Mit welchen Verweildaueränderungen gehen Whiteboards als Lean-Management-Werkzeuge einher? Eine retrospektive Zeitreihenstudie in zwei Krankenhäusern

Abstract

Introduction: Whiteboards are lean management instruments that serve to govern the length of stay on hospital wards. They are implemented to bundle up-to-date patient information, to enable regular and structured interdisciplinary team meetings, to stimulate the collaboration within the team and hereby to govern the care process and improve the discharge management. The aim of this study was to investigate, whether the implementation of whiteboards was associated with a change of the length of stay. Methods: In order to answer the research question, a retrospective interrupted timeseries analysis of DRG routine data before and after implementation of whiteboards in two hospitals was performed. A total of 3,734 clinical cases covering the period January 2018 to December 2019 from one hospital (medical specialty surgery) and 54,049 clinical cases from the period July 2013 to December 2019 from the second hospital (medical specialty internal medicine) were included.Results: Comparing the average length of stay before and after (expressed as the relative difference from the statewide mean per DRG) showed no significant difference for the first hospital and a significant deterioration for the second hospital. The descriptive timeseries analysis revealed in both hospitals, that the length of stay worsened shortly after the introduction of the whiteboards, however, improved later, which meant that patients were discharged earlier. During the further course, this difference faded reaching the baseline level values. Discussion: In summary, no improvement of the length of stay could be found in a before-after comparison of the means. The descriptive timeseries analysis could partly explain these findings revealing a strong variability that reflected a short-term worsening followed by improvements, which, however, in the end did not last. This meant that patients were discharged again later. From a methodological point of view, only the timeseries perspective could yield an insight into the course of the events whereas the comparison of the averages aggregating the values could not capture the variability. From a practical point of view, it can be concluded that whiteboards can be a useful lean management instrument to govern the length of stay as the short-term improvements suggest. However, this requires the staff to continuously update the information on the board and for the entire handling to yield a tangible added value for the staff. Therefore, it seems rewarding to implement digital whiteboards to mitigate the manual effort of updating the information on the board.

Keywords

• lean management
• length of stay
• discharge management
• whiteboard
• patient journey board
• process optimisation
• evaluation