Using value stream mapping and discrete event simulation to improve efficiency of emergency departments

Bal, Alperen; Ceylan, Cemil; Taçoğlu, Caner

doi:10.1080/20479700.2017.1304323

Cited by 49 publications

(48 citation statements)

References 26 publications

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“…Methodology Areas Tools Improvements Difficulties (Aleem, Torrey, Duncan, Hort, & Mecchella, 2015) AR A15 T33; T12; T44; T36 I4 D1;D3 (Andersen & Røvik, 2015) CS A19;A3 N/A N/A D1 (Bal, Ceylan, & Taçoğlu, 2017) AR A1 T41; T29; T9 I3; I4 D6 AR A2 T17; T14 N/A N/A (Barnabè, Giorgino, Guercini, Bianciardi, & Mezzatesta, 2017)…”

Section: Appendix -List Of 114 Articlesmentioning

confidence: 99%

Implementation of lean in health care environments: an update of systematic reviews

Lima

Dinis‐Carvalho

Souza

et al. 2020

IJLSS

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Purpose Even though the implementation of lean in health care environments is relatively recent, it has been receiving a lot of attention in recent years. Partly because of the fact that it is a recent field of practise and research and partly because the number of works developed in this field has grown rapidly, it is important to frequently update the perspectives on this field of investigation. Thus, this study aims to review the implementation of lean tools and techniques applied to hospital organizational areas in a five-year period, between 2014 and 2018, complementing some of the most relevant reviews already published. The most important criteria such as tools, methods and principles, hospital areas intervened, improvements and difficulties were assessed and quantified. Design/methodology/approach As starting point for this systematic literature review (SLR), a set of selected pre-existing review publications was used to support the current study and as the ground base for the expansion of the studies about lean health care. The current study contemplated 114 articles from a five-year period between 2014 and 2018. A subset of 58 of these articles was critically assessed to understand the application of lean tools and methods in different hospital areas. Findings The thorough analysis of selected articles show a lack of works in continuous improvement approaches when compared to the application of production organization methods, visual management and diagnosing and problem-solving tools. The reported improvement results demonstrate alignment with the principles and foundations of lean philosophy, but such results are presented in isolated initiatives and without robust evidence of long-term maintenance. Moreover, this study shows an evolution in the number of articles referring to lean implementation in hospital areas, but in its great majority, such articles report isolated implementations in different areas, not spreading those for the global organization. Thus, some of the main recommendations are the need to implement studies on complete flows of patients, drugs and materials, instead of isolated initiatives and strive to promote the cultural change of hospitals through structural changes, following new visions and strategic objectives, supported by real models of continuous structural and sustained improvement. Originality/value The current study develops a new perspective of the articles published under the thematic of lean health care, published in a recent period of five years, which are not completely covered by other works. Additionally, it explicitly applied, in an innovative way, an approach that used a set of previous reviews as the starting point for this SLR. In this way, it integrates approaches and categories from different SLRs, creating a framework of analysis that can be used by future researchers. Finally, it shows the most recent implementations of lean health care, exposing the current trends, improvements and also the main gaps.

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Section: Appendix -List Of 114 Articlesmentioning

confidence: 99%

Implementation of lean in health care environments: an update of systematic reviews

Lima

Dinis‐Carvalho

Souza

et al. 2020

IJLSS

View full text Add to dashboard Cite

show abstract

“…Similar applications using DES and optimization models can be found at Kuo [174] and Sinreich et al [121]. Other studies expose the integration of simulation with BSC and PRIME [131], FAHP and MAUT [129], DGP [20], lean manufacturing [116,166], six sigma [198], DOE [111,124], approximation algorithm [103], and other OR methods [102] for reducing overcrowding within emergency departments. However, none of these integrations has been widely adopted in the ED context.…”

Section: Papers Focusing On Reducing the Waiting Timementioning

confidence: 80%

“…For instance, the use of hybrid approaches emerging from the combination of several prominent approaches is at the earlier stages and more contributions are then expected to increase the evidence base related to these applications. In particular, the use of combined interventions using simulation and lean manufacturing remains limited in the reported literature [113,115,116,166,176,216]. Likewise, researchers are advised to take into account the methodological trends regarding process improvement in emergency departments.…”

