In Siriraj Hospital in Thailand, we successfully implemented lean management principles in our emergency room and outpatient pharmacy. Our experience yielded several lessons that may be valuable for anyone seeking to apply them in other hospital settings, including the lab.

Optimising the pharmacy and emergency room

A central goal of lean management is improving efficiencies by reducing waste in workflows, and to achieve this, we deployed efficiency engineers to review our operations. One area where we found inefficiencies was in the outpatient pharmacy. We discovered that the layout of the various pharmacy stations required our pharmacists to move around excessively. By reorganising those stations to correspond to the steps of filling prescriptions, traffic flow improved and waiting time was reduced, as shown in the diagram below:

When we applied the same type of thinking to our emergency department, we discovered that nurses spent 60-75% of their time walking around to look for documents or find equipment. In total, they walked many kilometres per day, but after a lean engineer designed a new emergency unit layout, the amount of walking around fell by roughly 25%. This reduction in wasted time and movement meant that nurses had more time for patient care.

Lessons for the lab

Our experience provides several lessons that may be valuable for anyone seeking to implement lean management principles in other hospital settings, including the lab:

• Get buy-in from leadership by sharing success stories with hospital or laboratory administrators to convince them that lean evaluations and transformations are valuable.
• Form a team assigned to documenting existing processes and establishing all baseline metrics, then set goals and systematically explore options for achieving KPIs.
• Focus on areas of waste and change your workflows to allow greater efficiency to naturally result from the new process.
• Explore training programmes and educational resources from universities, professional organisations and other sources that offer training in lean thinking and Lean Six Sigma for healthcare (formal courses, such as those offered by the American Society for Quality [1], can provide everything from a basic introduction to advanced certification, while free online tools and templates [2] can help you map out processes and implement changes).
• Consider automation when feasible through lean process management software, automated result reporting equipment, automated specimen retrieval and testing systems, medical robotics, or other technology solutions.

By taking these lessons into account, you can build a case to apply lean management thinking to your lab and drive greater efficiencies and quality in your operations.

[1] Lean Six Sigma in Healthcare, American Society for Quality

[2] Lean templates, Go Lean Six Sigma

This article is based on a presentation “Improving Hospital Services with Lean Concept” at Roche Scientific Days 2018 in Dusit Thani Hua Hin, Thailand.