Lean management principles have been used effectively in the manufacturing industry for many decades. The Institute for Healthcare Improvement (IHI) believes that lean principles can be successfully applied to hospitals to have a positive impact on quality, cost, productivity and timely delivery of services.
Lean thinking begins by driving out waste so that all work adds value and serves the customers needs. It is a management strategy used to improve processes that create value for those who use or depend on services. In this case, our patients and community of Person County.
The journey to the LEAN transformation in the Emergency Department at Person Memorial Hospital began in March of 2009. Senior Executives began to see a need for change with the expansion and renovation of our Emergency Department. The improvement project led to an increase in beds from 6 to 17, a larger space to work in, a designated triage area which was somewhat isolated from the department, and private rooms with state-of –the-art-technology. The workflow in the 6-bed design could not accommodate the needs in the new and improved space. Another factor for "going lean" was evaluation of our patient wait times and length of stay. Our philosophy embraces a patient-centered environment where the needs of patients are met timely and with accuracy. We wanted to not only provide adequate space and new facilities for our patients, we wanted to improve the way we delivered care and exceed the expectations of our community. Reducing wait times and improving length of stay in the Emergency Department would be a step in that direction.
A "LEAN" team was assembled and training on lean management techniques began. The "LEAN" team consisted of physicians, nurses, unit secretaries, registration personnel, managers, administrators, and Laboratory and Radiology personnel. The team met for several days to determine value and non-value added steps in the way we care for patients. We eliminated waste by keeping in mind that our patients wanted to see a qualified physician quickly, get appropriate treatment for the condition, be discharged efficiently, afford the care that they receive, and be treated with dignity and respect along the way. The findings based on this innovative thinking demonstrated that non-value added steps could be eliminated to improve care delivery. As a result, we have built a process to meet those needs, a process that is supported from the top down.
Since implementation on April 28, 2009, we have significantly reduced the amount of time it takes our patients to see a physician. The average wait time is under 30 minutes. Other successes since implementation is the fact that we rarely have patients "waiting" to be seen. Our patients are seen immediately by a triage nurse (within 5 minutes) and placed in a room within 15 minutes. Our overall length of stay has decreased by 1 hour in the short time this process has been in place.
This is just the beginning of the journey. With the help of our patients and community, we have identified other opportunities that will assist us on our road to success. Future activities include implementing an electronic health record to improve documentation allowing us more time with our patients and implementing a patient-centered model which will focus on ways to improve customer satisfaction and the overall experience in the Emergency Department.