Lean Management: organizational innovations in hematological Day-Hospitals

Background. Lean Thinking is a management method which, despite its industrial origins, has spread in the health-care environment too. Objective. To describe the path followed and the results reached implementing Lean Thinking in four case studies. Methods. Such case studies were conducted in as many hematological Day-Hospitals (DHs), located in Central-Italy. At the beginning of each study, the DH internal processes, activity volumes and patient flows were analyzed and satisfaction questionnaires were administered to both operators and patients. Based on the returned questionnaires, deficiencies were focused on; for each deficiency data was collected and objectives defined. Following such definitions, the analysis of inefficiency causes was performed and countermeasures were identified. In the final meeting the results were assessed and monitoring/maintenance methods were defined. All these steps were supported by Lean Thinking instruments for analysis and solution. Results. Activity organization and patient satisfaction improved everywhere. Time losses and workloads imbalances were minimized in two DHs, particularly through higher standardization in the management of clinical-administrative documents. In another DH, the output capacity of the hospital pharmacy and the workflows in the DH were aligned with respect to the course of the day, so reducing delays in the delivery of therapies. Appointment planning was improved in the fourth DH, standardizing time slots (15-minutes) necessary for each therapy, so optimizing the number of stations (beds and chairs) used. Conclusions. Poor management of health care facilities can affect efficiency, security and quality of services provided. Lean Thinking is a valid method to address such problems.