Applying Lean Principles to Develop a Care System for Patients Undergoing Robotic-Assisted Kidney Cancer Surgery at a Special Clinic

Abstract

Kidney cancer patients who have undergone robotic-assisted surgery and previously received pre- and post-operative care at a specialized clinic encountered challenges related to the limitations of the original care system. These challenges included overlapping activities between departments, nurses experiencing stress due to time constraints, and patients lacking comprehensive knowledge and confidence in self-care. In response to these concerns, nursing services have adopted Lean principles as a tool to improve the quality of the nursing system by focusing on eliminating waste, maintaining value-added activities to continuously develop a smooth workflow, reducing patient waiting times, decreasing the incidence of adverse events, and ensuring that patients receive standardized and safe care. After implementing this nursing system, various positive outcomes were observed: 1) Nurses provided knowledge and skill training to patients in a more systematic and standardized manner through the use of video media. 2) The number of repetitive activities was reduced by 11.  3) The time spent on the operation was decreased by 100 minutes. 4) Relatives correctly performed wound care techniques with a rate of 100%. 5) The cost of care was reduced by approximately 25,000–30,000 baht per case. 6) The length of hospital stay decreased from 5–7 days to just 3–4 days. 7) Patient and nurse satisfaction reached a very high level of 100%. 8) Nurse anxiety levels significantly decreased from 7.5 to 3.0 on a 10-point scale. 9) The job satisfaction rate among nurses, ranging from high to very high, was 100%.