Benchmarks & Case Studies
Improvement of the Emergency Service in a Hospital Centre
The case report is a success story of the implementation of the KAIZEN™ philosophy in the healthcare sector and in an emergency service of a hospital centre. This project aims to demonstrate that the challenges of internal efficiency, waste and reduced productivity can be successfully overcome with simple solutions that require little financial investment.
The Hospital Centre provides healthcare to approximately 500,000 people, and has an organic structure made up of three major services: Care Providers, Support and Logistics Management.
Simplified organisational structure
The Emergency Department is the centre of responsibility of the Hospital, which receives emergency situations and oversees intensive care, receiving an average of 80,000 patients per year. This service is made up of three sequential stages:
- Triage and admission
- Medical care
- Discharge and check-out
The current European economic and political context has forced governments to reduce public spending on health services. At the same time, users expect an increase in the service level provided.
In the general context of health services, the lack of organisation is easily perceived by users. In the case of an emergency department, where every activity and every minute is crucial, waste is particularly notorious and harmful.
Problems such as long queues and bottlenecks are consequences of inefficiencies that affect the performance of the system. The average length of time a patient stays in the emergency department is 4h30m, an indicator that varies greatly according to the degree of priority and the bottleneck of the service.
The main motivation for the project was the desire to reduce the high waiting times by improving the internal organisation of the service, to ensure efficiency gains and simultaneously improve the service level provided to users.
In this context, the hospital initiated a set of improvement processes, in which it actively tried to involve all collaborators.
To make it possible to distinguish between value-added and muda (waste), the organisation defined value from the customer's perspective as "the act of being treated as quickly as possible with the problem being solved efficiently and with empathetic care".
The methodology followed consisted of applying the principles of the KAIZEN™ philosophy to the Hospital's Emergency Service to improve the quality of the service provided by eliminating waste in the processes. All stages were carried out as a workshop, resorting to the expertise and knowledge of the project team, formed by a multidisciplinary group of collaborators, to ensure the involvement of all, and the sustainability of the successes achieved.
The first stage was the mapping of the initial situation using Value Stream Mapping (VSM), in which the path of a patient from the moment they entered the Emergency Department to the moment they left was analysed.
Patient Flow Mapping
In addition, the percentage of waste in the process was calculated as the quotient between the value-added time (97 minutes) and the total stay time (4h30m). The percentage of muda obtained was 64%, against only 36% of value-added time. The distance travelled by the patient was also considered a good indicator of customer experience, totalling 922 steps or 550 metres.
In parallel, the corresponding information flow was mapped, involving the patient, the professionals in the emergency service and the complementary areas involved.
Information Flow Mapping
Next, all the problems highlighted in the VSM were identified by macro stage.
Triage and admission
- Flow signalling is very poor from the user's point of view
- Very time-consuming administrative processes and use of different systems
- Lack of visibility on waiting times
- Poor signalling of internal flows
- Delay by the medical team in calling new patients
- Too many empty movements by professionals
- Lack of communication in the transfer of information between areas
- High waiting times in the transport of patients between areas
Discharge and check-out
- Introduction of redundant information into the system
- Hospitalisation processes highly variable according to the specific unit, making it difficult to standardise the discharge procedure
- Issue of inadequate discharge notes, with non-relevant contents and missing critical data
Finally, solutions were designed to address the gaps in the main areas of intervention. These solutions were organised into two main improvement vectors: structured solutions (with intervention in the building layout) and non-structured solutions.
Structured solutions concern layout changes to optimise the creation of flow in the patient journey within the Emergency Service, including:
- Redesign of admission and discharge flows
- Redesign of medical care flows
- Improvement of physical areas
The non-structured solutions were implemented to overcome problems related to resource planning, visual management, flow of complementary diagnostic means and management of the standardisation system. In this category, the following initiatives were especially relevant:
- Optimisation of the resource planning process
- Implementation of visual management of the patient's journey
- Simplification and standardisation of administrative processes
In addition to robust processes, it is also important to have teams motivated to constantly seek improvement, therefore this transformation was also done at a cultural level.
Although the KAIZEN™ philosophy is not yet widely used in the health services sector, there are many opportunities for its use in this sector. The success of this project is an example of the contribution that this methodology can bring to the improvement of services provided to healthcare service users.
The return was measured according to four indicators:
- Patient satisfaction, measured by a standardised form filled in at the time of discharge and check-out
- Flow efficiency, measured by the value-added rate throughout the entire process
- The length of stay in the service, from admission to the discharge of the patient with diagnosed and solved problem
- The motivation of the internal team, estimated by the involvement of the staff in Lean dynamics, including participation in daily routines and the number of ideas for improvement launched
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