Application of Lean Concept to Improving Service Processes of Cardiovascular Clinic, Maharaj Nakorn Chiang Mai Hospital
Keywords:
Lean Concept, service process, cardiovascular clinicAbstract
Objective: To improve the service processes of the Cardiovascular Clinic, Maharaj Nakorn Chiang Mai Hospital, using the Lean Concept
Design: Developmental research
Methodology: This study employed a sample of 13 members of the Cardiovascular Clinic’s personnel and was conducted in three stages: pre-development, development, and post-development. The study sample was the number of observations of individual activities in the nursing service processes, ranging between 20 and 74 as calculated based on the standard time. The research instruments comprised 1) a table explaining activity types in the service process; 2) a process flow diagram; 3) an activity value analysis form; 4) an activity time recording form; and 5) group-interview question guidelines concerning obstacles to and recommendations for service process improvement. The data were analysed using descriptive statistics, namely, mean, SD, and range. The problems, obstacles, and recommendations were analysed using the content analysis.
Results: In total, four major service processes and 19 individual activities were improved through the Lean Concept, with the number of individual activities reduced from the pre-development stage by three. The standard duration of an improved service process was 93.59 minutes, which was 36.07 minutes faster than the pre-development duration. The major obstacles and recommendations identified concerned 1) the administration; 2) the personnel; 3) the communication; and 4) the equipment.
Recommendations: Nursing administrators can use the findings of this study as baseline data to implement the Lean Concept to improve the quality of service provided by other units within the organisation.
Downloads
References
Rotter T, Plishka C, Lawal A, Harrison L, Sari N, Goodridge D, et al. What is lean management in health care development of an operational definition for a Cochrane systematic review. J Educ Eval Health Prof 2018; 20(10): 1-25.
Chung S, Johns N, Zhao B, Romanelli R, Pu J, Palaniappan LP, et al. Clocks moving at different
speeds. Medical Care 2016; 54(3): 269-76.
Skeldon SC, Simmons A, Hersey K, Finelli A, Jewett MA, Zlotta AR , et al. Lean methodology improves efficiency in outpatient academic uro-oncology clinics. Urology 2014; 83(5): 992-8.
Gjolaj LN, Campos GG, Olier-Pino AI, Fernandez GL. Delivering patient value by using process improvement tools to decrease patient wait time in an outpatient oncology infusion unit. JCO Oncol Pract 2015; 12(1): 95-100.
Almomani I, AlSarheed A. Enhancing outpatient clinics management software by reducing patients’ waiting time. J Infect Public Health 2016; 9(6): 734-43.
Naidoo L, Mahomed OH. Impact of Lean on patient cycle and waiting times at a rural district hospital in KwaZulu-Natal. Afr. J. Prim. Health Care Fam 2016; 8(1): 1-9.
Radnor Z, Boaden R. Lean in public services-panacea or paradox. Public Money & Management 2008; 2: 3-7.
Lawal A K, Rotter T, Kinsman L, Sari N , Harrison L, Jeffery C, et al. Lean management in health care: definition, concepts, methodology and effects reported (systematic review protocol). Systematic Reviews 2014; 3(1): 103.
Sullivan P, Soefje S, Reinhart D, McGeary C, Cabie ED. Using lean methodology to improve productivity in a hospital oncology pharmacy. Am J Health Syst Pharm 2014; 71(17): 1491-8.
Maharaj Nakorn ChiangMai Hospital. Clients statistics. Chiang Mai: Faculty of Medicine, Chiang Mai University; 2018. (in Thai)
Outpatient and Emergency Nursing Section. Services cycle time reports. Chiang Mai: Outpatient and Emergency Nursing Section, Faculty of Medicine, Chiang Mai University; 2017. (in Thai)
Womack JP, Jones DT. Lean thinking : banish waste and create wealth in your corporation. New York: Simom & Schuster; 2003.
Barnes RM. Motion and time study. New York: John wiley & Sons; 1958.
Boonjai S. Strategic management of health care system in An Era of Asean Economic Community. Bangkok: Tammasat University; 2017. (in Thai)
Gholizadeh L, Asl IB, Hajinabi K, Dehkordi PR. Critical success factors of lean management: an investigation of factors affecting lean management in public hospitals in Kohgiluyeh and Boyerahmad and Bushehr provinces. Int Arch Health Sci 2018; 5(4): 126-30.
Callaway NF, Park JH, Maya-Silva J, Leng T. Thinking lean: improving vitreoretinal clinic efficiency by decentralizing optical coherence tomography. Retina 2016; 36(2): 335-41.
Wannasiri U. Implementation of lean concept in healthcare service sector for reducing waste system: a case study of radiotherapy department tertiary hospital. Naresuan University Journal: Science and Technology 2016; 24(3): 75-85. (In Thai)
Kelendar H, Mohammed MA. Lean and the ECRS principle: developing a framework to minimise waste in healthcare sectors. IJPHCS 2020; 7(3): 98-110.
Grout JR, Toussaint JS. Mistake-proofing healthcare: why stopping processes may be a good start. Bus Horiz 2010; 53(2): 149-56.
Young FY. The use of 5S in healthcare services: a literature review. IJBSS 2014; 5(10). 240-8.
Khunpolkaew C. Digital lean, a new dimension of production and services in the 4.0 era. Investor Club Association 2019; 18 :15-8. (In Thai)
