Lean management practices applied to system healthcare facilities

Abstract

This thesis concerns the results of a simulation study that has involved the Surgical Department and Intensive Care Unit of a public healthcare facility located in South Italy. After a preliminary work devoted to map the processes and after data collection and analysis, Lean Tools have been studied before and simulation models have been developed after. The models, that have been validated by stakeholders and through comparison with real data, can be used for evaluating actual and maximum capacities but also for testing alternative scenarios before the implementation in the real system. Moreover, thanks to the model parametrization, the proposed tools can be easily adopted in other similar facilities or for evaluating different configurations in terms of resources allocation and availability. In addition, the simulation models have been equipped with build-in functions implementing the “pull method” and "kanban" from Lean Management practices showing that substantial performance improvements can be achieved . The most healthcare organizations push patients from one area to another, from wards to operating blocks, without knowing when the patient will be treated. Instead, according the pull method, thanks to a definitive scheduling and some basic preconditions such as continuous checking and resources availability, patients are pulled when they are actually needed and as a result wastes are reduced and productivity is enhanced. The effects of the pull method implementation are accurately investigated in the simulated environment that has served as playground to assess the potential impact of the proposed approach. Regarding Intensive Care Unit, the staff works under enormous stress and the workload has continued to increase during the last years. Usually this type of environment creates an atmosphere of frustration and anxiety for all staff due to particulars conditions of patients. In this particular scenario, the Intensive Care Unit team that we presented in this research work was introduced to the results of the simulation and to the Lean concepts through dedicated training courses. The Lean methods and tools as well as simulation results were successfully transferred to the real system with a relevant increase of the overall performances. The implementation of Lean methods and tools can help any organization to launch its Lean transformation and improvement. This is even more important for Hospitals that cannot continue to operate as they have done in the past. The hospitals need to ensure their processes with much more value added work and such work must be totally directed on patients.