Download - Using Lean concept in DM clinic Thailand
Using LEAN concept to increase efficiency in
Diabetic clinic service, Public Health Center 67
Taweewatthana
Suthee Saritsiri, MD Director of Public Health Center 67
• Public Health Center 67 was established in 2007.
• DM clinic opened service in 2008.
Background
-
5,000
10,000
15,000
20,000
25,000
6,445 (*100)
8,843(*122)
12,339(*172)
15,221(*214)
20,600(*295)
Patients * Registered DM patients 2008 2009 2010 2011 2012
By1. Providing accurate, fast, through, and fair (good Governance) service2. Development benefits to the organization and society.3. Monitoring and evaluation of customer satisfaction.4. Potential mechanisms of management within the organization.Strengthen the personnel and the potential quality of life and pride. Allocate the necessary resources.
12 years Development PlanBangkok Metropolitan
Administration’s Policy 5th Strategy: Develop a model management system of sustainable metropolis
LEAN concept
Be better
Using LEAN concept to increase efficiency service .
DMPatients
Visit monthl
y
NPO for DTX
Unsatisfied emoti
onWell glycemic control
Healthcare providers may not
be tired.
Loss F/UIncreased risk of
complica
tions morbidit
y mortality
Win – Win: Between patient and staff satisfaction
Research question
Can LEAN concept increase efficiency in DM clinic service?
Metodology of the study
1. Pre LEAN February 2012
2. Root Cause Analysis
3. Using LEAN Concept
4. Evaluate comparison Pre LEAN and Post LEAN
March 2013
External Customer
needSWOT Analysis
1.Time and Length in each steps of services (start to the end)
(value+nonvalue but necessary+waste)
Outcome evaluationQuantitative Qualitative
1.Physical environment:
No. of service points2. Human Resources: No. of Healthcare providers3. Process: No. of steps in services4. Time and Length: in each steps of services (start to the end)
1.Efficiency of service % = value Time x 100
Total Time
2. Satisfaction: DM patients and Healthcare providers
Implement LEAN concept
1. Physical environment
Door
Nursing room
2 Medical record roomPhar
macy
Finan
ce room
Examroom.1Exam
room. 2
counseling room
Health education room
preparing
Cue cards
13
4
5
6
7
8
Elevator
Waiting Point
Service
1 Cue cards
2 Medical records room
3 preparing
4 Nursing room
5 Examination room
6 Counseling room
7 Finance room
8 Pharmacy
Pre Lean
Door
Nursing room
Medical records
room
Pharmacy
roomFinance
room
Examroom 1Examroom 2
counseling room
Health
educat
ion room
preparing
Cue cards
1
Elevator
Waiting7
8
Floor 1
Post Lean
Blood
exam
counselin
g roomX-ray
room
3
5
Elevator
Waiting
preparing
4
2
6
Screen
Floor 2
Point
Service
1 Cue cards
2 Screen BW BP
3 Blood
4 Preparing
5 Exam room
6 Counseling room
7 Finance room
8 Pharmacy room
Exam room
Post Lean
2. Human Resources
Evaluate complication on Diabetes’ Day
Post - LEAN
• Prepare appointed OPD card in advance• Self completion in each service point
3. Concised Process
4. Developed tools• Medical reconciliation sheet• Colored checklist sheet
Educational tools and Self Help Group
• Mutimedia educational channels
Result
MeasurePre
LEANGoal
Post LEAN
Outcome
Service points
8 - 8 same
Human Resources
12 - 11 decreased
Steps in service
27 3 step 24 3 step
Time taken (Minute)
141.2 10 % 62.2 55.95 %
Length (Meter)
111 10 % 77 30.63 %
Quantitative
MeasurePre
LEANGoal
Post LEAN
Outcome
Efficiency service (%)
33.36 10 % 65.90 32.54 %
Satisfaction High to Highest level-External customer (n=50)
- Internal customer
(n=50)
84.77
81.55
increased
increased
93.22
92.21
increased
increased
Result
Qualitative
Diabetic patients’Satisfaction
(n=50)
Mean Score
Pre LEAN
Post LEAN
p-value*
Convenience and speed in service
The speed of the process is available (From visit to go home)
3.44 4.10<
0.001*
System managed service is a first (Queue system) 4.36 4.56 0.219
Providing a quick and easy dispensing 3.62 4.24
< 0.001*
Quality in serviceAvailable tools 4.04 4.26 0.063
Personnel have knowledge and talent in service 4.04 4.58
< 0.001*
Doctor followed by Clinical Practice Guidelines 4.60 4.64 0.753Courtesy and empathyPersonnel have service mind 4.76 4.86 0.307Personnel attention and caring as well 4.68 4.72 0.752Personnel advice in good verbal and polite 4.60 4.80 0.064Give information about health care and serviceGive in patients’ need 4.56 4.60 0.756The pharmacist explains how to use each drug clearly 4.28 4.28 1.000
Adequate information and channels 4.04 4.48 0.00
5*Service charges and costsDelight in the service charges and costs 4.80 4.74 0.587Compare between cost and services received. Worth? 4.82 4.90 0.377Building and facilitiesSeparate property. Easy to use 4.74 4.86 0.244Safety 4.82 4.84 0.841Clean 4.90 4.86 0.543Clear direction. 4.70 4.76 0.610
Conclusion
• Utilizing LEAN concept can lead to substantial improvement in quality and efficiency of healthcare service (DM clinic)
• Key success factor: Lean concept technique and Good teamwork
Thank you