Implementation
of Lean Thinking to the Radiology Department
By Shayakhmet
Umirzak, Shimkent University, 2016
1.
Introduction
The
health care industry is one of the world’s largest and fastest-growing
industries in the world recently. Healthcare management is a complex business
that must continuously balance the need for medical care together with an
attention to the financial constraints. Ageing population, technological
investments, and operational inefficiencies may cause cost increases in health
care systems. One way to improve this situation for the healthcare sector is to
examine its processes and to deliver care more efficiently and effectively
within available budgets.
Although
involving a number of excellences and demonstrating outstanding advances in
technology and treatment, the healthcare sector is rife with inefficiencies and
errors (Taner et al., 2007).The related costs are largely under the control of
healthcare professionals (De Koning et al., 2006). Applying continuous
improvement philosophy and the techniques from lean management can provide a
basis for innovations as high quality healthcare service with lower costs
(Brandao de Souza, 2009).
This
study demonstrates how to apply lean philosophy in a teaching medical hospital,
particularly in the radiology department, with regards to the patient waiting
time and cost of printing the MR images. The study also expects to increase
access to hospital services and reduce costs while improving the quality of
patient care.
Keywords:
5S, Kaizen, Lean Hospital, Lean Healthcare Applications
2.
Lean
Thinking
Lean
is a customer-centric methodology focused on continuously identifying
improvement opportunities by eliminating “non-value added” (or wasteful)
activities and creating value. Lean thinking puts the expectations of patients
at the center of the procedures for improving the hospital efficiency;
getting an appointment quickly, understanding the consequences of their
treatment, knowing how long they will stay in hospital, being
able to choose their meals, etc. These basic patient requirements are no
longer unmet due to operational constraints but are incentives for changing the
organization of the hospital.
3.
Implementation
of Lean Thinking to the Radiology Department
Founded
in 1996, the medical university hospital has over 20,000 students and 810
academic staff operates under the motto of ‘A world university’. Having over
15 years of experience in medical education in Ankara, than it has been moved
and opened several branches in Istanbul. Along with the medical faculty, the
radiology department serves patients 24 hours a day, 7 days a week. Screening
devices used to set diagnosis can be connected to each other with the help of
digital radiology and archiving system at the radiology department. The
screening results are saved in the computer and can be sent online to another
centre.
This
study emphasized the improvement of the system performance by using lean
management tools adding value to the service rendered, reducing costs and
increasing the healthcare revenue in the hospital. Processes within the system
of the patients admitted to the radiology department was transferred to a time
function map, bottlenecks and unnecessary costs are identified and
measured,activities to achieve the goal of kaizen has been planned. Then PDCA
cycle have been utilized to identify the root cause of our study.
Time
Function Analysis
While
making the value-stream map value added time and waste should be separated from
each other. Non-value added time of the system are named as waste and will be
eliminated from the system. Net hours worked are calculated by dividing the patient
demand. The following is how we proceeded to calculate the Net Working Time.
Healthcare institutions are working 7/24. Therefore, total operation time is
calculated over 24 hours.
Total
Run Time = 24Hours / day x 60 minutes / hour = 1440 Minute = 86400 seconds /
day
Net
Working Time = 24 hours / day = 1140 minutes / day = 86400 seconds / day is
calculated.
The
results shows that the patient time in the department have been reduced from
22,75min to 13,75min as indicated on the map.
Tact
Time
The
tact time is a term used for the rate of just equal Production quantities sold
. Tact time = /. It is compared to the cycle time. Cycle time is a reflection
of the production: this is the unit of time required to produce 1 piece to the
customer. TC = /. It is used in this study to determine the time spent by a
patient before and after lean tool implementation in radiology department.
The
total number of patients admitted to MRI, CT and X-ray in Department of
Radiology is 53 523 persons as given in Table 4.
Radiology
department provides services 365 working days in a year. Accordingly, the tact
time is calculated as follows.
