Friday, January 28, 2011

Less waiting as a result of Lean around the world

Bangkok Blog#4 – Written on Wednesday, January 26, 2011 

By Michele Jordan, VP Quality Improvement and Transformation, RVHS

Sawadee Ka!  (That means ‘hello’ in Thai.  Actually Sawadee means hello and ‘ka’ is added because I’m a female).  The Thai people are so friendly and welcoming that I’m starting to feel like a local.  I can see why they call Thailand ‘the land of smiles’.

Day 3 of the conference was a fantastic experience.  We visited two hospitals to see their Lean improvements. First stop was the Saohai Hospital .  This is a small, rural hospital located about 90 minutes outside of Bangkok so we boarded our convoy of vans around 6:30am.  The hospital has 30 beds and an occupancy rate of 82%.  They serve an average of 280 outpatients daily.  There are 3 doctors, 2 dentists, 3 pharmacists, 48 nurses, 4 medical technicians and 100 supporting staff.  The hospital is a beautiful open-air facility that resembles a spa more than an institution.  This is not a far-fetched comparison because the hospital offers a blend of modern medicine and alternative medicine including massage, acupuncture, infrared sauna, music therapy, 'past life regression' and more.

As we disembarked from the van we were greeted by several hospital staff who presented each of us with a beautiful bracelet made of flowers.  We proceeded to a large auditorium where, to our surprise, we were treated to a local dance performance.  This was followed by a formal presentation on the hospital’s Lean initiatives.   Like all of the demonstration projects, Saohai began their Lean journey in mid/late 2008.  For a small facility they have made tremendous progress.  One of their projects focused on reducing the waiting time in their outpatient diabetes mellitus clinic.  They implemented visual management, a 6S, an A3 and a series of kaizen events.  The biggest change they put in place was to work with the 13 Primary Care Units (PCUs) in the community to reassign roles.  Before Lean, patients arrived at the hospital clinic very early in the morning so they could have their blood taken before seeing the doctor.  Now, patients are asked to go their local PCU the day before their clinic appointment to have their blood taken by the PCU.  For many patients this reduced the travel distance significantly and meant they didn’t have to come as early to their clinic appointment.  Skype is used for communication between the PCUs and the hospital clinic if needed.  When one considers that the 13 PCUs are completely separate from the hospital, this is a huge system integration achievement. Here are some of the results of this initiative:
·         Reduced total Turnaround time in the clinic from 258 min to 196 min (59% improvement)
·         Reduced waiting time for consultation with the doctor from 72 min to 30 min (58% improvement)
·         Increased patient satisfaction rate from 81% to 91%

They have also used Lean techniques to educate and empower patients to use self-care.  After lunch, more dancing and group picture we boarded the van for our second stop – the Saint Louis Hospital in Bangkok .  The two hospitals are in stark contrast to one another.

Saint Louis is a non-profit, private general hospital that is run by the Sisters of Saint Paul de Chartres.  The 500-bed facility is extremely modern and includes escalators, a new state of the art cardiac clinic and a large board room with computer terminals and microphones at every seat.

The hospital leadership is strongly committed to Lean.  They said that they chose Lean because it fits well with their vision – ‘to be a leader of hope in health care and health promotion’. Their first Lean project was focused on improving the cardiology outpatient care process.  Improvements include:  setting up a schedule to phone patients 3 days after their visit, streamlining the process for preparing the medical record, creating a handover sheet for the patient’s next clinic/service, using visual controls and standard work.  The biggest change was renovating the entire clinic based on Lean’s cell concept.  The cell concept requires co-locating all the services that are part of the patient’s value stream in one area to reduce walking for the patient/family. They also have several large screen monitors that display who and how many patients are waiting for each doctor at any given time.   These changes have resulted in a 23% reduction in the waiting time for doctor consultation (from 43 min to 33 min); a 20% reduction in total patient turnaround time (from 186 min to 149 min), improved patient satisfaction and improved staff satisfaction.

This hospital also used Lean to improve the non-emergency patients care process in the ED. An analysis of ED volumes by time of day found that the peak period is between 4pm to 10pm (just like at RVHS) so the team focused their efforts on this time period. They set up a new flow for patients who need only medical treatment and set up a new medical treatment room near the ED.  Patients who just require a wound dressing and are not first time patients are seen and treated by a nurse.  Cycle time and takt time calculations have been used to establish a process control board that lays out the timing for each step in the dressing change process. They introduced lots of visual management and standard work is posted in the department.  An x-ray alert card has been created to communicate when x-ray results are ready.  This hospital has empowered and trained nurses to function independently.  They can order x-rays before the doctor has seen the patient to reduce waiting time.  As a result of all these changes they have improved ED turnaround time by 69% - from 96 minutes to 30 minutes!

Saint Louis Hospital has a clear plan for where they wish to go with Lean.  They have a ‘Lean Council’ and invest in training. They are introducing a ‘unit optimization’ program whereby each unit will be asked to identify 3 priority problems they need to fix and they will pick one problem to work on.  There will be awards for the best performing teams.

All in all, this was a very interesting day. Both hospitals – one large and one small- have made very impressive progress and seem motivated to stick with Lean for the long term.

Read Bangkok Blog#1
Read Bangkok Blog#2 
Read Bangkok Blog#3 

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