Lean production focuses on what is valuable to customers and designs work processes to produce value for customers. This approach includes removing waste to increase efficiency, speed, and quality. After waste is eliminated, more of the production time and activity adds value to the customer’s service and experience. Managers remove the following types of waste (which often occur in HCOs) because they do not add value for the customer:
• Wait time–when someone is waiting for someone or something to become available
• Transit time–when patients, workers, or equipment move somewhere else
• Idle time–when work is not being done because of system downtime or a planned break
• Transition time–when resources are cleaned after one patient and prepared for the next patient
• Overproduction–producing more than is needed, such as too many meals
• Overprocessing–extra processing and steps to accomplish a task, such as extra “clicks” and screen changes on a computer or device
• Defects–production of parts or services that have to be redone or thrown away
• Inventory–supplies, materials, work-in-progress, and finished products that are stored for future use
• Unnecessary motion—motion that does not add value to the product or service
Lean closely examines processes and workflows (called value streams) that provide a service to a customer. Each step of each value stream process-such as patient registration, insurance certification, patient transportation, and patient treatment is analyzed using value stream mapping. This is a visual diagram of all steps in a process used to transform inputs to outputs when creating a product or service for customers. Managers use this Lean tool to find and eliminate wasted steps, wasted time, wasted supplies, wasted labor, and other waste that does not add value to the customer.
The executive team of Clear Lake Hospital reviewed the patient satisfaction scores over the previous two quarters. They noted a declining trend in patient satisfaction scores. The satisfaction surveys ask several questions about patient perceptions of their care. They are asked to rate everything from registration, admission, interactions with various staff members and physicians, outcomes of the interventions, and finally, the billing process. The interactions with registration and admissions were rated as low. The physician interactions were rated as average. The interactions with the clinical staff were rated as average, also. In the qualitative statements, the patients state that the staff seems stressed and in hurry to complete their tasks.
Using the Lean concept of creating value for the customer, the executive team wants to know the best course of action to increase these scores and more importantly, they want to know the cause of these patients’ low perceptions of their care. Part of the discussion was on whether the managers are involved in patient satisfaction and if they know where they can find information useful in planning how to address the problem. It was questioned if they review the report scores and know where to find the qualitative statements that often provide details on the scores. Middle management bears the responsibility for the quality of care and patient satisfaction. They can use the data from the electronic medical records and patient satisfaction surveys to look for areas of improvement. These are just a few of the data sets and uses in the delivery and management of healthcare.
Assume that you serve as Hospital Business Manager, and the Chief Executive Officer Mr. John Jackson asked you to create a process flow chart to trace the patient’s interactions with various departments and staff members that can be used as process map to determine what caused patients’ perceptions. Create the process flow chart in a PowerPoint file (with no more than 5 slides and the list of references on the last slide) with voice over to be provided for the executive team consideration. Using voice over, explain the points of patient’s interactions with various department and staff, and how the Lean approach can be used for flow analysis and performance improvement. Be sure discuss where to find the specific data and how it can be used to improve both patient satisfaction and the quality of care by specifically focusing on potential training.