Yıl 2020, Cilt 2 , Sayı 3, Sayfalar 271 - 284 2020-12-14

A Project To Improve Service Delivery Of Medical Clinic In A State Hospital In Sri Lanka By Application Of Lean Principles

Amila P. MADURAGODA [1] , Sayakkara Mesthrilage Navoda Sandamali Maleesha MALLAWARACHCHİ [2]


          Lean is a set of operating philosophies and methods that could create maximum value for patients by reducing waste and waits when applied for health care. The study aimed to improve the service delivery of medical clinic in Base Hospital Dambadeniya (BHD) in Sri Lanka through the application of lean principles to the clinic process. Focus Group Discussions (FGDs) with patients and staff, Key Informant Interviews (KIIs) with the medical superintendent and Consultant Physician, survey of patient satisfaction with the use of self-administered questionnaire, and process mapping were carried out to gather data at pre and post-intervention stages. Long waits, congestion at the clinic, undue queuing at pharmacy, and unnecessary movements had led to poor patient satisfaction and raised concerns in the staff regarding unsatisfactory work environment. 
          Application of lean management based on the elimination of waste, combining, rearranging and simplifying of elements of the process, reduced waits by 52%. The total requirement of staff reduced by 26% and patient satisfaction improved in selected attributes by 40%.
Lean Principles, Medical Clinic, Process Mapping, Service Delivery, Waiting Time
  • Campbell, R. J. (2009). Thinking Lean in Healthcare. Journal of AHIMA 80, 40–43.
  • Chan, H. (2014). Lean techniques for the improvement of patients’ flow in emergency department. World Journal of Emergency Medicine, 5,24.
  • Fine, B., Golden, B., Hannam, R., Morra, D. (2009). Leading Lean: A Canadian Healthcare Leader’s Guide. Healthcare Quarterly, 12,32–41.
  • Green, C. F., Crawford, V., Bresnen, G., Rowe, P. H. (2015). A waste walk through clinical pharmacy: How do the ‘seven wastes’ of Lean techniques apply to the practice of clinical pharmacists: A waste walk through clinical pharmacy. International Journal of Pharmacy Practice, 23,21–26.
  • Henrique, D. B., Rentes, A. F., Godinho Filho, M., Esposto, K. F. (2016). A new value stream mapping approach for healthcare environments. Production Planning & Control, 27,24–48.
  • Holweg, M. (2007). The genealogy of lean production. Journal of Operations Management, 25, 420–437.
  • Houchens, N., Kim, C. S. (2014). The Application of Lean in the Healthcare Sector: Theory and Practical Examples. In N. Wickramasinghe, L. Al-Hakim, C. Gonzalez, & J. Tan (Eds.), Lean Thinking for Healthcare (pp. 43–53). Springer New York.
  • International Group for Lean Construction (Ed.). (2014). 21st annual conference of the International Group for Lean Construction 2013: (IGLC 21) ; Fortaleza, Brazil, 29 July - 2 August 2013. Curran.
  • Jamjoom, A., Abdullah, M., Abulkhair, M., Alghamdi, T., Mogbil, A. (2014). Improving Outpatient Waiting Time Using Simulation Approach. 2014 European Modelling Symposium, 117–125.
  • Kabeya, Y., Uchida, J., Toyoda, M., Katsuki, T., Oikawa, Y., Kato, K., Kawai, T., Shimada, A., Atsumi, Y., Higaki, M. (2017). Factors affecting consultation length in a Japanese diabetes practice. Diabetes Research and Clinical Practice, 126,54–59.
  • LaGanga, L. R., Lawrence, S. R. (2012). Appointment Overbooking in Health Care Clinics to Improve Patient Service and Clinic Performance. Production and Operations Management, 21, 874–888.
  • Lawal, A. K., Rotter, T., Kinsman, L., Sari, N., Harrison, L., Jeffery, C., Kutz, M., Khan, M. F., Flynn, R. (2014). Lean management in health care: Definition, concepts, methodology and effects reported (systematic review protocol). Systematic Reviews, 3,103.
  • Mathugama, S. C. (2011). Waiting time studies to improve service efficiency at national hospital of Sri Lanka.
  • Mazzocato, P., Holden, R. J., Brommels, M., Aronsson, H., Bäckman, U., Elg, M., Thor, J. (2012). How does lean work in emergency care? A case study of a lean-inspired intervention at the Astrid Lindgren Children’s hospital, Stockholm, Sweden. BMC Health Services Research, 12,28.
  • Medical Statistics Unit, Base Hospital, Dambadeniya (2019). Hospital statistics, Base Hospital Dambadeniya.
  • Radnor, Z. J., Holweg, M., Waring, J. (2012). Lean in healthcare: The unfilled promise? Social Science & Medicine, 74,364–371.
  • Radnor, Z., Walley, P. (2008). Learning to Walk Before We Try to Run: Adapting Lean for the Public Sector. Public Money & Management, 28,13–20.
  • Teich, S. T., Faddoul, F. F. (2013). Lean Management – the Journey from Toyota to Healthcare. Rambam Maimonides Medical Journal, 4, 7.
  • Trebble, T. M., Hansi, N., Hydes, T., Smith, M. A., Baker, M. (2010). Process mapping the patient journey: An introduction. BMJ, 341,4078-4078.
  • Young, T. (2004). Using industrial processes to improve patient care. BMJ, 328,162–164.
Birincil Dil en
Konular Sağlık Bilimleri ve Hizmetleri
Bölüm Makaleler
Yazarlar

Orcid: 0000-0001-6361-4112
Yazar: Amila P. MADURAGODA
Kurum: Ministry of Health Sri Lanka
Ülke: Sri Lanka


Orcid: 0000-0001-5323-3367
Yazar: Sayakkara Mesthrilage Navoda Sandamali Maleesha MALLAWARACHCHİ (Sorumlu Yazar)
Kurum: Ministry of Health,Sri Lanka
Ülke: Sri Lanka


Destekleyen Kurum Self-funded
Teşekkür Medical Superintendent and medical clinic staff of BH Dambadeniya
Tarihler

Yayımlanma Tarihi : 14 Aralık 2020

APA Maduragoda, A , Mallawarachchi, S . (2020). A Project To Improve Service Delivery Of Medical Clinic In A State Hospital In Sri Lanka By Application Of Lean Principles . Journal of Health Systems and Policies , 2 (3) , 271-284 . Retrieved from https://dergipark.org.tr/tr/pub/jhesp/issue/57010/737314