+1-817-968-5551
+61-488-839-671
+44-7480-542904About Expert
Key Topics
Requirement
PART 1
Identify 3 projects in your own work organisation which can be improved employing one of the improvement tools used in Lean Management. Each project should employ one tool of your choice (3 tools in total). You may employ a tool which has not been taught during the course.Word Count: 2500-2600 excluding references if any
Solution
ABSTRACT
The purpose of this assignment is to evaluate the effectiveness of Lean Principles in the Healthcare domain. Lean as a concept has been well established in the Manufacturing Industry especially Automotive. The principles are yet to be successfully implemented in many segments of the service industry. Healthcare, in particular, has been a late adopter of Lean (in 2002) in comparison to the Auto Industry where Lean principles were adopted in the early 1940s. There have been several studies on such an implementation in Healthcare. However, not all of them base their claims on very solid grounds. The effects of Lean in healthcare present a wide opportunity for improving the service processes along with other factors mentioned during the course of this assignment.
If you want an assignment sample like the one above, get medical surgical nursing assignment help from the talented experts of Allassignmenthelp.com. Our psychoanalysis assignment experts are quite experienced and professional and thus can handle any type of unique and rare assignments related to psychoanalysis. We also provide last minute assignment help to the students who usually forget to complete their assignments
INTRODUCTION
Healthcare sector in the Western hemisphere faces serious budget problems. With the advent of technology and research, the number of ailments that can be treated, has risen exponentially. Since the average life expectancy has also increased, there is a high dependence of aged people on these services. The older population demands more care, leading to increased consumption of these services. Capital and operating expenditures have increased significantly over time with little help from the government authorities and insurance companies. Pumping in more capital in the industry is only a short term solution to these inherent problems. In the long term, Healthcare institutions have to figure out ways to reduce costs and simultaneously match the demand. Thus, factors like patient waiting times and staff satisfaction have to be taken into account without affecting the quality of treatment. Redesigning procedures, though challenging, is a low hanging fruit which has potential of increasing both efficiency and productivity. “Lean” can simultaneously improve quality, morale and productivity (Fillingham, 2007).
STREAMLINING PATIENT FLOW USING VALUE STREAM MAPPING
As perKoning et al (Koning, 2006), a Value Stream Map is the “primary analytical tool” in bringing about a lean transformation. It is an “extended process flowchart with information about speed, continuity of flow and work in progress that highlights non-value added steps and bottlenecks” (Koning, 2006). A Value Stream map will help in understanding the flow of customer which is a patient in this case.
The VSM conducted at Torsby Hospital (A Case study conducted at Torsby Hospital, 2012), revealed different types of wastes (Muda) that can be eliminated. The findings for the same are as follows:
Scope
From the time the patient walk in to the hospital, till the time the patient is discharged.
Study
Following process flow was identified:
-
Patient referral to the medicine clinic
-
Patient books an appointment.
-
Patient arrives at the facility
-
Patient waits in the waiting area
-
Preliminary examination by a specialist
-
Prescription of lab tests by the specialist
-
Diagnosis and information about the treatment plan
-
Patient either goes home to follow the treatment plan, or, Is admitted in the facility
-
Patient registration for admission in the ward
-
Daily treatment and Specialist visits
-
Treatment is completed and patient is discharged, or,
-
Patient undergoes extended treatment in home care services.
-
Discharge patient if support from municipal services is available(A Case study conducted at Torsby Hospital, 2012).
Patient waiting time was the biggest waste identified. According to the findings, a patient, at times, has to wait for upto three months to get hold of a specialist. This can be fatal for some of the patients. To reduce this, following opportunities were identified (A Case study conducted at Torsby Hospital, 2012):
a. The process of referring at the primary health centers could be shifted to medical clinics. This would reduce the waiting time in a significant way
b. Specialists booked for appointments should not be given duties such as the ER. The hospital should have one specialist as a backup to fill in for the other.
-
Over processing: Too much time was spent in documentation. In some cases, the documentation wasn’t even relevant to the disease or treatment the patient had come for. The key take away here is that forms and other documentation should be customized according to the nature of the disease. This will reduce the waiting time to a great extent. Opportunity identified here was Standardization of treatment procedures. For instance, a nurse could directly consult a doctor for a test as simple as a blood test. Procedures like these can be inbuilt into the system. Also, it is very important that the entire medical staff follows the built procedures. Since these will be customer facing processes, they can prove to be value adding processes.
