Improving Lean Clinics (Lean Healthcare): A Voice of Employee Approach to Reduce Waiting Times

Öz

Bu çalışma, Ankara'daki bir estetik kliniğinde hasta bekleme sürelerini azaltmaya yönelik çözüm odaklı bir strateji sunmaktadır. Operasyonel verimlilik ve hasta memnuniyetinin dinamik kesişimine odaklanan bu çalışma, hizmet sunumundaki önemli rollerini kabul ederek ön saflardaki personelden içgörü toplamak için "Çalışanların Sesi" yaklaşımını kullanmaktadır. Kalite çemberleri, Pareto ve balık kılçığı diyagramı analizleri, eksik ilk kayıt süreçleri, ERP ve CRM uygulamalarındaki yetersizlikler ve yetersiz bekleme alanı olanakları gibi faktörleri belirleyerek uzayan bekleme sürelerinin temel nedenlerini ortaya çıkarmaktadır. Bu araştırma süreci pragmatik çözümler üretmekte ve çalışmayı estetik kliniklerinde hizmet kalitesinin artırılması ve hasta memnuniyetinin sağlanması için stratejik bir rehber olarak konumlandırmaktadır. Araştırma, doğrudan etkilerinin ötesinde, operasyonel stratejilerin şekillendirilmesinde çalışan perspektiflerinin ayrılmaz rolünü savunarak sürdürülebilir sağlık hizmetleri çözümlerine ilişkin daha geniş akademik söyleme katkıda bulunmaktadır. Bu çalışmadan çıkarılan rafine sonuçlar, sağlık kurumlarını, sürekli gelişen sağlık hizmetleri ortamının karmaşıklıklarında gezinirken hasta ihtiyaçlarına uyum sağlayan, sürekli iyileştirme ile işaretlenmiş bir geleceğe doğru ilerletmektedir.

Anahtar Kelimeler

• Yalın Klinikler
• Çalışanların Sesi
• Kök Neden Analizi
• Sağlık Hizmetlerinde Verimlilik
• Kalite İyileştirme

Improving Lean Clinics (Lean Healthcare): A Voice of Employee Approach to Reduce Waiting Times

Abstract

This study presents a solution-focused strategy for reducing patient waiting times at an aesthetic clinic in Ankara, Turkiye. Focused on the dynamic intersection of operational efficiency and patient satisfaction, this study employs a "Voice of Employee" approach to glean insights from frontline staff, acknowledging their pivotal role in service delivery. Quality circles, Pareto, and fishbone diagram analyses discern the root causes of prolonged waiting times, identifying factors such as deficient initial registration processes, inadequacies in ERP and CRM applications, and suboptimal waiting area facilities. This investigative process yields pragmatic solutions, positioning the study as a strategic guide for enhancing service quality and ensuring patient contentment in aesthetic clinics. Beyond its immediate implications, the research contributes to the broader academic discourse on sustainable healthcare solutions, championing the integral role of employee perspectives in shaping operational strategies. The refined conclusions drawn from this study propel healthcare institutions toward a future marked by continual improvement, attuned to patient needs while navigating the complexities of an ever-evolving healthcare landscape.

Keywords

• Lean Clinics
• Voice of Employee
• Root Cause Analysis
• Healthcare Efficiency
• Quality Improvement

