Identifying Improvement Opportunities in Emergency Department Processes Using Value-stream Mapping: A Case Study

Abstract

Background: This study aimed to identify improvement opportunities in emergency department processes by value-stream mapping in Imam Reza hospital of Birjand. Methods: This qualitative study was carried out in 2017. Data were collected through observation and interviews. Time consumed for each step from registration to disposal was measured and documented on the value-stream map. Then in a group discussion session consisted of emergency personnel, the value-stream map was drawn and analyzed and the source of waste were identified. It was designed using Lean thinking techniques, and Edraw Max 6.7 software. Results: The results showed that the total attendance time in the emergency department was an average of 216.29 minutes, 143.6 minutes of which was spent on waiting for receiving services. After investigating the sources of waste, a suitable solving tool was proposed. In order to reduce the waiting time for reception and overcrowding, the "5Whys" method was used and further coordination with the Emergency Management Center and activation of overflow system was suggested. To reduce attendance time in the emergency department, "visual management" and "arrangement system "methods were proposed. Conclusion: The Lean thinking system is an approach to analyze processes and improve efficiency by focusing on the staff in order to provide the maximum value to the patient and improve patients' progress.

Keywords

• Process modification
• Lean thinking
• Emergency department
• Value-stream mapping