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Can ‘Lean Management’ Improve Hospitals?

Authors propose ways to cut ED waiting times

Waiting times in hospital emergency departments (EDs) could be cut with the introduction of Lean Management and Six Sigma techniques, according to an inter-university team of researchers in Melbourne, Australia. Their findings were published in the International Journal of Human Resource Management.

Lean Management involves continuous efforts to eliminate or reduce ‘waste,’ whereas Six Sigma is a data-driven method for eliminating defects in any process. These methods, developed in manufacturing contexts, can be combined and referred to as Lean Six Sigma (LSS), according to the authors.

Big contributors to increased work and stress in public hospitals are high bed occupancy levels and increases in in-patient numbers.

The new study investigated the application of LSS in a large hospital to see whether it could reduce the time taken to assess and stabilize patients in the ED. The authors also assessed whether LSS helped to increase the flow of patients through the hospital, from their admission, transit through various units to their discharge into the community, without increasing the staff’s workload.

The researchers found that balancing such conflicting flows was important to ensure the smooth running of an ED, to limit the amount of time patients are waiting for a bed, and to reduce work and stress levels.

Professor Greg Bamber, a management expert at Monash University in Melbourne, said Lean Management and Six Sigma were developed to improve the productivity and efficiency of the automobile and manufacturing industries.

“In recent years, hospitals have been trying to adapt LSS processes to streamline processes and improve costs,” he explained. “There have been earlier claims about work intensification experienced by employees in lean manufacturing. Therefore, we studied the outcomes after transferring LSS concepts into a hospital context, to streamline processes and to improve costs there.”

The project found that introducing LLS in hospitals was more challenging than in manufacturing, but that it can help improve patient flow from the ED to hospital beds.

Implementation also allowed the hospital to open more beds as well as to install new software for monitoring bed availability. At the ward level, opening more rehabilitation beds, which improved the discharge process, enhanced patient flow.

Professor Pauline Stanton of RMIT University, Melbourne, cautioned that to be successful with innovations such as LSS, hospitals needed to have sufficient resources and an excellent implementation process –– a process that takes the time to involve the key stakeholders, including the front-line staff.

Sources: Monash University; January 30, 2015; and IJRM; October 21, 2014.


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