The Development Care Process of Diabetic Retinopathy Patients by Lean Concept

Abstract

This participatory action research (PAR) has the objective of 1) improving the service process for diabetic retinopathy patients at the Eye clinic, Udonthani hospital. 2) compare the procedure, waiting period, satisfaction of patients and personnel before and after the procedure for treating diabetic      retinopathy. After applying the concept of Lean to be used as a routine, in the sampling group, there were 21 personnel in the Eye clinic and 38 patients in the diabetic retinopathy group, calculated by the G*Power program. Purposive sampling was selected. Collected data during March 2022 - June 2022. The research instruments included a general data record form, a satisfaction assessment form, a timing    recording form for each sub-activity of the service process, value stream mapping (VSM), and a waste analysis tool that used DOWNTIME to design an operation to be used in the service process. Validated by 3 experts, Cronbach’s alpha coefficient test, the reliability of the personnel satisfaction assessment pre-lean was 0.69, and the patient satisfaction assessment pre-lean was 0.68, comparing the mean   waiting time and satisfaction of patients and personnel before and after the development by Mann Whitney U-Test.

The results of the study found that applying the idea to the process serving diabetic retinopathy patients, the service process can be reduced from 13 to 9, and lead time is reduced. The mean of    process time (PT) is reduced from 58.25 minutes to 51.98 minutes, delayed time (DT) is reduced from 306.98 minutes to 137.55 minutes, pre-doctor time is reduced from 73.29 minutes to 48.40 minutes. Total cycle time spent in the process from the beginning (total turnaround time: TAT) decreased from 365.23 to 189.53 minutes. The mean patient satisfaction scores after applying other concepts increased from 34.05 points (S.D.=2.95) to 41.74 points (S.D.=2.51), with statistical significance (p-value < 0.001). The average personnel satisfaction score increased from 56.90 points (S.D.=3.08) to 65.90 points (S.D.=5.88), with statistical significance (p-value < 0.001).