Lean Implementation in Hospital Departments: How to Move from Good to Great Services -

155 Pages·2019·2.811 MB·English

by  HERI ISWANTO, A

Contents Contents
Lean Implementation in
Hospital Departments
How to Move from Good
to Great Services

Lean Implementation in
Hospital Departments
How to Move from Good
to Great Services
By
A. Heri Iswanto
A PRODUCTIVITY PRESS BOOK
First edition published in 2019
by Routledge/Productivity Press
52 Vanderbilt Avenue, 11th Floor New York, NY 10017
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN, UK
© 2019 by Taylor & Francis Group, LLC
Routledge/Productivity Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
Printed on acid-free paper
International Standard Book Number-13: 978-0-367-14552-1 (Hardback)
International Standard Book Number-13: 978-0-367-14550-7 (Paperback)
International Standard Book Number-13: 978-0-429-03228-8 (eBook)
This book contains information obtained from authentic and highly regarded sources. Reasonable
efforts have been made to publish reliable data and information, but the author and publisher
cannot assume responsibility for the validity of all materials or the consequences of their use. The
authors and publishers have attempted to trace the copyright holders of all material reproduced in
this publication and apologize to copyright holders if permission to publish in this form has not
been obtained. If any copyright material has not been acknowledged please write and let us know
so we may rectify in any future reprint.
Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced,
transmitted, or utilized in any form by any electronic, mechanical, or other means, now known
or hereafter invented, including photocopying, microfilming, and recording, or in any information
storage or retrieval system, without written permission from the publishers.
For permission to photocopy or use material electronically from this work, please access www.
copyright.com (http://www.copyright.com/) or contact the Copyright Clearance Center, Inc. (CCC),
222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit organization that
provides licenses and registration for a variety of users. For organizations that have been granted a
photocopy license by the CCC, a separate system of payment has been arranged.
Trademark Notice : Product or corporate names may be trademarks or registered trademarks, and
are used only for identification and explanation without intent to infringe.
Visit the Taylor & Francis Web site at
http://www.taylorandfrancis.com
Contents
1 Introduction .............................................................1
Efficiency and Effectiveness Issues ....................................1
The Model of Lean Healthcare ...........................................2
The Benefits of Lean Hospitals ..........................................3
References ...........................................................................6
2 Lean Principles ........................................................9
Lean Philosophy ..................................................................9
Lean Methodology .............................................................12
References ..........................................................................14
3 Lean Implementation in the Emergency Unit ........17
Emergency Unit Issues .......................................................17
Lean Implementation in the Emergency Unit ...................20
References ..........................................................................25
4 Lean Implementation in the Outpatient Unit ........27
Outpatient Unit Issues........................................................27
Lean Case Studies in Outpatient Units ..............................29
References ..........................................................................33
5 Lean Implementation in the Ward Unit .................35
The Quality of Care of Services in the Ward Unit ...........35
Lean Case Studies in Ward Units ......................................37
References ..........................................................................41
v
vi ◾ Contents
6 Lean Implementation in the Central
Surgical Unit ..........................................................43
Central Surgical Unit Issues ...............................................43
Lean Case Studies in Central Surgical Units .....................45
References ..........................................................................52
7 Lean Implementation in the Intensive
Care Unit ................................................................55
Intensive Care Unit Issues .................................................55
Lean Implementation in the Intensive Care Unit ..............57
References ..........................................................................61
8 Lean Implementation in the Radiology Unit .........63
The Waste of the Radiology Unit ......................................63
Lean Implementation in Radiology Units .........................64
References ..........................................................................72
9 Lean Implementation in the Clinical
Pathology Unit .......................................................73
Clinical Pathology Unit Issues ...........................................73
Lean Case Studies in Clinical Pathology Units .................74
References ..........................................................................78
10 Lean Implementation in the
Pharmaceutical Unit ..............................................81
Waste of Time Issues .........................................................82
Unavailability of Drugs Issues ...........................................82
Expired Drugs Issues ........................................................84
Waste of Drugs Issues .......................................................84
Waste of Space Issues .......................................................86
References ..........................................................................87
11 Lean Implementation in the Nutrition Unit ...........89
Nutrition Unit Issues ..........................................................89
Lean Case Studies in Nutrition Units ................................90
References ..........................................................................93
Contents ◾ vii
12 Lean Implementation in the Medical
Record Unit ............................................................95
Medical Record Unit Issues ................................................95
5S ....................................................................................... 98
Visual Management ..........................................................100
Kaizen ...............................................................................101
References ........................................................................102
13 Lean Implementation in the Hospital Facilities
and Infrastructure Maintenance Units ................105
Hospital Facilities and Infrastructure Maintenance
Unit Issues ........................................................................105
Lean Case Studies in Hospital Maintenance Units ..........107
References ........................................................................112
14 Lean Implementation in the Referral Unit ...........115
Referral Unit Issues ..........................................................115
Patients Who Are Referred from Another Place .............116
Patients Who Are Referred to Another Place ..................119
References ........................................................................120
15 Lean Implementation in the Administration
and Management Unit ..........................................123
Change Management in the Administration and
Management Unit .............................................................123
The Lean Steps .................................................................130
References ........................................................................133
16 Conclusion ...........................................................135
The Principles of Lean .....................................................135
References ........................................................................138
Index ..........................................................................141

Lean Implementation in Hospital Departments Introduction
Chapter 1
Introduction
Efficiency and Effectiveness Issues
Efficiency and effectiveness are two key words in organiza-
tional activities. An organization is said to be efficient if it is
able to use all of its resources to produce something valuable
without leaving undesirable things. Meanwhile, an organization
is said to be effective if it is able to perform in line with what
is expected of the organization. These criteria should also be
applied to hospitals as organizations in the health system.
A number of efficiency and effectiveness issues can be
found at the hospitals in Indonesia. Antibiotics are still inef-
ficiently given to 44%–97% of hospital patients regardless of
their need or the appropriateness.1 In addition, current hospi-
tal utilization has tended to decline since 1997.2 This is due to
developments in information technology that encourage people
to rely more on self-medication, with various types of drugs
available from drug stores or pharmacies. Communities view
going to the hospital as more complicated because they must
register, wait in line, and pay the consultation fee. Meanwhile,
self-medication is seen to be as effective as hospital services
in terms of the achievement of the goal to obtain a patient’s
health, at least for ailments. This is shown in Figure 1.1.
1