References

1. Aboumatar, H.J., Chang, B. H., Al Danaf, J., Shaear, M., Namuyinga, R., Elumalai, S. & Pronovost, P.J. (2015). Promising practices for achieving patient-centered hospital care. Medical Care, 53(9), 758-767.
2. Adler-Milstein, J., Holmgren, A. J., Kralovec, P., Worzala, C., Searcy, T. & Patel, V. (2017). Electronic health record adoption in US hospitals: the emergence of a digital “advanced use” divide. Journal of the American Medical Informatics Association, 24(6), 1142-1148.
3. Aggarwal, A., Walter, F. M., Sullivan, R. & van der Meulen, J. (2022). “Shopping around” for treatment is not a solution to cancer backlog. BMJ, 379, 1-5.
4. Alam, M., Banwell, C., Olsen, A., & Lokuge, K. (2019). Patients’ and doctors’ perceptions of a mobile phone–based consultation service for maternal, neonatal, and infant health care in Bangladesh: a mixed-methods study. JMIR mHealth and uHealth, 7(4), e11842.
5. Arvanitoyannis, I.S. & T.H. Varzakas (2007). Application of failure mode and effect analysis (FMEA), cause and effect analysis and Pareto diagram in conjunction with HACCP to a potato chips manufacturing plant. International Journal of Food Science & Technology, 42(12), 1424–1442.
6. Biddell, C.B., Johnson, K.T., Patel, M.D., Smith, R.L., Hecht, H.K., Swann, J.L. & Hassmiller Lich, K. (2022). Cross-sector decision landscape in response to Covid-19: a qualitative network mapping analysis of North Carolina decision-makers. Frontiers in Public Health, 10, 906602.
7. Browne, A. J., Varcoe, C., Lavoie, J., Smye, V., Wong, S. T., Krause, M. & Fridkin, A. (2016). Enhancing health care equity with Indigenous populations: evidence-based strategies from an ethnographic study. BMC health services research, 16, 1-17.
8. Boudreaux, C. J., Nikolaev, B. N. & Klein, P. (2019). Socio-cognitive traits and entrepreneurship: The moderating role of economic institutions. Journal of Business Venturing, 34(1), 178-196.