-
Excess Inventory: Here the identified inventory was because of unnecessary holding of patients who could have very well been discharged. This is the case with patients who are old, aged, disabled, and/or in need of special services like the home care services. Whenever such a patient is critical, the norm is that the facility has totake care of the patient for seven days. Need of the hour here is a proper information flow between the facility and the Municipal Department. A person should be employed to pass this information as and when the patient has recovered or the treatment is over. This will not only expedite the relieving process but will also reduce the waiting period for patients who would be in need of this inventory. For this to happen, it is necessary that a proper and effective channel of information is created between the medicine department, the home care services and the hospital.
Place Order For A Top Grade Assignment Now
We have some amazing discount offers running for the students
Place Your OrderIMPLEMENTATION USING KAIZEN
The basic principle on which kaizen works is pull rather than push (Laursen, 2003). This gives rise to future improvements in the current state.
Reasons for adoption in Healthcare include factors such as increasing focus on condition and disease specific treatments like children immunization; rapid expansion leading to increase in number of patients, increase in competition and cumbersome claims & reimbursements process. Moreover, the California Healthcare Foundation (CHFC) sought the following:
-
Feasibility of lean in a community clinic
-
Key outcomes of such an implementation like efficiency, staff engagement, both patient and customer experiences
-
Information about facilitators, challenges, and other feasible options
In a case study of a Community Health Centre, Kaizen and 5S principles were used to increase resource availability and understand metrics such as cycle time and facilitate employee buy-in. The implementation resulted in the following outcomes (Implementation of Lean in a Community Health Center, 2012):
a. Efficiency:
-
Decrease in prescription wait time from 3 hours to 45 minutes
-
Quicker referrals
-
Faster documentation
-
“Third available appointment” – is “a measure of access to care- the average number of days between the day a patient requests an appointment with a physician and the third available appointment” (Implementation of Lean in a Community Health Center, 2012). This led to an increase of 0.75 days on an average compared to clinics without
Kaizen events
-
Reduction in appointment completion rate from 64% to 72%. “Appointment completion rate” is defined as “ratio of completed appointments to available appointments in a given month” (Implementation of Lean in a Community Health Center, 2012). The increase was because of factors like reorganization of care coordination and outreach call to patients.
-
Increase in Provider Productivity: This is a measure of average number of patients seen per hour by the clinic provider (Implementation of Lean in a Community Health Center, 2012). Examination time reduced by 10 minutes
b. Cultural change within the Organization
-
Improved teamwork and lesser blame-games: It led to increase in metrics like Job engagement, affective commitment, employee satisfaction, safety perception, punitive response perception and punitive response behavior
-
Reduction in wait times led to higher customer satisfaction
c. Employee Engagement
-
Higher employee satisfaction
-
Staff found their work more relevant and value adding
Key takeaways and recommendations include:
• Change Management:
-
Build confidence within the staff
-
Plan must suit to the organization’s budget, goals, and timelines. This will also bring about a cultural change in the organization
-
Changes attributed to Kaizen must be communicated to different functions within the organization
• Leadership Involvement
-
Lean methodology has to be built top-down in an organization.
-
Top and middle level management must be trained as to how to indulge the lower level staff in these activities
-
Contrary to the top-down approach, the implementation has to happen bottom-up
LEAN IMPLEMENTATION IN ACCIDENT & EMERGENCY DEPARTMENTS
Healthcare organizations are function based and have less focus towards the individual needs of the patients. Many such organizations are adopting lean methodology to integrate better healthcare delivery mechanisms into their existing processes. Many literature reviews document the effectiveness of lean methodology in Healthcare institutions. These address problems like crowding, treatment delays, cost containment, and patient safety. Many reviews have been conducted involving different patient streams. These have often led to changes like adoption of new technologies and communication systems, changes in staffing and scheduling, and the relaying of the facility. Healthcare has shown improvements after implementation of Lean in many instances.Quite a few Emergency Departments(EDs) have reported a significant decrease in length of stay, waiting times, and proportion of patients leaving the ED. There have been fewer instances where a negative feedback was received from the patients. Also, there have been absolutely no instances of wrong treatments on grounds of patient safety or treatment quality(RJ, 2011). Holden's recent review in this field also resonates with this idea of lean implementation. Most published examples of lean in healthcare, point towards the usage tools such as process mapping, to achieve short-term improvements (L, 2009)(Mazzocato P, 2010)(Radnor Z, 2008). Efforts are seldom taken to involve ground level staff and management in structured problem solving(B, n.d.), and only fewer times, lean methodology makes through an organizational-wide strategy(Radnor Z, 2008).
