How to improve personal and time consuming patient waiting times - ER of a Swiss Private Hospital

The Swiss hospitals are under high cost pressure (Walker et al., 2013). Is the cost-controlled Lean Management Paradigm the only success promising solution to improve Health Care processes? It seems so, if we believe to the current Swiss literature like: The new Knowledge Compendium for the Transformation into a Lean Hospital 2019, by Prof. Dr. Alfred Angerer for Health Management from the Zürich ZHAW university. He emphasizes that the healthcare sector is facing major cost challenges. These include rising patient expectations and growing economic pressure. Improving process efficiency with compromising quality requires radical, needs innovative approaches. The current philosophies especially the Lean Management he propagated increasingly finding its way into the healthcare system, as some pioneers have already achieved impressive results thanks to Lean. However, in order to work more efficiently according to the Lean philosophy, there are more effective solutions. The following work will show this.

As an alternative the essay start with introducing [1]QRM into the private Swiss hospital sector, as a continuing process. As a pilot project it should increase the customer satisfaction, caused by reducing waiting times. The focus are the Swiss emergency rooms and low urgent treatments. The selected emergency room from a leading private hospital, the name is Lindberg in Winterthur near Zurich Switzerland. It closed for cost reasons and time expenditures of the leading physicians in 2010. Currently the intensive care unit takes care over some functions as [2]IMC, intensive care unit, for private emergency patients and as well as recovery room for patients with operations after to office hours. The financial and political reason for the now closed [3]ER are not task of this essay.

The Goals and Methodology of this project are:

? Learn basic QRM principles.

? Study specific and creating multi-functional QRM product cells in the ER environment.

? Analyze principles of system dynamics affecting total lead time.

? Master techniques of calculating basic and target MCT (Manufacturing Critical-Path Time).

? Developing a competency matrix for QRM cell members in the second examination.

? Calculate QRM Index and use it as a motivation basis for QRM cell.

? Explain the costs for QRM project using “The Power of Six Rule”.

1.   Unsatisfied Patient Group and Employees

The first contact patients find in the emergency room. Theref.ore, this is an important reputation door keeper. But you’ll also find a lot of bad news in the media and a lot mouth to mouth experiences of long waiting times especially in the non-urgent segment. More than 60% of the ER workforce suffer from burnouts and in the last phase from depressions caused due work overload and too much administrative functions in the Swiss hospitals (Walker et al. 2013). This employee group has got a high intrinsic motivation to fulfill their work. Nevertheless, often it is not possible to handle everything in a useful time caused of systemic and structural issues. But why should patients with non-urgent treatments wait longer caused from systemic issues. A guest in a restaurant needs not to wait longer, only for reason he orders a small salad (Walker et. al. 2013).

Another reason for the selected patient clientele segment is the following: These patient types do not suffer from any serious illness or injury, so they often have time to think that the waiting times are extremely unpleasant. Severely ill patients are treated more quickly. In addition, for these patients the service and not the necessary treatment could be in the foreground. This fact is confirmed by own surveys carried out by the patients themselves. In the small Lindberg emergency room with 6 places capacities. I made a survey 2008 by my own. 170 out of the 200 patients surveyed had only average ratings for waiting times and service. The other patients, who were allowed to undergo serious treatment, gave better ratings. A frequent reason for the increased empty and waiting times were the various examinations and departments X-Ray, [4]CT and Hematology laboratory involved. One other time-consuming process is to find the diagnosis and the confirmation of treatments from the leading physicians. The average waiting time until the right therapy and treatment was 85 minutes. The waiting times did variate from 20 minutes to 225 minutes.

In order not to miss the main topic, which would also go beyond the time frame, the important emergency triage and time setting standard is only initially and rudimentarily discussed for understanding. As mentioned, the focus therefore is on level 4 patients, the less urgent emergency supplies of the Swiss triage scale. Triage is a process in which the medical urgency of patients visiting the emergency ward is identified, evaluated and classified according to certain criteria. The appropriate care for these persons is decided within a reasonable period of time. The "Swiss Triage Scale" (SETS) is used at the leading University Emergency Centre of the Bern University Hospital.

Urgency levels:

Stage 1: Acute emergency, immediate treatment

Stage 2: Treatment within 20 minutes

Stage 3: Treatment within 120 minutes

Level 4: Non-urgent situation

[1] QRM = Quick Response Manufacturing

[2] IMC = Intermediate Care Unit

[3] ER = Emergency Room

[4] CT = Computer Tomographie

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