Abstract:

The current study focuses on an application of lean thinking to the healthcare context, illustrating organizational aspects, phases and activities of the applied methodology, tools and procedures, and the achieved outcomes, with the final aim to highlight the key factors enabling the adoption of lean thinking in this context.

The Emergency Department (ED) has been chosen due to the high impact of this setting on society, and the many challenges it is facing (e.g. overcrowding, cost containment, increasing demand from patients). To this extent, innovative managerial approaches should be adopted in order to develop safer and more efficient environments.

In particular, this study reports how, applying lean management principles and techniques, radiology turnaround times (TAT) for ED can be significantly reduced. Since in ED nearly half of the patients require diagnostic imaging (National Hospital Ambulatory Medical Care Survey, 2015), and medical decision-making relies heavily on image interpretation, radiology TAT impacts heavily on the quality of care delivered by the ED.

Following a research framework developed in the literature to analyse lean projects in healthcare, and adapted to the specific analysis, the following dimensions have been analysed: organizational aspects (such as team identification and building, top management support, key role, training, meetings, employee involvement) motivations and objectives of the project, phases and activities performed, tools and techniques adopted, results obtained. The hospital chosen for the analysis is placed in the North of Italy and it has about 500 beds it delivers about 1.200.000 yearly health services for outpatients.

The project was conducted during a lean training course, during which a multidisciplinary team was built, including the teacher (an external consultant specialised in lean management). After defining specific project objectives, a value stream map was drawn in order to identify the process wastes and rank them by importance. Improvement solutions were found out by the team; adopting pull approach and defining a specific process for the patients coming from ED, TAT decreased, contributing to enhance the quality of care delivered to the patient.
Besides tangible results, through the adoption of lean management, staff Communication, involvement and process awareness were favoured, and lean culture started to spread among the hospital.

Keywords:

Lean management, healthcare, emergency department, key factors.