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Dissertation/Thesis Abstract

The Caveats of Applying Lean in Knowledge-Intensive Services with Hierarchy: Evidence from an Emergency Department
by Khoshnazar, Iman, M.S., Southern Illinois University at Edwardsville, 2019, 70; 27665685
Abstract (Summary)

These days better performance of health systems is a serious concern and different methods have been proposed to overcome the performance challenges. Emergency departments (EDs) are one the most crowded part of the health systems, treating patients in a wide range of conditions. Various patient flow management approaches have been tested to enhance system output. However, visiting patients by a medical doctor (MD) in a short time, patients waiting time, and length of stay in the system are still great challenges. In the past few decades, healthcare systems and institutions have begun to employ operations management techniques within the EDs to enhance flows, better organize work, and improve productivity.

Globalization of the Toyota Production System has introduced modern manufacturing methods, which integrate waste reduction activities and quality into the production processes as they are performed. This combination of the management philosophy and activities, aiming to reduce waste and improve quality, is known as lean thinking. Moreover, these manufacturing and service improvement principles are being used in an increasing number of sectors including healthcare services.

In this thesis, after introducing lean principles and different aspects of its implementation in the industry, its application in healthcare was summarized. In the continue, applying pull strategy, the fourth principle of lean thinking, instead of push strategy in the Mary Washington emergency department, was tested. In the suggested strategy, instead of bringing in the patient by the triage nurse or physician when a bed is empty, the bottleneck resource, which is usually the treatment nurse in this ED, pulls a patient in when they are ready. It provides an opportunity to examine in detail how the implementation of lean thinking changes the patient flow and why the resulting outputs and outcomes were achieved.

Better performance of the system after the implementation of a pull strategy was expected. But the observations indicated that emergency departments are more complicated than that. The hierarchical structure of the hospital was the first barrier for achieving better performance. Physicians, having a higher rank in the hierarchical structure of healthcare, could not tolerate that treatment nurses be the decision makers. Therefore, they did not cooperate, and when a bed was empty, they wanted to use it as soon as possible regardless of treatment nurses' business. Usually, in these organizations, it is too difficult to change ways that physicians and nurses work among themselves. Therefore, instead of changing responsibilities that are effected by human behavior, altering system configuration was suggested.

Pooling two teams in the triage step with a close emergency severity index was suggested as the other solution for improving system quality and decreasing patient waiting time. Significant reduction in patients’ average wait time to get a bed and length of stay after pooling two teams (team two and team three)was obtained.

Indexing (document details)
Advisor: Eneyo, Emmanuel S., Torabi, Elham
Commitee: Cho, Sohyung, Chen, Xin
School: Southern Illinois University at Edwardsville
Department: Industrial Engineering
School Location: United States -- Illinois
Source: MAI 81/7(E), Masters Abstracts International
Subjects: Industrial engineering, Health care management
Keywords: Emergency department, Hierarchy system, Knowledge-intensive services, Lean thinking, Pull vs push
Publication Number: 27665685
ISBN: 9781392411735
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