The case considered here is a “mixed methods explanatory single case study”(RK, 2003)(Fisher I, 2004) relating to lean inspired improvement initiatives at the pediatric section of the A&E. challenges faces by A&Es are similar to those of other Healthcare institutions. These include absence of standardization leading to process and flow problems, fragmentation of processes and poor coordination between them. The study constituted both qualitative and quantitative components. The quantitative component helped in tracking the operational performance changes over time. It also helped in comparingA&E performance before and after the lean based improvement. Performance measures considered were (a) percentage of patients discharged from the A&E within the first 4 hours, and (b) waiting time, counted from triage to first assessment by a doctor or a specialist(Pamela Mazzocato, 2012). The qualitative component described lean methodology and provided data to help explain how the method worked herebasisfour lean principles (Pamela Mazzocato, 2012). Lean principles lead to high performance levels as they (a) standardize work, thereby, reducing ambiguity, (b) connect people who have high dependency on one another, (c) bring about seamless, uninterrupted workflow throughout the process, and (d) give power to investigate processes and to test and develop countermeasures in case of failure of the process. The pre-lean process used a triage system (Pamela Mazzocato, 2012) that specifically addresses the needs and characteristics of pediatric patients. This was primarily inspired by a triage system named ADAPT (Adaptive Process Triage) (Nordberg M, n.d.), that is in use in Sweden. It works in the following sequence. A nurse enters patient informationinto an electronic health record. Nature of emergency is determined, basis which, the patient is either kept in a waiting or holding area, or sent to medical room. The health record of the patient is extracted and printed. The patient is then sent to the treatment room. In this case, preliminary assessment and treatment was done by nurses and assistants (mostly residents). Lacking the specific skillset, they conducted these at their own pace and in their own style. In case of need of further assistance, referrals were wired to other departments. After the test results were obtained, the consultation wascontinued until a decision was made that the patient needs to be further treated, admitted or discharged. The A&E in consideration, had only one senior staff. This senior physician supervised residents, answered phone calls from primary care, hosted seminars, took referrals, and made rounds on wards. This delayed care further (Pamela Mazzocato, 2012).
The first step in bringing about process improvement was to mapthe current process, identify the patient inflow (expressed as the average number of patients, generally classified by the hour of arrival over a 24 hour period), review performance data and examine sources of waste-"non-value adding time". Waiting time to see a physician, including the first contact with physician and the follow-up assessment after the necessary investigations, were identified as the most crticial sources of waste (Pamela Mazzocato, 2012). It was found that a mismatch in capacity and demand was a major contributor to non-value adding waiting time. The root cause of this mismatch was found to be: inefficient working procedures; inadequate number of senior physicians (there was only one senior physician on duty who managed several competing tasks in parallel), employees mapped tomultiple and simultaneous tasks which led to workflow interruptions, inadequate resources (such as staffing) and capacity planning (staff scheduling was not done as per regular demand patterns) (Pamela Mazzocato, 2012). Specific goals were identified which included: reduction of the average time beginning from patients' arrival until initial assessment by a physician to 40 minutes; and reduction in the length of stay at the A&E so that 90% of all patients leave within the first 4 hours. A stepwise approach was taken by conducting an "end-to-end" view of the complete patient "journey". It was decided to leave certain process steps that involved wards and support services (such as radiology) for later stages of improvement. The prototype that was implemented had the following stages:
-
Multi-specialty care team and physical work resetting
-
Centralized management leading to better patient flow control, and information technology systems
-
Planned staffing and direct involvement of senior physicians
-
Work schedule changes
-
Redefinition of job roles and descriptions
-
Insistence on a team approach to problem solving and continuous improvement (Kaizen)
-
Monthly review meetings with the management group
This purpose of this case study was to highlight performance improvements. It led to a reduction in patient waiting and lead times by 19-24% in over two years at a Swedish pediatric A&E. This also inspired changes in employee job roles, better communication flow and coordination, increase in level of expertise, better scheduling and staffing, improved workspace management, and integrated problem solving. These changes brought about major transformation as they reduced ambiguity in individual work which was now more focused, improved information flow between interdependent resources, developed seamless and uninterrupted workflow, and led to inspired continual improvement (Pamela Mazzocato, 2012).
