Lean reductions in ED waiting times and improved patient flow

A multi-university trial of a combination of lean management and Six Sigma techniques in a hospital emergency department has shown that they can improve patient flow, open more beds and allow hospitals to more easily install software to monitor bed availability, Australian research shows.

A paper published in the upcoming issue of the International Journal of Human Resource Management by researchers from Monash, Victoria, La Trobe and RMIT universities shows that while introducing the techniques in hospitals is more challenging than in other industries, there are measurable benefits in patient flow and improvements in the discharge process.

Lean management involves eliminating or reducing ‘waste’ in certain processes while Six Sigma is a data-driven method for eliminating defects in any process.. The two methods can be combined and referred to as Lean Six Sigma (LSS).

The researchers investigated the application of LSS in a large Melbourne hospital to see if it could reduce the time taken to assess and stabilise patients in the ED, and to see if it could assist in increasing the flow of patients from admission, transit to wards and on to discharge without increasing the workload of staff.

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.

Monash Business School professor of management Greg Bamber said lean and Six Sigma had been developed to improve the productivity and efficiency of the automobile and manufacturing industries, but in recent years hospitals had been trying to adapt the techniques to streamline processes and improve costs.

“There have been earlier claims about work intensification experienced by employees in lean manufacturing,” Professor Bamber said. “Therefore, we studied the outcomes after transferring LSS concepts into a hospital context, to streamline processes and improve costs there.”

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

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

RMIT's Pauline Stanton said that to be successful with innovations such as LSS, hospitals needed to have sufficient resources and an excellent implementation process that took the time to include frontline staff.

Posted in Australian eHealth

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