Title: Performance Improvement in the Hospital Emergency Department Using the Manufacturing

Lean Tools: A Study in a Saudi Hospital

Objective:
The emergency department (ED) is a vital part of any hospital; its structure should be constantly
optimized in order to improve its performance to enable it to face the flow of the needy patients around
the clock. Past Lean implementations have proved to be successful in hospitals and other healthcare
settings in the United States, the United Kingdom, Canada, and Australia but no similar studies were
conducted inside an acute care setting in the Middle-East. This study examines the effect of
implementing the Lean principles on the staff satisfaction and the patients turnaround times inside the
ED of an acute care general hospital in Saudi Arabia.
Planning/Research Methods:
An interventional action research was conducted in order to identify the impact of Lean
implementation on the patients turn-around time (TAT) in a key area of the ED and to identify the
effect of such intervention on the levels of staff satisfaction and on the staff knowledge of their
workplace. ED physicians and nurses were surveyed to evaluate the impact of lean improvements on
their daily work. In addition, TAT data of the ED patients was captured from the hospitals
information system using the systematic random sampling method. The study has been conducted over
a six-month period.
Implementation Methods:
The 5Ss and the Spaghetti diagram Lean tools were used to introduce many changes inside the ED to
make it more organized and more user-friendly workplace with multiple guiding visual signals and
cues in order to ensure that the workflow inside this area is smooth and seamless. The ED staff were
oriented about the Lean principles and were involved in the implementation of the Lean tools inside
the ED.
Results:
Lean tools implementation resulted in improvement of the satisfaction level of the ED staff about their
workplace. Also the degree of their perception that the daily tasks are being executed in a smoother
manner than pre-Lean implementation has improved. The overall average score of the questionnaire
distributed to the selected ED staff increased from 2.9 before implementation, to 3.5 after
implementation, using a Likert-scale with a range from 1 to 5. The average turnaround time spent by
the ED patients decreased from 70.3 minutes before implementation, to 66.3 minutes after Lean
implementation (i.e., reduced by 5.7%). This difference was found not to be statistically significant
using a paired sample t-test which requires further investigation to identify if there are other possible
reasons in the process that might contribute to the prolonged patients stay inside the ED (e.g., the
ancillary functions of the hospital such as the laboratory and the radiology departments). On the other
hand, the staff responses to two thirds of the questionnaire questions enquiring about their level of
satisfaction showed statistically significant improvement using a paired sample t-test. Lean tools and
techniques used in this study were found to be easy-to-implement with a high degree of acceptance
among the ED staff who showed their enthusiasm towards such methods, which are imported from
other industries (e.g., the manufacturing industry).
Authors:
Ehab A. Yaseen, Ph.D.
Head of the Operations Management Department, the German University in Cairo, Cairo, Egypt
emails: ehab.yaseen@guc.edu.eg; ehabyaseen317@hotmail.com
Alber G. Paules, MD, MBA
Quality Officer, the Royal Commission Health Services Program, Yanbu, Saudi Arabia
emails: paules@rcymc.med.sa; alber.gaafar@gmail.com