Lean management in a liaison psychiatry department: implementation, benefits and pitfalls

Abstract

Aims and methodTo apply process mapping, a component of lean management, to a liaison psychiatry service of an emergency department. Lean management is a strategy that has been adapted to healthcare from business and production industries and aims to improve efficiency of a process. The process consisted of four stages: individual interviews with stakeholders, generation of process maps, allocation of goals and assessment of outcomes.ResultsThere was a significant reduction in length of stay of psychiatric patients in the emergency department (median difference: 1 h; P = 0.015). Five of the six goals were met successfully.Clinical implicationsThis article demonstrates a management intervention that successfully reduced length of stay in an emergency department. Further to the improvements in tangible (quantitative) outcomes, process mapping improved interpersonal relations between different disciplines. This paper may be used to guide similar quality improvement exercises in other areas of healthcare.

A framework to guide the implementation of lean management in emergency department

“…Interventions pilot test Carney et al (2020) Standard creation (Allaudeen et al, 2017;Ben-Tovim et al, 2008;Dickson et al, 2009a;Eller, 2009;Furterer, 2018;Improta et al, 2018;Kane et al, 2015;Mazzocato et al, 2012;Naik et al, 2012;Ng et al, 2010;S anchez et al, 2018;Sanders and Karr, 2015;Vashi et al, 2019;Wolak et al, 2020) Standard maintenance (Allaudeen et al, 2017;Ben-Tovim et al, 2008;Kane et al, 2015;S anchez et al, 2018;Sanders and Karr, 2015;Vashi et al, 2019) Target monitoring (Alexander et al, 2020;Allaudeen et al, 2017;…”

“…Data mining, process steps measurement (Bal et al, 2017;Carter et al, 2012;Dickson et al, 2009a, b;Elamir, 2018;Furterer, 2018;Improta et al, 2018;Matt et al, 2018;Mazzocato et al, 2012;Ng et al, 2010;Nicholas, 2012;S anchez et al, 2018;Sanders and Karr, 2015;White et al, 2014;Wolak et al, 2020) Identification of wastes and root causes (Al Owad et al, 2018;Alowad et al, 2021;Alexander et al, 2020;Allaudeen et al, 2017;Arbune et al, 2017;Bal et al, 2017;Carney et al, 2020;Carter et al, 2012;Chiarini, 2013;Cookson et al, 2011;…”

“…Multidisciplinary team (Carter et al, 2012;Cookson et al, 2011;Dickson et al, 2009a, b;Furterer, 2018;Kane et al, 2015;Mazzocato et al, 2012;Ng et al, 2010;Nicholas, 2012;Rees, 2014;S anchez et al, 2018;Verbano and Crema, 2019) Leadership support (Ben-Tovim et al, 2008;Carter et al, 2012;Cookson et al, 2011;El Sayed et al, 2015;Furterer, 2018;Kane et al, 2015;Naik et al, 2012;Ng et al, 2010;Rees, 2014;Verbano and Crema, 2019) Stakeholder involvement in the project team (Al Owad et al, 2018;Alowad et al, 2021;Alexander et al, 2020;Allaudeen et al, 2017;Arbune et al, 2017;Cookson et al, 2011;El Sayed et al, 2015;Furterer, 2018;Improta et al, 2018;Naik et al, 2012;Nicholas, 2012;Rees, 2014;Verbano and Crema, 2019) Small and simple changes (Alexander et al, 2020;Arbune et al, 2017;Carter et al, 2012;Dickson et al, 2009a, b;El Sayed et al, 2015;Improta et al, 2018;Naik...…”

Process Mapping in Healthcare: A Systematic Review

“…85% of the studies stated that data and information had been gathered to inform the PM exercise as a substitute for (55%), or in addition to (30%), the group knowledge generated in the facilitated process mapping sessions. This included evidence-based best practice recommendations [35][36][37], interviews [65][66][67][68][69][70], and more detailed approaches such as observations, operational data collection, time-andmotion studies, and video footage. [64,[71][72][73][74] Phase 3 81% of studies included perspectives from diverse stakeholders.…”

“…[74,86,114] Reviewed studies also show that the capacity of PM to facilitate the dialogue between diverse stakeholders helps to smooth barriers and tensions occurring during improvement projects or reach consensus on solutions. [65,74,80,86,97,98,[117][118][119] For example, some studies reported how PM helped to promote the integration of health services across different settings by developing clinical evidence-based recommendations agreed among different healthcare professionals. [66,79,81,83] Finally, studies describe how PM can be a valuable tool for documenting a care process for further dissemination.…”