Author(s):
Heba Mohamed Alanwer Ashour, Zeinab Mohamed Nabawy, Ghada Mohamed Hamouda
Email(s):
heba.elanwer@yahoo.com
DOI:
10.5958/2454-2652.2021.00035.4 
Address:
Heba Mohamed Alanwer Ashour1, Zeinab Mohamed Nabawy2, Ghada Mohamed Hamouda3
1Lecturer of Nursing Administration, Faculty of Nursing, Alexandria University, Alexandria, Egypt.
2,3Professor of Nursing Administration, Faculty of Nursing, Alexandria University, Alexandria, Egypt.
*Corresponding Author
Published In:
Volume - 9,
Issue - 2,
Year - 2021
ABSTRACT:
Designing a lean system in healthcare to identify and reduce the wastes is very important approach to improve health services process flow, reduce cost, and improve quality of care. Aim: This study aimed to identify Lean wastes in health service (admission process) and develop an improvement process. Design. A descriptive research design was selected for fulfilling the aim of this study. Setting. The current study was carried out at outpatient clinic and four surgical wards at Alexandria Main University Hospital Subjects. The participants in this study encompassed 50% of total patient number who were involved in process flow (N=50). Tool Lean Wastes Identification Tool (LWI), is an observation record developed by Sanders (2014) which is a modified version of original hospital inpatient waste identification tool ,it was used for recording the observation of each process tasks which includes: name of unit for selected process, date of process observed, name of selected process observed, description of tasks for observed process, duration (time consumed) for each task , classification for each task of observed process if value adding or not, classification for eight types of lean wastes in relation to each task of observed process in form of eight types of Lean wastes. Main finding were that, the percent of value added tasks in admission represent less than half of whole process tasks as well as consuming less than half of process lead time. Compared to non value added tasks (Lean wastes) that constitute more than half of whole process tasks and consuming more than half of process lead time. The predominant wastes in admission process were waiting, overproduction, motion, transportation, defect, and over processing. In addition, an improvement process was developed process cycle efficiency was increased after proposed improvements to be higher than 25%. Therefore, the study recommended that hospital managers, physicians, nursing administrators and staff nurses work together to improve current health service process flow as well as reduce non value added activities (lean wastes) in admission process.
Cite this article:
Heba Mohamed Alanwer Ashour, Zeinab Mohamed Nabawy, Ghada Mohamed Hamouda. Lean Wastes in Health Services Flow: Development of an improvement Process. Int. J. of Advances in Nur. Management. 2021; 9(2):151-159. doi: 10.5958/2454-2652.2021.00035.4
Cite(Electronic):
Heba Mohamed Alanwer Ashour, Zeinab Mohamed Nabawy, Ghada Mohamed Hamouda. Lean Wastes in Health Services Flow: Development of an improvement Process. Int. J. of Advances in Nur. Management. 2021; 9(2):151-159. doi: 10.5958/2454-2652.2021.00035.4 Available on: https://ijanm.com/AbstractView.aspx?PID=2021-9-2-7
REFERENCES:
1. Rosmulder R. Improving healthcare delivery with Lean thinking: Action research in an emergency department. Published Master Thesis. University of Twente.2011. Available at https://www.research.utwente.nl/en/publications/improving-healthcare-delivery-with-lean-thinking-action-research. Retrieved on 20/10/2017
2. Alwan F. Lean implementation problems in the healthcare system: A Case study conducted at Torsby Hospital. Published Master Thesis. Karlstad Business School. Karlstad University.2012.
3. Poksinska B. The current state of lean implementation in health care: literature review. Quality Management in Health Care 2010; 4 (19): 319-29.
4. Machado VC, Leitner U. Lean tools and lean transformation process in health care. International Journal of Management Science and Engineering Management 2010; 5(5): 383-92.
5. Balushi A, Sohal P, Singh A, Hajri YM, Farsi R. Readiness factors for lean implementation in healthcare settings: A literature review". Journal of Health Organization and Management 2014; 28(2): 135 – 153.
6. Graban M. Lean Hospitals Improving Quality, Patient Safety, Employee Satisfaction, 2009.
7. Liker JK. The Toyota way: 14 management principles from the world's greatest manufacturer. New York: McGraw-Hill. 2004.
8. Fine B, Golden B, Hannam R, Morra D. Leading Lean: A Canadian Healthcare Leader’s Guide. Healthcare Quarterly 2009; 12(3): 32-41.
9. Johnson J, Smith A, Mastro K. From Toyota to the Bedside Nurses: Can Lead the Lean Way in Health Care Reform. Nursing Administration Quarterly 2012; 36(3):234-42.
10. Dick K. Lean Implementation and Pediatric Intensive Care Unit Bed Availability Analysis via Simulation at the Winnipeg Children’s Hospital. Published Master Thesis. Faculty of Graduate Studies. University of Manitoba. 2011. Available at: www. mspace.lib.umanitoba.ca/handle/1993/4990. Retrieved on 20/10/2017.
11. Armstrong P. Lean implementation manual for reducing cost in health care throughout the application of lean principles. Published Master Thesis. California State University.2010. Available at: www.gradworks.umi.com/14/84/1484854.html. Retrieved on 2010/2017.
