Lean wastes in health services flow: Development of an improvement process

Designing a lean system in healthcare to identify and reduce the wastes is very important approach to improve health services process flow, reduce cost, and improve quality of care. Aim: This study aimed to identify Lean wastes in health service (admission process) and develop an improvement process. Design. A descriptive research design was selected for fulfilling the aim of this study. Setting. The current study was carried out at outpatient clinic and four surgical wards at Alexandria Main University Hospital Subjects. The participants in this study encompassed 50% of total patient number who were involved in process flow (N=50). Tool Lean Wastes Identification Tool (LWI), is an observation record developed by Sanders (2014) which is a modified version of original hospital inpatient waste identification tool ,it was used for recording the observation of each process tasks which includes: name of unit for selected process, date of process observed, name of selected process observed, description of tasks for observed process, duration (time consumed) for each task , classification for each task of observed process if value adding or not, classification for eight types of lean wastes in relation to each task of observed process in form of eight types of Lean wastes. Main finding were that, the percent of value added tasks in admission represent less than half of whole process tasks as well as consuming less than half of process lead time. Compared to non value added tasks (Lean wastes) that constitute more than half of whole process tasks and consuming more than half of process lead time. The predominant wastes in admission process were waiting, overproduction, motion, transportation, defect, and over processing. In addition, an improvement process was developed process cycle efficiency was increased after proposed improvements to be higher than 25%. Therefore, the study recommended that hospital managers, physicians, nursing administrators and staff nurses work together to improve current health service process flow as well as reduce non value added activities (lean wastes) in admission process.