By January 19, 2011 0 Comments Read More →

Lean Healthcare Comes to Hong Kong

The website HK News Watch published an article called “Hospitals take initiative to tackle long waits” that describes efforts to use Lean and kaizen to reduce patient waiting times.

City of Gold - Hong Kong 黃金之城

The article describes waste and waiting time that would familiar to any reader, anywhere:

For patients at public outpatient clinics, a five-minute consultation with a doctor can mean a half-day expedition, including travelling time, lining up to register, waiting to be called, paying and picking up medication.

But some public hospitals are using their own innovative measures to cut waiting time, which can add up to three to four hours.

While some hospitals increased staffing (which increases costs), one hospital has gone the Lean route:

At Castle Peak Hospital in Tuen Mun, for example, management has cut the waiting time at its outpatient mental clinic by 45 per cent in the past year using a scheme modelled on one devised by carmaker Toyota.

What causes these long waits? One familiar cause is the lack of patient focus in scheduling:

Some clinics allocated too many appointment slots in every hour. “The system is designed for the sake of convenience to doctors; it makes sure doctors do not need to wait for patients, so many patients are booked in the same time slot,” he said. “The Hospital Authority should consider making the system more patient-oriented.”

At Castle Peak, leaders and staff members used Lean to put creativity over capital, as we’d often say in the Lean methodology:

The Castle Peak solution, according to the hospital’s senior executives, does not come from any advanced technology or extra money but a change of mindset and a detailed review of procedures.

Modelled on Toyota’s kaizen improvement system – meaning improvement or change for the better – it looks at every detail of a patient’s movement through the hospital system, seeking to raise efficiency.

“Reviewing the whole patient journey and reforming the appointment system has successfully solved the old problem that had been with us for a long time,” consultant psychiatrist Dr Lam Ming said.

“The reform is not complicated; mainly it is about a change of mindset. Our experience tells us that hospital managers have to visit the site to see the real situation themselves, and to talk to staff and patients directly to get their views.”

As the author David Mann (Creating a Lean Culture: Tools to Sustain Lean Conversions) advises, when you have a problem you need to go to the place where the problem occurs (go to “gemba”), talk to the people involved, and show respect.

The article describes how they created a level loaded schedule that was realistic instead of having patients all arrive at 9 am or 2 pm. Amazingly, those used to be the only two time slots offered. What other business runs that way or treats its customers as if their time is so invaluable?

The clinic observed patient flow and saw that most of the time was waste. That’s not surprising.

What’s also not surprising is that staff morale improved with Lean:

Staff morale has also improved. “In the past, doctors had to bear with the dozens of patients’ files piled on their desks. From the time they stepped into the consultation room at 9am they felt stressed. The new system means they have a rather fixed number of patients in each session, and they feel more relaxed.

Wouldn’t you like those results in your clinic, as a physician, a staff member, or a patient?

Creative Commons License photo credit: Dennis Wong


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Mark Graban's passion is creating a better, safer, more cost effective healthcare system for patients and better workplaces for all. Mark is a consultant, author, and speaker in the "Lean healthcare" methodology. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. His most recent project is an eBook titled Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also the VP of Improvement & Innovation Services for the technology company KaiNexus.

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