Lean management for improving hospital waiting times—Case study of a Vietnamese public/general hospital emergency department

Le, Duong X. and Do, Hoa T. and Bui, Khoa T. and Hoang, Truong Q. and Nguyen, Ghi H. and Nguyen, Anh V. and Nguyen, Quynh T. and Gorgui-Naguib, Hannah and Naguib, Raouf N.G. (2021) Lean management for improving hospital waiting times—Case study of a Vietnamese public/general hospital emergency department. The International Journal of Health Planning and Management. ISSN 1099-1751

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Introduction: Emergency departments (EDs) at public hospitals in Vietnam typically face problems with overcrowding, as well as being populated by a wide variety of illnesses, resulting in increasing dissatisfaction from patients. To alleviate these problems, we used the increasingly popular value-stream mapping (VSM) and lean strategy approaches to
(1) evaluate the current patient flow in EDs; (2) identify and eliminate the non-valued-added components; and (3) modify the existing process in order to improve waiting times.
Methods: Data from a total of 742 patients who presented
at the ED of 108 Military Central Hospital in Hanoi, Vietnam, were collected. A VSM was developed where improvement possibilities were identified and attempts to eliminate non-value-added activities were made. A range of issues that were considered as a resource waste were highlighted, which led to a re-design process focusing on prioritizing blood tests and ultrasound procedures. On the administrative side, various measures were considered, including streamlining communication with medical departments, using QR codes for healthcare insurance payments, and efficient management
of X-ray and CT scan online results.
Results: By implementing a lean approach, the following reductions in delay and waiting time were incurred: (1) pre-operative test results (for patients requiring medical procedures/operations) by 33.3% (from 134.4 to 89.4 min); (2) vascular interventions by 10.4% (from 54.6 to 48.9 min); and (3) admission to other hospital departments by 49.5% (from 118.3 to 59.8 min). Additionally, prior to the implementation
of the lean strategy approach, only 22.9% of patients or their proxies (family members or friends), who responded to the survey expressed satisfaction with the ED services. This percentage increased to 76.5% following the curtailment of non-value-added activities. Through statistical inferential test analyses, it can be confidently concluded that applying lean strategy and tools can improve patient flow in public/
general hospital EDs and achieve better staff coordination within the various clinical and administrative hospital departments. To the authors' knowledge, such analysis in a Vietnamese hospital's ED context has not been previously undertaken.

Item Type: Article
Additional Information and Comments: The definitive version is available at https://onlinelibrary.wiley.com/doi/10.1002/hpm.3310
Keywords: accident and emergency department, hospital information systems, lean strategy, value-stream map
Faculty / Department: Faculty of Science > Mathematics and Computer Science
Depositing User: Raouf Naguib
Date Deposited: 16 Sep 2021 10:47
Last Modified: 16 Sep 2021 10:47
URI: https://hira.hope.ac.uk/id/eprint/3357

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