CHALLENGES IN LEAN IMPLEMENTATION
However, there are certain challenges in implementation of Lean in Healthcare (Poksinka, 2010):
-
There is resentment in the staff in adopting this methodology as they draw parallels with manufacturing industry. According to them, the organizational settings and problems are unique to the Healthcare Industry.
-
Dearth of trainers and consultants who have cross functional knowledge of both healthcare sector and Manufacturing to provide real-life examples to the staff.
-
Lean implementation requires teamwork and open communication. However, healthcare structure is hierarchical where physicians possess the highest power.
-
Healthcare has a complex structure with high level of inter-dependencies. Hence, it is required to improve the entire value stream and not just individual departments, which can be quite challenging.
CONCLUSION
The above cases present actual scenarios where lean implementation has been successful. The applications were made successful by using the four theoretical lean principles which demonstrate specific ways in which lean-inspired changes can transform work and improve performance, specifically in an A&E. The adapted lean principles mentioned throughout the exercise are expected to help healthcare organizations and management to decideand adopt the right components of Lean framework. This will help them understand better, the reasons behind lean's success as well as failure.
REFERENCES
-
1. A Case study conducted at Torsby Hospital (2012) Fadjer Alwan.
-
2. B, P., n.d. The current state of Lean implementation in health care: literature review. Quality management in health care, 19(4), pp. 319-329.
-
3. Fillingham, D., 2007. Can lean save lives? Leadership in Health Services. 20(4), pp. 231-241.
-
4. Fisher I, Z. J., 2004. Explanatory case studies: Implications and applications for clinical research. Australian Occupational Therapy Journal, 51(4), pp. 185-191.
-
5. Implementation of Lean in a Community Health Center (2012) American Institute for Research.
-
6. Koning, H. V. J. a. e. a., 2006. Lean six sigma in healthcare. Journal for Healthcare Quality, pp. 28(2):4-11.
-
7. Laursen, M. G. F. a. J. J., 2003. Applying Lean thinking in Hospitals.
-
8. L, B. d. S., 2009. Trends and approaches in lean healthcare. Leadership in Health Services. 22 (2), pp. 121-139.
-
9. Mazzocato P, S. C. B. M. A. H. T. J., 2010. Lean thinking in healthcare: a realist review of the literature. Quality & safety in health care, 19(5), pp. 376-382.
-
10. Nordberg M, L. S. C. M., n.d. The validity of the triage system ADAPT. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 18(1), p. 36.
-
11. Pamela Mazzocato, R. J. H. M. B. H. A. U. B. M. E. a. J. T., 2012. How does lean work in emergency care? A case study of a lean-inspired intervention at the Astrid Lindgren Children's hospital, Stockholm, Sweden.
-
12. Poksinka, B., 2010. The Current state of Lean Implementation in Healthcare. Quality Management in Healhcare, 4(19), pp. 319-329.
-
13. Radnor Z, W. P., 2008. Learning to walk before we try to run: Adapting Lean for the public sector. Public Money & Management, 28(1), pp. 13-20.
-
14. RJ, H., 2011. Lean thinking in emergency departments: A critical review. Annals of Emergency Medicine. 57(3), pp. 57 (3): 265-278.
-
15. RJ, H., 2011. Lean Thinking in emergency departments: a critical review. Annals of emergency medicine. 1(3), pp. 59 (3): 328-372.
-
16. RK, Y., 2003. Case study research: design and methods. 1(3).
Give your grades a boost
Just share your requirements and get customized solutions on time.
-
1,168,768 Orders
-
4.9/5 Overall Rating
-
5,052 Experts
