09 Sep LEAN Methodologies Improved Wait Time In VA Medical Center
MedicalResearch.com Interview with:
Dr. Andrew Eppstein
Andrew C. Eppstein, MD, FACS
Assistant Professor of Clinical Surgery
Indiana University School of Medicine
Department of Surgery, Division of General Surgery
Richard L. Roudebush VA Medical Center
Indianapolis, Indiana
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: A few years ago we encountered long wait times for patients undergoing elective general surgery in our tertiary care VA medical center. Demand had grown and our existing systems were not able to accommodate surgical patients in a timely fashion. By fiscal year (FY) 2012, our wait times averaged 33 days, though patients with malignancies would be moved to the head of the line, pushing more elective cases further back.
To address rising demand and worsening wait times, our Surgery Service convened an analysis of our processes using Lean methodology in collaboration with the Systems Redesign Service. Multidisciplinary meetings were held in 2013 to analyze inefficiencies in the current system and ways to address them to create a streamlined, ideal system. The collaborations included surgeons, nurses, ancillary staff, operating room and sterile processing staff, and hospital administration. Projects were rolled out stepwise in mid-2013 under General Surgery, the busiest surgical service at our institution.
We noted a sharp decline in patient wait times after initiation of reforms such as improved OR flexibility, scheduling process changes, standardization of work within the department, and improved communication practices. These wait times dropped to 26 days in FY 2013 and further to 12 days in FY 2014, while operating volume and overall outpatient evaluations increased, with decreased no-shows to clinic. Our decreased wait times were sustained through the remainder of the observed period.
MedicalResearch.com: What should readers take away from your report?
Response: Employing Lean methodologies using a multidisciplinary approach may be an effective way of decreasing patient wait times and improving overall systemic efficiencies in the VA and elsewhere.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: This study should be externally validated by other services and institutions attempting Lean projects of their own to assess the impact on patient wait times. Additionally, long-term effects of Lean reforms should be examined with respect to sustainability, overall effects on patient care, and satisfaction.
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Last Updated on September 9, 2016 by Marie Benz MD FAAD