Using a Combined Lean and Person-Centred Approach to Support the Resumption of Routine Hospital Activity following the First Wave of COVID-19

Abstract

The unexpected advent of the COVID-19 pandemic led to a sudden disruption of routine medical care, with a subsequent reorganization of hospital structures and of care. Case studies are becoming available in the literature referring to the logistical difficulties involved in a hospital resuming normal activity following the first COVID-19 lockdown period. This paper details the experience of a study site, a private hospital in Dublin, Ireland, in the redesign of service delivery in compliance with new COVID-19 prevention regulations to facilitate the resumption of routine hospital activity following the first wave of COVID-19. The aim was to resume routine activity and optimize patient activity, whilst remaining compliant with COVID-19 guidelines. We employed a pre-/post-intervention design using Lean methodology and utilised a rapid improvement event (RIE) approach underpinned by person-centred principles. This was a system-wide improvement including all hospital staff, facilitated by a specific project team including the chief operation officer, allied therapy manager (encompassing health and social care professionals), infection prevention and control team, head of surgical services, clinical nurse managers, patient services manager and the head of procurement. Following our intervention, hospital services resumed successfully, with the initial service resumption meeting the organizational target of a 75% bed occupancy rate , while the number of resumed surgeries exceeded the target by 13%. Our outpatient visits recovered to exceed the attendance numbers pre-COVID-19 in 2019 by 10%. In addition, patient satisfaction improved from 93% to 95%, and importantly, we had no in-hospital patient COVID-19 transmission in the study period of July to December 2020.

The impact of the COVID-19 pandemic on patient complaints within one Irish teaching hospital

“…This increased collaboration could possibly account for the lack of differences between the two time points as staff worked to reduce the negative impact of the pandemic on patients. Additionally, by Q4 of 2020, the Irish healthcare system had been managing COVID-19 for 6 months, and the initial lack of PPE and knowledge about the virus had somewhat abated, along with the return of elective and routine care [8,29]. Further inquiry into the standard of patient care during the pandemic is required to clarify whether the similarities in complaints across the two time points reflect a continuing level of care throughout the pandemic or whether other factors were at play that mediated this relationship.…”

“…The COVID-19 pandemic started in Ireland in March 2020 [27]. Elective healthcare was postponed, with staff redeployed to manage the virus and its impacts [8]. Visitors to the hospitals were also restricted, and patients were mostly unaccompanied by family members or advocates [27].…”

“…Healthcare staff experienced immense pressure during the early stages of the pandemic, with limited initial knowledge about the features of the virus or its transmission, a shortage of appropriate personal protective equipment (PPE), and the psychological strain of treating patients who were very sick with COVID-19 [4][5][6][7]. Two years on from the beginning of the pandemic, the true extent of the impact the virus has had on the safety and quality of care provided to patients is beginning to be understood [8,9].…”

Making a Sustainable Difference to People, Processes and Systems: Whole-Systems Approaches to Process Improvement in Health Systems

“…Eight out of the nine papers in this part of the Special Issue report on distinct process improvement projects in a single organization [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ]. Each of these papers outlines how the project achieved its process improvement goals, while taking a person-centred and systems perspective.…”

“…The key lessons from these projects are considered in a case study on whole-system change that is discussed below [ 11 ]. The quality and patient safety improvements reported in the papers include for example: using Lean and person-centred approaches to support the resumption of routine hospital activity following restrictions during the first wave of the COVID-19 pandemic [ 3 ]; a reduction of the length of stay for surgeries, leading to fewer healthcare-associated infections [ 4 ]; giving nursing and healthcare assistants time to care for patients [ 6 ]; an increase in capacity to deliver Basic Life Support across an organisation [ 8 ]; surgical notes transferred to electronic platforms to improve legibility and accessibility [ 9 ]. The other paper seeks to understand waste in the flow of care for patients in a referral emergency unit using process mapping and value stream analysis of patients in different pathways [ 12 ].…”