9. Cascella, M., Cascella, A., Monaco, F. & Shariff, M. N. (2023). Envisioning gamification in anesthesia, pain management, and critical care: basic principles, integration of artificial intelligence, and simulation strategies. Journal of Anesthesia, Analgesia and Critical Care, 3(1), 33.
10. DelliFraine, J. L., Wang, Z., McCaughey, D., Langabeer, J. R. & Erwin, C. O. (2013). The use of Six Sigma in health care management: Are we using it to its full potential? Quality Management in Healthcare, 22(3), 210-223. Dobrzykowski, D. (2019). Understanding the downstream healthcare supply chain: Unpacking regulatory and industry characteristics. Journal of Supply Chain Management, 55(2), 26-46.
11. Elyoussoufi, S., Mazouzi, M., Cherrafi, A. & Tamasna, E. M. (2022). TRIZ-ISHIKAWA diagram, a new tool for detecting influencing factors: a case study in HVAC business. In Proceedings of the International Conference on Industrial Engineering and Operations Management, March 7-10, Istanbul, Türkiye.
12. Faessen, S. (2008). An explorative study of the experience of space in the waiting room (Doctoral dissertation, Master Thesis Culture). Retrieved from http://www. fsw. vu. nl/nl/Images/Thesis% 20Sanne% 20Faessen_tcm30-117649. pdf. (V.D.: 11/09/2023)
13. Ferreira, J., Gomes, C. & Yasin, M. (2011). Improving patients' satisfaction through more effective utilization of operating rooms resources: An informational‐based perspective. Clinical Governance: An International Journal, 16(4), 291-307.
14. Filip, R., Gheorghita Puscaselu, R., Anchidin-Norocel, L., Dimian, M., & Savage, W. K. (2022). Global challenges to public health care systems during the COVID-19 pandemic: a review of pandemic measures and problems. Journal of Personalized Medicine, 12(8), 1295.
15. Firican, G. (2018). "How to use the fishbone diagram to determine data quality root causes," https://www.lightsondata.com/how-to-fishbone-diagram-data-quality-root-causes/, (A.D.: 08/09/2023)
16. Franklin, A., Gantela, S., Shifarraw, S., Johnson, T.R., Robinson, D. J., King, B.R. & Okafor, N.G. (2017). Dashboard visualizations: Supporting real-time throughput decision-making. Journal of Biomedical Informatics, 71, 211-221.
17. Fun, W.H., Tan, E.H., Khalid, R., Sararaks, S., Tang, K.F., Ab Rahim, I., & Nawawi, M.K. M. (2022). Applying discrete event simulation to reduce patient wait times and crowding: The case of a specialist outpatient clinic with dual practice system. In Healthcare, 10(2), 189, 1-15.
18. Goyal, A., Agrawal, R. & Sharma, A.K. (2022). Green quality circle: Achieving sustainable manufacturing with low investment. Resources, Conservation & Recycling Advances, 15 (200103). 1-14.
19. Gilmore, D., Harris, L., Hanks, C., Coury, D., Moffatt-Bruce, S., Garvin, J. H. & Hand, B.N. (2023). "Giving the patients less work": A thematic analysis of telehealth use and recommendations to improve usability for autistic adults. Autism, 27(4), 1132–1141.
20. Gualandi, R., Masella, C., Viglione, D. & Tartaglini, D. (2019). Exploring the hospital patient journey: What does the patient experience?. PloS one, 14(12), e0224899. 1-15.
21. Harrison, M., Rhodes, T. & Lancaster, K. (2023). Situating 'best practice': Making healthcare familiar and good enough in the face of unknowns, SSM - Qualitative Research in Health, 4, 100343, https://doi.org/10.1016/j.ssmqr.2023.100343.
22. Heinonen, K. & Lipkin, M. (2023). Ordinary customer experience: Conceptualization, characterization, and implications. Psychology & Marketing, 40(9), 1720-1736.
23. Iyendo, T.O., Uwajeh, P.C. & Ikenna, E.S. (2016). The therapeutic impacts of environmental design interventions on wellness in clinical settings: a narrative review. Complementary therapies in clinical practice, 24, 174-188.
24. Jamaludin, M.A., Salleh, K.M., & Sulaiman, N.L. (2023). The elements for employee voice of non-union employee representation in malaysian manufacturing sector. Tuijin Jishu/Journal of Propulsion Technology, 44(2). 373-387.
25. Jin, K. (2023). Kaizen and Non-cognitive Skills Development in Africa in the Age of Digitalization, Ohno, I.; Jin, K.; Amatsu, K. & Mori, J. (Eds). Introducing Foreign Models for Development: Japanese Experience and Cooperation in the Age of New Technology, (pp. 275–301), Singapore: Springer.
26. Kumpunen, S., Webb, E., Permanand, G., Zheleznyakov, E., Edwards, N., van Ginneken, E. & Jakab, M. (2022). Transformations in the landscape of primary health care during COVID-19: Themes from the European region. Health policy, 126(5), 391-397.
27. Li, L. (2022). Reskilling and upskilling the future-ready workforce for industry 4.0 and beyond. Information Systems Frontiers, 1–16.
