Study Finds Internationally Recognised Quality Management Approach Highly Valuable in Health Care

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“The Impact of Lean Thinking on Operational Efficiency in a Rural District Hospital Outpatient Department in KwaZulu-Natal” was the thesis title of Public Health Master’s graduate, Dr Logandran Naidoo.

The subject matter of this quasi-experimental action research was unique in that a production industry management philosophy, pioneered by the Toyota Production System in Japan, was applied to a health service in a rural hospital fraught with operational issues and resource constraints.

“Lean” is a Toyota management practice that believes the expenses on resources for any goal other than the creation of value for the end customer, is wasteful,’ said Naidoo. ‘Value is thus defined by any action or process in which the customer is willing to pay for.’

The results of Naidoo’s study showed that Lean can be applied quite easily and with minimal resources but maximum benefit can be derived from the services (do more with less). This operational efficiency was measured by Lean’s impact on waiting times, cycle times and staff attitudes and morale at the study site.

Naidoo said ‘this has tremendous positive implications for public hospitals under severe resource constraints, in light of the Department of Health’s implementation of National Core Standards and focusing on improvements in six priority areas, one of which is patient waiting time in health care institutions. Lean can thus serve as a valuable management approach in gearing hospitals towards the phasic roll out of National Health Insurance.’

The research took the form of a before-and-after interventional study with mixed qualitative and quantitative approaches. Action research was conducted with the investigator and facilitator of Lean implementation being a person who is not an expert in Lean, but the study participants were still able to achieve the waiting and cycle time targets set by the kaizen (Japanese term for “continuous improvement”) team within a very short space of time - four months - with minimal resources.

Furthermore, routine patient care was never disrupted and the tools and techniques used were easily adaptable to a health care setting. ‘I was also intrigued by the fact that Lean has proven to be a scientifically sound and acceptable method for improvements in operational efficiencies in a rural district hospital,’ said Naidoo.

Naidoo, a Senior Manager of Medical Services at Grey’s Hospital in Pietermaritzburg, said after graduating with his MBChB cum laude and MBA cum laude, his ‘passion for quality management has grown ever since’, and he has now found a reliable and esteemed approach to forging ahead with his quality improvement goals in health care.

‘With the success of this research, I intend to use the approach to assist health care facilities in improving quality and efficiency of health care services delivered through management. Health care is my ocean, quality is my ship, and Lean is my rudder!’

-        Zakia Jeewa