The impact of lean thinking on operational efficiency in a rural district hospital outpatient department in KwaZulu-Natal.
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Date
2013
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Abstract
Introduction
Health-care service in South Africa, especially in the public sector, is fraught with
numerous problems, including ineffective operations management in health care
facilities. This contributes to poor service delivery and a lackluster work environment.
Non-value-adding activities result in, inter alia, long cycle and waiting times, and low
staff morale. With Lean thinking, health care managers could tackle specific issues to
improve operational efficiency.
Aim
The purpose of the study was to apply Lean thinking, and to determine its effect on
efficiency and staff morale within the outpatient department at Catherine Booth
Hospital, in order to inform recommendations to improve operational efficiency in rural
district hospital outpatient departments.
Methods
An operational action-research study design was used. The study sample consisted of all
service nodes and employees of the outpatient department in Catherine Booth Hospital.
Cycle and waiting times were iteratively measured for all service nodes. Statistical
analyses on pre- and post-intervention results were carried out.
Results
Cycle and waiting time targets were met and exceeded in three service nodes, but only
the Investigations node showed statistically significant results (cycle time reduced from
16.7 to 12.2 minutes; p=0.04; and waiting time reduced from 11.93 to 10 minutes;
p=0.03). The waiting time for Consulting Rooms improved significantly (80.95 to 74.43
minutes; p<0.0001). Significant decreasing trends in waiting times over the study period
were found in Patient Administration (p=0.04), Patient Screening (p<0.0001) and
Consulting Rooms (p<0.0001). The trend in average operational efficiency improved
over time from 16.35% to 20.13%.
The implementation of Lean had a positive impact on the proportion of OPD staff
satisfied with their jobs (increased from 21.1% to 77.8%; p<0.0001) and proportion of
staff that felt motivated (increased from 15.8% to 77.8%; p<0.0001).
Discussion
Rural public sector hospitals require a novel and evidence-based approach to improving
operational efficiency and staff morale in OPDs and other departments. Lean
implementation had a positive impact on cycle and waiting times in all service nodes.
Attitude towards teamwork and communication strength are positively impacted by the
process of Lean implementation. However, factors such as differing priorities and logic
among staff in the OPD and management negatively affect the outcomes of Lean
implementation.
Conclusion and recommendations
The application of Lean principles, tools and techniques is possible in a rural district
hospital OPD, without any demands on staff in terms of learning and adopting a new
quality-improvement management approach by which to improve operational
efficiency. The lessons learnt from the implementation of Lean thinking at a rural
hospital used in this study may be emulated for quality improvement across similar
hospitals and its sustainability can be assessed further.
Description
Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2013.
Keywords
Rural hospitals--KwaZulu-Natal--Administration., Hospitals--Outpatient services--KwaZulu-Natal--Administration., Theses--Public health.