Trends and Approaches in Lean Healthcare - Case Study Example

 Introduction I am the Ward Manager of the Respiratory Unit where we care for all patients with various respiratory diseases e.g. Asthma, Chronic Obstructive Pulmonary diseases (COPD), Patients requiring Non-Invasive ventilation, Tracheostomies and chest drains. The ward takes patients from all other wards and stepping down patients from Intensive Care Unit (ICU). My Goals in the Improvement Project As ward manager of the respiratory ward, I will set out to achieve a number of objectives. First among them would be to ensure that customers receive the highest quality care and services. This is the primary goal of the ward that my team will always aspire to achieve. A second objective would be to to reduce the amount of time that patients spend in the hospital by eliminating time wastages due to inefficient processes (Marshall, Vasilakis & El-Darzi, 2005). I will seek to achieve this by implementing an improvement initiative aimed at incorporating efficiency into the clinical operations of the ward. Thirdly, I will strive to build a strong united team in my ward. The strength of our teamwork is a critical factor in the provision of healthcare because stronger teams give out better output in terms of the quality of healthcare they provide to our patients. Teamwork is our foremost value in striving to provide the best possible care to our patients (Young et al., 2004). Improving the Patient Flow In healthcare, the term flow refers to the movement of patients frrom the hospital staff, its departments and other organisations along the pathway of care (Varkey, Reller & Resar, 2007). Flow is concerned with various aspects of health care provision such as how the access to the care services are designed, when and where the assessment and treatment are available as well as who provides it. Thus, to improve patient flow in the ward, various changes have to be made along the patient pathway aimed at meeting the following. Meeting demand at the front in real-time Research has shown that delay in GP assessment as well as transportation mean that most patients arrive in hospitals in the afternoon when senior decision makers are likely to have left. The situation is made worse over the weekend with longer queues that use the subsequent week’s capacity to clear, the overall unwanted effect being longer stay times in the ward (Marshall, Vasilakis & El-Darzi, 2005). This can be tackled by changing consultant working hours so as to coincide their availability with patient demand. As well, it has been shown that pooling of junior specialists can be done differently in such a way as to reduce duplications in assessments, which makes it easier to absorb differences in demand for their services. Improving the turnaround time of core processes Core processes such as blood tests, work management systems, word rounds and board rounds have a significant impact on the pace of patient flow within the healthcare system. Improving these core processes will therefore directly have a positive impact on the flow of patients within the system (King, Ben‐Tovim & Bassham, 2006). This can be achieved by improving the core processes such as improved turnaround times for the blood tests, an introduction of an electronic work management system, an improved scheme of take home medicine as well as daily word and board rounds. Since multiple points of delays have been observed in process mapping, patient stories and reviewing of notes all which lead to missed opportunities for discharge; improvements can be made, in these areas, to reduce their turnaround times (King, Ben‐Tovim & Bassham, 2006). Another model that has been widely used to improve the patient flow has been the “discharge to assess” model where patients in need of post-discharge care are discharged as soon as they are declared medically fit in order to put in place assessment and care packages to the patients’ homes. This goes a long way in minimising reducing the hospital stay times for the patients in the ward (Perla, Bradbury & Gunther‐Murphy, 2013). The ‘Lean’ Methodology in Healthcare The ‘lean’ methodology is an industrial production system aimed at producing what the system wants quickly and efficiently, with as little “waste” as possible (Kollberg, Dahlgaard & Brehmer, 2006). The primary mission of the ‘lean’ methodology is elimination of waste and the maintenance of a smooth flow in the production process. The system has been extensively applied in healthcare provision as it has been proved to produce excellent results in the other industries it has been used, e.g., it has been intensively used by the Japanese motor vehicle production company, Toyota, for its sterling industrial output (Laursen, Gertsen & Johansen, 2003). In healthcare, the system is used to streamline and improve the quality of care by minimising or eliminating waste through such channels as reducing re-works unnecessary delays, as well as inappropriate procedures and errors. Secondly, the ‘lean’ methodology improves the whole health care system by improving flow. Specifically, the ‘lean’ system has been applied to the healthcare industry with the view to improving patient flow by minimising unnecessary procedures that lead to delays. Analogous to the Toyota industrial process, the system can be specifically applied in the healthcare context, in the following ways (Burgess and Radnor, 2013; Weinstock 2008): Transport Moving medical records to different locations for different services during a single visit by a patient. These movements can be reduced to reduce the total amount of time spent on a minimal level (Young et al., 2004). Holding equipment in a single store. This is unnecessary as it leads to unnecessary waste of time in collecting the equipment. The equipment should be decentralised to service locations instead. Inventory Instead of holding medical supplies that are not needed at hand, they should be kept in convenience stores nearby and only what is needed should be kept at hand. Under inventory, the use of waiting lists also goes a long way in eliminating the waste (Brandao de Souza, 2009). Motion This is one of the prime areas of time wastage. Cases of time wastage in this area include: a nurse looking for case notes, a doctor moving between wards to find their patient, a patient service officer going to clean the patient’s bed only to find that the nurses haven’t stripped it, etc. (Jimmerson, Weber & Sobek, 2005). Waiting Once again, this is another area of time wastage that needs elimination in the healthcare system (Jimmerson, Weber & Sobek, 2005). Cases here include: a patient arriving too early and thus wasting his or her time waiting, a doctor waiting for medical imaging procedures such as X-rays, CT scans or MRIs to be taken, a patient lying idly in the hospital bed waiting for the nest step of the treatment process, etc. Overproduction Activities that exemplify overproduction include such activities such as unnecessary daily routine X-rays checks on the patient’s chest, repeated dilation of the patient’s eye prior to cataract surgery, keeping investigation slots open when uncertain of the future scenario, etc.