Lean management for improving hospital waiting times—Case study of a Vietnamese public/general hospital emergency department

Abstract

Introduction: Emergency departments (EDs) at public hospitals in Vietnam typically face problems with overcrowding, as well as being populated by a wide variety of illnesses, resulting in increasing dissatisfaction from patients. To alleviate these problems, we used the increasingly popular value-stream mapping (VSM) and lean strategy approaches to (1) evaluate the current patient flow in EDs; (2) identify and eliminate the non-valued-added components; and (3) modify the existing process in order to improve waiting times.Methods: Data from a total of 742 patients who presented at the ED of 108 Military Central Hospital in Hanoi, Vietnam, were collected. A VSM was developed where improvement possibilities were identified and attempts to eliminate non-value-added activities were made. A range of issues that were considered as a resource waste were highlighted, which led to a re-design process focusing on prioritizing blood tests and ultrasound procedures. On the administrative side, various measures were considered, including streamlining communication with medical departments, using QR codes for healthcare insurance payments, and efficient management of X-ray and CT scan online results.Results: By implementing a lean approach, the following reductions in delay and waiting time were incurred: (1) pre-operative test results (for patients requiring medical proce-

Hospital operations management – characterising patients’ process flows in emergency departments

“…King et al (2006) suggest triaging patients only between those who need emergency care or not, serving non-emergencies on a first-come, first-served basis. Among the suggested improvements are layout changes, visual communication, team hiring, activity changes, merging resources' activities (Castanheira-Pinto et al, 2021;Aaronson et al, 2017;Gabriel et al, 2020;Cookson et al, 2011;Bal et al, 2017;de Barros et al, 2022;Le et al, 2022;Ryan et al, 2013).…”

“…As the exclusion criteria did not consider a time frame, the obtained articles span a range of 20 years, with the oldest from 2003 (Solberg et al, 2003) and the most recent from 2022 (de Barros et al, 2022;Le et al, 2022). Also, the studies were conducted in a wide variety of countries.…”

“…The possibility of patient transfer was discussed in some articles (Alexander et al. , 2020; Le et al. , 2022; Solberg et al.…”

“…Patient bed allocation is one of the major challenges of hospital management, considering constraints such as infrastructure and costs, and it is necessary to decide which patients can be admitted, which can wait, and which can be referred to other services (Wang et al, 2020). The possibility of patient transfer was discussed in some articles (Alexander et al, 2020;Le et al, 2022;Solberg et al, 2003). Again, it is necessary to evaluate the flows of each unit regarding transportation to determine which professionals will be responsible for this process.…”

“…Lean healthcare applied to the ED focuses on analysing and improving the entire patient experience with the lower level of waste possible, from the moment they enter the ED to the moment they exit, including all processes, systems and stakeholders involved. In this context, it is important to develop activities of process modelling (Neuner et al, 2021), waste identification (Lisiecka-Bielanowicz and Lisiecka, 2020), value stream analysis (Le et al, 2022), visual management (Mangum et al, 2021) and continuous improvement (Denicolo et al, 2021). It should also be considered that several other aspects of the entire hospital operation have a direct impact in the ED delivery of care, and that overcrowding of ED is a major contributor to reduction of efficient and timely clinical care (Kelen et al, 2021;Yarmohammadian et al, 2017).…”