Section: Discussionmentioning

confidence: 99%

“…Meanwhile, the use of DES-lean methodology is beginning to become prominent when addressing patient waiting time within EDs. Bal et al [166] provide a walk-through of how computer simulation and lean manufacturing can be utilized for tackling the waiting time problem. In this paper, the very-well known "Value Stream Mapping" was found to be useful for detecting non-value added times within Sadi Konuk hospital ED.…”

Section: Papers Focusing On Reducing the Waiting Timementioning

confidence: 99%

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Methodological Approaches to Support Process Improvement in Emergency Departments: A Systematic Review

Ortíz‐Barrios

Alfaro-Saiz

2020

IJERPH

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The most commonly used techniques for addressing each Emergency Department (ED) problem (overcrowding, prolonged waiting time, extended length of stay, excessive patient flow time, and high left-without-being-seen (LWBS) rates) were specified to provide healthcare managers and researchers with a useful framework for effectively solving these operational deficiencies. Finally, we identified the existing research tendencies and highlighted opportunities for future work. We implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to undertake a review including scholarly articles published between April 1993 and October 2019. The selected papers were categorized considering the leading ED problems and publication year. Two hundred and three (203) papers distributed in 120 journals were found to meet the inclusion criteria. Furthermore, computer simulation and lean manufacturing were concluded to be the most prominent approaches for addressing the leading operational problems in EDs. In future interventions, ED administrators and researchers are widely advised to combine Operations Research (OR) methods, quality-based techniques, and data-driven approaches for upgrading the performance of EDs. On a different tack, more interventions are required for tackling overcrowding and high left-without-being-seen rates.

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“…Categorizing patients based upon the acuity level and treating non-critical patients in a separate area also improved patient throughput and decreased ED crowding. 25 Bal et al 26 improved patient throughput by using a value stream map to identify the bottlenecks and non-value added activities within the system. Discrete-event simulation (DES) was adopted to evaluate different alternative scenarios, such as process change and capacity expansion.…”

Section: Literature Reviewmentioning

confidence: 99%

Modeling and analysis of business process reengineering strategies for improving emergency department efficiency

2020

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Emergency departments (ED) in the USA treat 136.9 million cases annually and account for nearly half of all medical care delivered. Due to high demand and limited resource (such as doctors and beds) availability, the median waiting time for ED patients is around 90 minutes. This research is motivated by a real-life case study of an ED located in central Missouri, USA, which faces the problem of congestion and improper workload distribution (e.g., overburdened ED doctors). The objective of this paper is to minimize patient waiting time and efficiently allocate workload among resources in an economical manner. The systematic framework of Business Process Reengineering (BPR), along with discrete-event simulation modeling approach, is employed to analyze current operations and potential improvement strategies. Alternative scenarios pertaining to process change, workforce planning, and capacity expansion are proposed. Besides process performance measures (waiting time and resource utilization), other criteria, such as responsiveness, cost of adoption, and associated risk, are also considered for evaluating an alternative. The experimental analysis indicates that a change in the triage process (evenly distributing medium-acuity patients among doctors and mid-level providers) is economical, easy to implement, reduces physician workload, and improves average waiting time by 20%, thereby making it attractive for short-term adoption. On the other hand, optimizing the workforce level based on historical demand patterns while adopting a triage process change delivers the best performance (84% reduction in waiting time and balanced resource utilization), and is recommended as a long-term solution.

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Using value stream mapping and discrete event simulation to improve efficiency of emergency departments

Cited by 49 publications

References 26 publications

Implementation of lean in health care environments: an update of systematic reviews

Implementation of lean in health care environments: an update of systematic reviews

Methodological Approaches to Support Process Improvement in Emergency Departments: A Systematic Review

Modeling and analysis of business process reengineering strategies for improving emergency department efficiency

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