( King, Ben‐Tovim & Bassham, 2006). Over-processing Over-procession leads to unnecessary time wastage through such procedures as repeatedly asking patients for the same details, providing allied health services to a pre-existing condition not related to the one the patient was admitted for, etc. (Brandao de Souza, 2009). Defects Defects that lead to wastage in the health system would include such things as re-admitting a patient due to a failed discharge; missing, incorrect or incomplete education; equipment breakdown due to poor maintenance; repeated blood test due to mislabelling or loss of original samples, etc.(Papadopoulos & Merali, 2008). All the above aspects contribute to the time wasted in the entire service of care delivery and as such, attention to the said activities could have a significant impact on increasing efficiency in the care process. The lean methodology can be regarded as a set of tools that can be used to eliminate time wasted in the healthcare provision process or the improvement of the ‘flow’ process itself, hence resulting in system improvements. The effectiveness of ‘lean’ in improving flow The ‘lean’ system has been applied to the healthcare industry with the view to improving patient flow by minimising unnecessary procedures that lead to delays. One particular criticism of the ‘lean’ methodology in this particular aspect has been the over-reliance on the ‘lean’ tools rather than on ‘lean’ thinking (Burgess and Radnor, 2013). Other researchers have noted that the concept of added value that is inherent in lean thinking is less straightforward in healthcare provision than in other industries (Young & McClean, 2009). The important lesson here is that only the relevant and effective aspects of the ‘lean’ methodology should be applied in a particular healthcare setting depending on its unique circumstances rather than a wholesale application that is likely to be ineffective. Teamwork in Healthcare A team in a typical healthcare setting consists of a variety of healthcare professionals with different backgrounds, skills, talents and expertise. Teamwork in the health care workplace cannot be overemphasised (Leggat, 2007). Since no professional in the healthcare environment can work alone to deliver a complete health experience, then division of labour among medical, nursing and allied professionals becomes an imperative. It is extremely important that members of my work group work together as a team to enhance the quality of patient care ensure patient safety as well as reducing fatigue issues that plague healthcare professionals (Leggat, 2007). Teamwork in my ward is of paramount importance for at least two important reasons. Firstly, every player in a team contributes his or her unique skills and talents to the overall objective of the whole team. This helps to make a stronger team because individual strengths combine to overcome individual strengths combine to overcome individual weaknesses (Leggat, 2007). This ensures the best possible output from the team which in turn guarantees the best possible care for the patients (Humphrey, Karam & Morgeson, 2010). Secondly, teamwork fosters a positive work environment and fosters good relationships among workers. This lightens the load on every individual and reduces incidences of such issues as worker burnouts that are common in conventional workplaces today (Humphrey, Karam & Morgeson, 2010). Therefore, all possible initiatives should be put, in place, to promote teamwork in the healthcare workplace. This could include such initiatives as: Encouraging building of trust among team members Team members should be encouraged to be absolutely open to each other as regards their strengths and weaknesses. This makes them to feel secure with one another and know that they can count, on each other, to deliver (Lemieux-Charles & McGuire, 2006). Encouraging empathy amongst each other Empathy means putting yourself in one’s shoes to appreciate the unique circumstances and experiences of each person. This helps each member to understand another member’s unique predisposition and know how to relate appropriately. Since healthcare professionals are experts in empathy towards their patients, they can easily extend the same towards each other so as to improve their productivity. Encouraging the right attitude among team members Having the right attitude in the workplace implies that each member leaves his or her personal problems at the door, expects the best from others, tries to solve problems as soon as they come before they grow into crises as well as being cheerful about the work they do. Promoting mutual respect Promoting mutual respect means that one member respects the uniqueness of others, their opinions as well as celebrating their successes and sharing their tribulations (Michan & Rodger, 2000). Perspectives on Change My improvement initiative as a leader during this programme will focus on improving the patient flow within the ward. This will ensure patients are receiving the best possible healthcare within the shortest possible time. The main stakeholders I shall involve will include my team members within the ward as well as the overall management (Swayne, Duncan & Ginter, 2012). The involvement of team members is critical so that they can own the process of impending change and participate in it effectively. The involvement of the overall management would be to offer the requisite technical and resource support to effect the improvement initiative (Vaughn et al., 2006). This will lead to my improvement initiative for the next work to be completed on the creation of a four bedded unit on the ward to house step down patients from Intensive Care Unit (ITU) to improve flow, help create more bed flow for ITU, improve the need for other nurses to come and work on the ward and use the platform to increase revenue, as well as centre of excellence. Bibliography Brandao de Souza, L., 2009. 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