Following the implementation of the Lean approach in four Gauteng hospitals, Chairman of the Lean Institute Africa (LIA), Prof Norman Faull, reports that there have been drastic reductions in patient waiting times in the key areas of pharmacy, patient record collection and medical outpatient departments (MOPDs).
LIA has been collaborating with the Gauteng Department of Health (GDoH) since December 2014 to roll out Lean workshops to eliminate wastage in Chris Hani Baragwanath Hospital (CHBAH), Leratong Hospital, Sebokeng Hospital and Kopanong Hospital.
According to Faull’s official report on the programme’s progress from April to June 2015, there have been numerous cuts in patient waiting times across each hospital due to the success of the Lean workshops and more particularly the follow-up coaching.
“On 30 June, 15 out of 20 Cohort 1 members met at CHBAH for reflection, feedback and a brief workshop to introduce a more structured Daily Management System based on the Toyota Kata approach. The quantitative feedback given by the Cohort members for the overall initiative to date is very positive,” said Faull.
As for the implementation of the Lean approach in the hospitals, according to Faull, the CHBAH Pharmacy team reported achieving waiting times of 25 minutes for five consecutive days early in July, even with high patient numbers. “This team is proving to be particularly persistent in following the guidelines of the Lean programme,” said Faull.
As depicted in the graph above, between April and June there have been remarkable improvements in the four hospitals since going Lean. Most notably, in CHBAH there’s been a 71% reduction in patients waiting for their patient records, from 276 minutes down to 80 minutes; in Leratong patient records there’s been a 68% reduction in the patient waiting time, from 143 minutes down to 45.6 minutes; in Sebokeng there’s been a 67% reduction in pharmacy patient waiting time, from 15 minutes down to 5 minutes; and in Kopanong there’s been a 52% reduction in patient waiting time in the MOPD, from 44.75 minutes down to 21.3 minutes during RPI week. However, Faull noted that the cumulative average to the end of June was 84 minutes due to the increased unavailability of doctors on leave and doctor starting times in wards.
While the data collected by LIA indicates that the Lean programme is a success, Faull noted that there isn’t a generally accepted definition of waiting time (WT) in the GDoH, or how it should be measured, and believes eHealth could play an important role here.
“Furthermore, there is confusion between WT and journey time (JT),” said Faull. “Once agreement is reached on what they are, and how they should be measured, we may well find that eHealth can provide a reliable and efficient way of measuring WT and JT across the various facilities that will lead to greater insight as to what drives the poor results and what we can do about them.”
Maintaining the Lean system in the hospitals is the next important step in order to ensure that staff don’t revert to any previous poorer practices. “Our team is working with the three model lines in each hospital to stabilise performance insofar as it is under the control of the staff,” said Faull.
“For example, the booking system is being studied in some places to level the patient load on the facilities so that day-to-day variations in patient numbers are reduced. In time we envisage spreading patients throughout the day as well, to further stabilise demand on the resources,” continued Faull.
Following the success of last year’s summit, this year’s Lean Healthcare Summit will take place in Johannesburg on 26 October, where the US Lean healthcare leader and CEO of the Thedacare Centre for Healthcare Value, Dr John Toussaint, will be the keynote speaker.
Faull is optimistic that the event will attract public and private healthcare managers as well as medical aid representatives. “I hope the event will motivate and inform the healthcare players on what can be achieved by taking a deliberate and long-term approach to adopting the Lean approach to healthcare provision,” said Faull.
“There will be a good mix of local and international examples to inform and inspire local action going forward,” concluded Faull.