Using LEAN concept to increase efficiency in

Diabetic clinic service, Public Health Center 67

Taweewatthana

Suthee Saritsiri, MD Director of Public Health Center 67

big_bossboom@hotmail.com

• 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