Lean management i högspecialiserad sjukvård

Abstract

Background
The queues within Swedish healthcare are presently unacceptably long.
The demands and costs of healthcare have increased and are expected to
rise in the future. This has resulted in a higher stress on all of the
healthcares resources, from the financial aspect to the human. As with
many other public establishments, Lund University Hospital has suffered
from weak finances, which in the last few years have occasioned cutbacks
and restructuring. In the shadow of these financial constraints new working
procedures that create better results using existing resources are being
pursued. In an attempt to improve healthcare for all parties concerned, the
management at Lund University Hospital has chosen to introduce the
philosophy of “lean” healthcare to the hospital’s administration.
The waiting time for cardiac surgery is presently too long for certain
patient groups. It is necessary for that reason to enhance the organization
and the methods of working in a way that the accessible resources obtain
optimal use. Cancellation of elective surgeries, long O.R. (operating room)
changeover times and overtime work are some of the problems that the
surgery ward at the department of cardiothoracic surgery has not yet
solved. This leads to budgetary excesses, which is not acceptable. There
currently exist several obvious challenges ready for the department to take
up and that the management will now assign by introducing lean healthcare
into the operation.
Objectives
The purpose of this paper is to accomplish a process mapping in and
around the surgery ward at the department of cardiothoracic surgery with
subsequent identification and suggested countermeasures with regard to
quality deficiencies by using lean production. In identifying and
eliminating quality deficiencies the aim is to be able to increase the
utilization of resources and thereby minimize O.R. changeover times,
decrease the number of cancelled elective surgeries and reduce the
overtime work. Finally this paper will offer suggestions on how lean
management could be implemented in and around the cardiothoracic
surgery ward.
Limitations
The work is focused on the identification of quality deficiencies in the
cardiothoracic surgery ward and the interface between the cardiothoracic
surgery ward and adjacent activities such as ward 17 and ward 18, thorax
intensive care unit, and surgery planning. This paper will accordingly not
generally deal with quality deficiencies or proposed solutions within the
adjacent hospital units. The process flow from heart conference through to
the surgery planning and to the cardiothoracic surgery ward and further on
to the thorax intensive care unit and the nursing ward is going to be
described in its entirety.
Methods
The study’s integral parts have explorative as well as descriptive and
illustrative directions. Because of the study’s scope a case study trial as
well as a cross-section trial of the survey type has been accepted.
Information collected during this study is primarily qualitative but has also
quantitative aspects. The principal methods used for the collection of
primary data have been personal interviews, direct observations and
written forms. A diverse amount of secondary data has been collected and
studied during the study’s course. Secondary data from specialist literature,
web pages, internal documents, presentations, and the activity’s intranet
have been reviewed in-depth. The choice of those practical data collection
methods for this investigation have been carefully chosen with great
consideration with a view to obtain the most reliable information.
Conclusions
The surgery ward at the department of cardiothoracic surgery has presented
problems for a long time with amongst other things; long waiting lists,
cancellation of elective surgeries, long O.R. changeover times and
overtime work. In a thorough analysis of the activity it becomes clear that
there are elements of multiple occurrences, which don’t exist, in a lean
organization.
There is a significant amount of non-value-adding use of resources in the
activity, there lacks an incentive system, there is little standardization, and
the visual control is defective. To put the problem right, a number of
countermeasures are suggested in accordance with the principles of lean
production. There follows a selection of these measures. The most
significant and important is the implementation of independent and
objective monitored teams in the surgery ward, which plans, organizes and
carries out their own work independently. To create better visual control a
web-based surgery planning application is recommended which is made
available to all units involved. Also, the introduction of an incentive
system is suggested which rewards industrious and creative collaborators.
Recommendations are also made to standardize work during surgery and in
the changeover between patients.

• author: Persson, Andreas
• supervisor: Bertil Nilsson
• organization: Production Management
• course: MIO920
• year: 2008
• type: M1 - University Diploma
• subject: Technology and Engineering
• keywords: lean management, lean healthcare, lean production, flow, muda, process mapping, standardization, quality deficiencies
• other publication id: 08/5297
• language: Swedish
• id: 1979633
• date added to LUP: 2011-06-17 14:21:11
• date last changed: 2011-06-20 11:12:26