Reassessing Efficiency in Human Development among ECOWAS Countries

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

PCDA Cycle

It is an iterative four-step management method used for the control and continuous improvement of processes and products.  Therefore it is useful to our study since the aim of kaizen is to eliminate waste and keep it improving. The plan–do–check–act cycle (Figure 1) is a four–step model. Just as a circle has no end, the PDCA cycle should be repeated again and again for continuous improvement.

Figure.2 PDCA cycle

Fig.3 PCDA cycle step by step

 

PLAN

The planing importance layed on the requirement to educate the radiology department’s physicians, employees on the cause of switching to the digital system and adopting lean management method. In planing process three questions were asked to help us implement the lean management tool: What, why and how?  The answers leads us to the followings:

July 2014 - July 2015 data

	NUMBER		UNIT PRICE	COST
LOGO CD	15400		3,05 (unit)	8442,68 (unit)
The CD CUP LOGO	16475		0,15	2471,25
BIG BAG X-RAY	23841		1,05	25033,05
X-RAY PURSE SMALL	10995		0,70	7696,5
TOTAL                                                                                                        43643,23
FILM + MACHINE FEE		148147,70
TOTAL		191790,93

It shows the total cost of both films and machines  fromJuly 2014 - July 2015. 

Determination of the cause

The PCDA cycle help us to determine the root cause of waste in the department. Some of these causes are mentioned in the following table:

1.      Patient complaints (patients have to carry X-rays results with them)

2.      Patients forget have to print again the film that is why patients must pay a fee for it

3.      waste of time staff who prints (workload again)

4.      Delays being experienced in the treatment

5.      Archive storage space shortage (forgotten films are stored 1 month)

6.      Loss of prestige, environment and state hospitals already have passed this system of hospitals)

7.      Have increased the cost of the film

8.      Business inserting the film in the present operation leads to loss of time in service.

9. Lack of connection between different departments

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.

The study presented here was restricted to the objective of studying the impact of lean thinking on the cost and time wastage of the patients in radiology department only. The study was limited within only radiology department. However, a careful observation of the results led to the conclusion that there could be further scope of improvement in managing the image printing time and its cost. Utilizing advantages of information technology could be effective for further improvements.

References

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