Development of a Patient Discharge Process in a Surgical Ward by Applying Lean Concept at Lamphun Hospital

Abstract

Delays in discharge process affect the quality of patients’ cares, cost of services and patient’s satisfaction. The purpose of this study was to develop a patient discharge process in the surgical unit at Lamphun Hospital based on the Lean concept of Womack and Jones (2003).  The study population included 30 nursing staff, 9 nurse aids, 1 nurse assistant working in the surgical  unit  and the number of  activities in patient discharge process. The research instruments included 1) the patient discharge flow chart 2) the value analysis form 3) the duration of activities recorded form and 4) interview guidelines regarding problems and obstacles for patient discharge process improvement. The inter-rater reliability of two observers for the time recording was 0.84. Data were collected by observing the duration of the patient discharge process and were analyzed by using percentage, mean and Mann-Whitney U test. The results were as follows: 1) the new developed patient discharge process consisted of 4 major activities but decreased from 20 to 15 minor activities 2) The previous patient discharge process was 171.17minutes in average whereas the new patient discharge process was 129.24. Discharge process time was decreased by 41.93 minutes.  Average time spent in a new model was less than that in the old model at the significant level of 0.05.
3) The new process could eliminate wasteland in the patient discharge process, resulting in faster discharge and admission of patients but still having 3 problems, including 1) Organization: a large organization causes communication problems 2) Implementation: delays in processes related to outside agencies because of a high workload 3) Personnel: inadequate knowledge and understanding in the Lean concept. The administrators can apply the Lean concept to improve quality of services in other departments of the hospital to develop communication, practices and understanding of personnel in the whole organization .The results of the study show that the development of a working process using Lean concept is applicable, decreases working time, and maintains quality of nursing services.