Lean and queuing integration for the transformation of health care processes

Abstract

PurposePatient satisfaction and quality care are important indicators for the success of any health care enterprise. The critical nature of health care operations entails that some excess capacity is stored in the system to provide the necessary flexibility of response. To prepare health care organizations to deliver high quality services at lower costs, this paper aims to report a lean health care (LEAN‐HC) transformation model that integrates queuing theory and lean methodology to improve the dynamic performance of the health care system.Design/methodology/approachThis paper reviews and evaluates an emergency department health care system that adopts a system dynamic model, redesigned the process using value stream mapping to eliminate non‐value‐added activities to achieve just‐in‐time (JIT) services. This study was conducted at SD Mission Hospital, India. The LEAN‐HC model includes three steps. First, the patient arrival flow is assessed and adjusted, using physicians at the front of the queue to separate patients at triage into major, medium, and minor injury classes. Second, a cross‐functional team consisting of process, information and clinical experts maps the hospital's current state to identify and eliminate wasteful non‐value‐added activities. Third, the process is continually de‐bottlenecked using a variety of lean techniques, such as 5S visual management, one‐piece‐flow to reduce service lead time, and adoption of standard operating procedures.FindingsThe authors' results reveal that a lean integration to queuing methodology frees up capacity in the health care system, providing necessary flexibility of response. The implementation of the LEAN‐HC model resulted in the following improvement. First, an improved process flow and increased capacity. Second, emergency department length of stay for all patient classes decreased. Third, value stream mapping was found to be useful in detecting opportunities to decrease patient turnaround. Fourth, the service bottleneck could be identified and shifted to where it could be most easily controlled, adhering to the principle of one piece flow. No changes in resource availability and safety or quality issues occurred during the implementation of lean methodology.Originality/valueThis study demonstrates how to apply lean methodology in conjunction with the queuing modeling in the health care industry, particularly with regards to the patient wait time and reduction in medical errors. The LEAN‐HC model delivers more efficient service by increasing hospital capacity while reducing non‐value‐added times and overhead costs.