Purpose

Increased demand and the pressure to reduce health-care costs have led to longer waiting time for patients to make appointments and during the day of hospital visits. The purpose of this study is to identify opportunities to reduce waiting time using lean techniques and discrete-event simulation (DES).

Design/methodology/approach

A five-step procedure is proposed to facilitate the effective utilization of lean and DES to improve the performance of the Otolaryngology Head and Neck Surgery Outpatient Clinic at Cleveland Clinic Abu Dhabi. While lean techniques were applied to reduce the potential sources of waste by aligning processes, a DES model was developed to validate the proposed solutions and plan patient arrivals under dynamic conditions and different scenarios.

Findings

Aligning processes resulted in an efficient patient flow reducing both waiting times. DES played a complementary role in verifying lean solutions under dynamic conditions, helping to plan the patient arrivals and striking a balance between the waiting times. The proposed solutions offered flexibility to improve the clinic capacity from the current 176 patients up to 479 (without violating the 30 min waiting time policy) or to reduce the patient waiting time during the visit from the current 33 min to 4.5 min (without violating the capacity goal of 333 patients).

Research limitations/implications

Proposing and validating lean solutions require reliable data to be collected from the clinic and such a process could be laborious as data collection require patient and resource tracing without interfering with the regular functions of the clinic.

Practical implications

The work enables health-care managers to conveniently conduct a trade-off analysis and choose a suitable inter-arrival time – for every physician – that would satisfy their objectives between resource utilization (clinic capacity) and average patient waiting time.

Social implications

Successful implementation of lean requires a supportive and cooperative culture from all stakeholders involved.

Originality/value

This study presents an original and detailed application of lean techniques with DES to reduce patient waiting times. The adopted approach in this study could be generalized to other health-care settings with similar objectives.

中文翻译：

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使用精益技术和离散事件模拟提高门诊诊所的绩效

目的

需求增加和降低医疗保健成本的压力导致患者预约和住院期间的等待时间更长。本研究的目的是确定使用精益技术和离散事件模拟 (DES) 减少等待时间的机会。

设计/方法/方法

提出了一个五步程序，以促进精益和 DES 的有效利用，以提高阿布扎比克利夫兰诊所的耳鼻喉头颈外科门诊的绩效。在应用精益技术通过调整流程来减少潜在的浪费来源的同时，还开发了一个 DES 模型来验证所提出的解决方案并在动态条件和不同场景下计划患者到达。

发现

调整流程导致有效的患者流动减少了等待时间。DES 在动态条件下验证精益解决方案方面发挥了补充作用，有助于计划患者到达并在等待时间之间取得平衡。提议的解决方案提供了灵活性，可将诊所容量从目前的 176 名患者提高到 479 名（不违反 30 分钟等待时间政策）或将就诊期间的患者等待时间从目前的 33 分钟减少到 4.5 分钟（不违反333 名患者的容量目标）。

研究限制/影响

提出和验证精益解决方案需要从诊所收集可靠的数据，并且这样的过程可能很费力，因为数据收集需要在不干扰诊所的常规功能的情况下跟踪患者和资源。

实际影响

这项工作使医疗保健管理人员能够方便地进行权衡分析，并为每位医生选择合适的到达间隔时间，以满足他们在资源利用（诊所容量）和平均患者等待时间之间的目标。

社会影响

精益的成功实施需要所有利益相关者的支持和合作文化。

原创性/价值

本研究展示了 DES 精益技术的原始和详细应用，以减少患者等待时间。本研究中采用的方法可以推广到具有类似目标的其他医疗机构。