Daily demand = 53
523/365 = 146,7≈147 person / day
Takt Time = Daily
Working Time / Daily Demand
Takt Time = 86400
seconds / 147 = 587.8 seconds / person. So, for a patient MR to CT or X-ray
takes average 9.8 minutes.
Table 1. Radiology
department cycle time before lean thinking
|
X-RAY
|
MR
|
CT
|
Image Printing
|
10 minutes
|
10 minutes
|
10 minutes
|
Report hours
|
4 hours
|
4 hours
|
4 hours
|
Table 2. Radiology
department cycle time after lean thinking
|
X-RAY
|
MR
|
CT
|
Report
|
1 hours
|
4 hours
|
4 hours
|
Do stage:
After detecting
the causes of waste in the radiology department, some steps have been put
forward to correct them. Kaizen
have been implemented in the department process, from patient’s admission to
the issue of the CDs. Therefore some measures are taken:
§ When pictures
doesn’t fit on CDs then the department can use DVDs. (films shot on the same
day at the same CDs)
§ Keeping CDs
According to the shooting
§ Tomography is
recorded on the DVD.
§ Patients who
applied again will be given CDs
§ Designing of
paperboard CD
Check:
In this area plan
is made to test the efficacy and efficiency of our implemented Kaizen method.
For improvement results must be reviewed:
o MR, CT writing on
CDs 08/07/2015
o Getting lost in
the floor, CDs should be in CD container files
o The plaza is not
used; print of CDs is slow, missing image, difficulties in guiding patients
o The fail
probabilities in Plaza
o The determined
image of a doctor can be which detects or visual may have difficulties
o Films print
request from the outside (another hospital external filming, and then getting
the patient treatment)
o CD printing by
patients requests, Storage increased of X-ray CD printing.
o We will continue
through the PACS
o MR Tomography
devices can benefit their own CDs.
o The launch of the
draft work of the files (for the patient's final report and CD storage)
o Printing Machine
Company gets back. DSA will have own room.
o The first CD robot
is not working properly.
Before
lean implementation, the following table shows cost of performance
July
2014 - July 2015 data
|
NUMBER
|
UNIT PRICE
|
COST
|
LOGO CD
|
15400
|
$0,18(3,05TL KUR)
|
$2772/ 8442,68 TL
|
The CD CUP LOGO
|
16475
|
0,15 TL
|
2471,25
|
BIG BAG X-RAY
|
23841
|
1,05 TL
|
25033,05
|
X-RAY PURSE SMALL
|
10995
|
0,70 TL
|
7696,5
|
43643,23
|
FILM + MACHINE FEE
|
148147,70
|
TOTAL
|
191790,93
|
|
|
|
|
|
After
Lean Implementation
August
2015-August 2016 (number and unit price is calculated from the maximum value)
|
NUMBER
|
UNIT PRICE
|
COST
|
LOGO CD
|
40000
|
$0,14(3,05 KUR)
|
$5600/ 17080 TL
|
BIG BAG X-RAY
|
1000
|
1,05 TL
|
1050
|
POCKET REPORT FILE
|
35000
|
0,5 TL
|
17500
|
35630
|
EARNINGS
|
156160,93
|
·
FILM
PRINTING MACHINERY Removed
·
SMALL
X-RAY BAG deprecated
·
DIGITAL
PRINTING FAIR USE CD with CD were REDUCED COST
·
CD
CUP COST lifted
4.
Conclusion
and Future Work
The
radiology department is one of the most highly congested departments in the
hospital services, and faces a great pressure, compared to the other
departments in the hospitals. Delays in the activities of this department would
result in difficulties in scheduling services at specialty units and decrease
patients satisfaction. This study addressed the cost and time reduction through
lean thinking. The objective of this research was to study the scope of lean
thinking and in particular to explore its successful deployment in the
radiology department of a medical university hospital.
References
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