12. Sanders J H. Strengthening the IHI waste identification tool with lean waste 2014. Available at www.xcdsystem.com/iie2014/.../finalpapers/I1291.pdf. Retrieved on 20/10/2017
13. Womack J, Jones D. Lean Thinking: Simon and Schuster New York, NY; 1996.
14. Bridge O.A Guide to Process Mapping 2015. Available at https://www.thefis.org/.../2015/.../Best-Practice-A-Guide-to-Process-... Retrieved on 20/10/2017
15. Luna, l. Klökner B. Ferreira J. Applying Value Stream Mapping to Identify and Evaluate Waste in a Company of the Ceramic Sector. Springer: Switzerland 2013.
16. Graban, M. Lean Hospitals, CRC Press, Taylor and Francis Group, FL 2012
17. Da Silva S. Valácio R. Botelho F. Amaral. Reasons for discharge delays in teaching hospitals. Rev Saode Poblica 2014;48(2):1-7.
18. Bercaw R G. Lean Leadership for Healthcare Approaches to Lean Transformation Taylor and Francis Group 2013. Available at http:www.m-bikeshop.com/library/download/asin=1466515546andtype=stream Retrieved on 20/10/2017.
19. Ajami s, Ketabi S. An analysis of the average waiting time during the patient discharge process at Kashani Hospital in Esfahan, Iran: a case study. Health information Management Journal 2007; 36 (2): 37-42.
20. Capital, M Introduction to Lean Manufacturing for Vietnam 2004. Available at http.www.industrvweek.com/Current Articles/asp/articles.asp?. Retrieved on 20/10/2017.
21. Parr J. Patient Flows to Improve Hospital Performance.2010. Available at http: www.digitalcommons.bryant.edu/cgi/viewcontent.cgi?article=1008.. Retrieved on 20/10/2017.
22. Gill S. Application of Lean principles in the Emergency department within resources constrained environment. Published Doctorate Dissertation. University of California.2011.Available at https://www.emergencymedicinekenya.org/990/. Retrieved on 20/10/2017
23. Oche M, Adamu H. Determinants of Patient Waiting Time in the General Outpatient Department of a Tertiary Health Institution in North Western Nigeria. Ann Med Health SCi Res 2013; 3(4): 588-592.
24. Ofilli AN, Ofowve CE. What patients want: A content analysis of key qualities that influence patient satisfaction. J Med Pract Manage. 2007;22: 255–61.
25. Ofilli AN, Ofowve CE. Patient's assessment of efficiency of services at a teaching hospital in a developing country. Ann Afr Med. 2005;4: 150–3.
26. Mohebbifar R, Hasanpoor E, Mohseni M, Sokhanvar M, Khosravizadeh O, Isfahani H. Outpatient Waiting Time in Health Services and Teaching Hospitals: A Case Study in Iran. Global Journal of Health Science2014; 6(1): 172-180.
27. Saeed A, Ahmed B, Jamil S, Marzyeh S, Zahra T, Hasan A, Negar F. Measuring and Analyzing Waiting Time Indicators of Patients’ Admitted in Emergency Department: A Case Study. Glob J Health Sci 2016; 8(1): 143–149
28. Bush RW. Reducing waste in US health care systems. JAMA 2007;297: 871–4.
29. Teich ST, Faddoul FF. Lean Management: The Journey from Toyota to Healthcare. RMMJ 2013;4 (2): 1-9.
30. David B. Reducing waste in administrative services with lean principles. Published Master Thesis. University of Twente. 2016
31. Lazarus I, Neely C. Six sigma raising the bar. Managed Healthcare executive 2003;13(1):31-33
32. Brady A, Malone A, Fleming S. A literature review of an individual and systems factors that contribute to medication errors in nursing practice. Journal of Nursing Management 2009; 17:679-97
33. Manos A, Sattler M, Alukal G. Make healthcare lean. Qual Prog 2006;39 (7):24-30.
34. Tufts J. Lean Healthcare: Continually Eliminating Waste to Reach Value To Patients 2015. Available at www.icetechnologies.com/.../lean-healthcare-continually-eliminating... Retrieved on 20/10/2017
35. Alsmadi M, Almani, A, Jerisat, R. A comparative analysis of Lean practices and performance in the UK manufacturing and service sector firms. Total Quality Management, Business Excellence 2012; 23(3-4): 381–396.
36. Di Pietro L, Mugion, R. G, Renzi, M. F. An integrated approach between Lean and customer feedback tools: An empirical study in the public sector. Total Quality Management andBusiness Excellence 2013;24(7-8): 899–917.
37. Patel PB, Combos MA, Vinson DR. Reduction of admit wait times: the effect of a leadership-based program.2014. Acad Emerg Med. 2014 Mar;21(3):266-73.
38. Haron S. Patient Process Flow Improvement: Value Stream Mapping. Journal of Management Research 2015; 7(2): 495- 505.
39. Al Khani R. Improving Waiting Time and Patients' Experience in a Medical Retina Clinic. Published Master Thesis. Royal College of Surgeons in Ireland, 2015.Avaialble at http://epubs.rcsi.ie/mscttheses/64/. Retrieved on 20/10/2017.