28. Loan, F.A. & Mushtaq, R. (2023). Pareto 80/20 Rule: A New Principle for Serial Subscription. Serials Review, 49(1-2), 10-14.
29. Malik, A., Budhwar, P., Mohan, H. & Srikanth, N.R. (2023). Employee experience–the missing link for engaging employees: Insights from an MNE's AI‐based HR ecosystem. Human Resource Management, 62(1), 97-115.
30. Mandavilli, S. R. (2023). Postulating ‘Ethnography of Enculturation’: A high-level overview of various social science research techniques that can be used to study human enculturation processes. IJISRT July.
31. Mowen, J. C., Licata, J. W. & McPhail, J. (1993). Waiting in the emergency room: how to improve patient satisfaction. Marketing Health Services, 13(2), 26.
32. Nadayama, N. (2023). Global Management in Japanese MNEs: An Agenda for Future Research, Banaszak, S. & Oyama, K (Eds), Japanese and Polish Management, Göttingen, Germany: Unipress.
33. Naiker, U., FitzGerald, G., Dulhunty, J. M. & Rosemann, M. (2017). Time to wait: a systematic review of strategies that affect out-patient waiting times. Australian Health Review, 42(3), 286-293.
34. Namakshenas, M., Mazdeh, M.M., Braaksma, A. & Heydari, M. (2023). Appointment scheduling for medical diagnostic centers considering time-sensitive pharmaceuticals: A dynamic, robust optimization approach. European journal of operational research, 305(3), 1018-1031.
35. Niaz, M. & Nwagwu, U. (2023). Managing Healthcare Product Demand Effectively in The Post-Covid-19 Environment: Navigating Demand Variability and Forecasting Complexities. American Journal of Economic and Management Business (AJEMB), 2(8), 316-330.
36. Noort, M.C., Reader, T.W. & Gillespie, A. (2019). Speaking up to prevent harm: A systematic review of the safety voice literature. Safety Science, 117, 375-387.
37. Octaviani, S., Antonio, F. & Andy, A. (2023). The antecedents of patient experience of the aesthetic clinic and its impact on revisit intention. South African Journal of Business Management, 54(1), 1-13.
38. Ogrinc, G., Davies, L., Goodman, D., Batalden, P., Davidoff, F. & Stevens, D. (2015). SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process. The Journal of Continuing Education in Nursing, 46(11), 501–507.
39. Okafor, L. & Chen, A.F. (2019). Patient satisfaction and total hip arthroplasty: a review. Arthroplasty, 1, 1-7.
40. Rubinelli, S., Häfliger, C., Fiordelli, M., Ort, A. & Diviani, N. (2023). Institutional crisis communication during the COVID-19 pandemic in Switzerland. A qualitative study of the experiences of representatives of public health organizations. Patient Education and Counseling, 114, 107813. 1-7.
41. Samson, D. & Swink, M. (2023). People, performance and transition: A case study of psychological contract and stakeholder orientation in the Toyota Australia plant closure. Journal of Operations Management, 69(1), 67-101.
42. Sarazen, J.S. (1990). The tools of quality, part 2: cause-and-effect diagrams. Quality Progress, 23, 59–62.
43. Sekar, S., Edakkat Subhakaran, S. & Chattopadhyay, D. (2023). Unlocking the voice of employee perspectives: exploring the relevance of online platform reviews on organizational perceptions. Management Decision. 61(11), 3408-3429.
44. Siddiqui, M. U. H., Khafagy, A. A. & Majeed, F. (2023). Program Report: Improving Patient Experience at an Outpatient Clinic Using Continuous Improvement Tools. In Healthcare, 11(16), 1-10.
45. Sifatu, W. O., Sjahruddin, H., Fajriah, Y., Dwijendra, N. K. & Santoso, A. (2020). Innovative work behaviors in pharmacies of Indonesia: Role of employee voice, generational diversity management and employee engagement. Systematic Reviews in Pharmacy, 11(2), 725-734.
46. Tsai, P.L., & Ghahari, S. (2023). Immigrants’ experience of health care access in Canada: A recent scoping review. Journal of Immigrant and Minority Health, 25, 712-727.
47. Vrontis, D., El Chaarani, H., El Abiad, Z., El Nemar, S., & Yassine Haddad, A. (2022). Managerial innovative capabilities, competitive advantage and performance of healthcare sector during Covid-19 pandemic period. foresight, 24(3/4), 504-526.
48. Yim, K.M., Yim, R.M., Gaspard, S., MacDougall, J., & Armstrong, A.W. (2022). Strategies to maximize clinical efficiency while maintaining patient safety during the Covid-19 pandemic: an interview-based study from private practice dermatologists. Journal of Dermatological Treatment, 33(3), 1503–1506.
49. Youn, S., Geismar, H. N., & Pinedo, M. (2022). Planning and scheduling in healthcare for better care coordination: Current understanding, trending topics, and future opportunities. Production and Operations Management, 31(12), 4407–4423.
50. Zighan, S., & Ruel, S. (2023). SMEs’ resilience from continuous improvement lenses. Journal of Entrepreneurship in Emerging Economies, 15(2), 233-253.