys are stocked may improve efficiency and reduce time wastage, thereby freeing staff to spend that time on activities that add more value.…”