Application of Lean Six Sigma to Improve Turnaround Time for Orthopedic Patients in Emergency Room of a Public Hospital in Southern Philippines
DOI:
https://doi.org/10.31674/mjn.2024.v16i02.015Abstract
Background: The Lean Six Sigma Methodology (LSS) is acknowledged for its potential in optimising emergency room (ER) efficiency, particularly turnaround time. Objective: This study explores the impact of LSS on ER turnaround time at Gregorio T. Lluch Memorial Hospital (GTLMH) in Iligan City, Philippines, using a mixed-methods approach. The aim is to fill the research gap by empirically investigating the effects of LSS implementation on the turnaround time for orthopaedic patients in the ER. Methods: Analysing data from 50 orthopaedic patients admitted to the ER from September to November 2023, the study employed descriptive statistics, chi-square, and three-way ANOVA. Qualitative interviews with six GTLMH personnel provided nuanced insights. Results: The findings revealed a higher prevalence of trauma-related injuries among orthopaedic patients, emphasizing the need for injury prevention. A significant association between lower family income and longer turnaround times suggests socio-economic factors influence timely care. The study underscores the importance of addressing healthcare disparities and improving registration efficiency. Challenges include patients not meeting admission criteria and those with political connections bypassing ER protocols. Strict adherence to admission criteria and protocol enforcement can address these issues. Conclusion: Despite challenges, the medical staff perceives the current system as efficient, indicating efforts to provide quality care. In conclusion, LSS is highly applicable for enhancing patient outcomes in GTLMH's ER. Utilising a data-driven approach, LSS can eliminate waste, reduce variation, and optimise processes, addressing inefficiencies in registration, streamlining workflows, and improving resource allocation. It also proves instrumental in addressing root causes of staff scarcity and bed capacity issues, leading to improved patient flow and more timely, efficient care.
Keywords:
Disposition Time, Embedded Research, Emergency Room, Lean-Six Sigma, Turnaround TimeDownloads
References
Alibudbud, R. (2023). Addressing the burnout and shortage of nurses in the Philippines. SAGE Open Nursing, 9. https://doi.org/10.1177/23779608231195737
Arabelen, G., & Kaya, H. T. (2021). Assessment of logistics service quality dimensions: a qualitative approach. Journal of Shipping and Trade, 6, 1-13. https://doi.org/10.1186/s41072-021-00095-1
Beltran, M. (2023). Philippines to lower bar for nurses as low pay drives many abroad. Al Jazeera. https://www.aljazeera.com/economy/2023/7/25/philippines-mulls-unlicensed-nurses-as-low-pay-fuels-brain-drain . Accessed on 23rd December, 2023.
Bhattacharyya, N., Baugh, R. F., Orvidas, L., Barrs, D., Bronston, L. J., Cass, S., ... & Haidari, J. (2008). Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngology--Head and Neck Surgery, 139(5_suppl), 47-81. https://doi.org/10.1177/0194599816689667
Cagula, F. M. (2023, May 7). Medicine Ward Sa GTLMH, I-Renovate. [Medicine Ward at GTLMH, Renovate]. Asenso News Iligan City, Philippines. https://www.iligan.gov.ph/news/this-news/63?26820119
Chugani, N., Kumar, V., Garza-Reyes, J. A., Rocha-Lona, L., & Upadhyay, A. (2017). Investigating the green impact of Lean, Six Sigma and Lean Six Sigma: A systematic literature review. International Journal of Lean Six Sigma, 8(1), 7-32. https://doi.org/10.1108/IJLSS-11-2015-0043
Creswell, J. W., & Creswell, J. D. (2017). Research design: Qualitative, quantitative, and mixed methods approaches. Sage publications, US. https://www.scirp.org/reference/ReferencesPapers?ReferenceID=1964849. Accessed on 24th January, 2024.
Elamir, H. (2018). Improving patient flow through applying lean concepts to emergency department. Leadership in Health Services, 31(3), 293-309. https://doi.org/10.1108/lhs-02-2018-0014
Furterer, S. L. (2018). Applying Lean Six Sigma methods to reduce length of stay in a hospital's emergency department. Quality Engineering, 30(3), 389-404. https://doi.org/10.1080/08982112.2018.1464657
De Mast, J. (2006). Six Sigma and competitive advantage. Total Quality Management and Business Excellence, 17(04), 455-464. https://doi.org/10.1080/14783360500528221
Jucal, E. R. N., & Tacay, R. M. (2022). Clinico-demographic profile of orthopedic trauma in a tertiary hospital from 2015–2019. International Journal of Scientific and Research Publications, 12(5), 201-205. https://dx.doi.org/10.29322/IJSRP.12.05.2022.p12524
Klein, E., Saheed, M., Irvin, N., Balhara, K. S., Badaki-Makun, O., Poleon, S., ... & Hinson, J. (2024). Racial and Socioeconomic Disparities Evident in Inappropriate Antibiotic Prescribing in the Emergency Department. Annals of Emergency Medicine. 84(2), 101-110. https://doi.org/10.1016/j.annemergmed.2023.12.003
Martin, S., Siciliani, L., & Smith, P. (2020). Socioeconomic inequalities in waiting times for primary care across ten OECD countries. Social Science & Medicine, 263. https://doi.org/10.1016/j.socscimed.2020.113230
Panayiotou, N. A., & Stergiou, K. E. (2021). A systematic literature review of lean six sigma adoption in European organizations. International Journal of Lean Six Sigma, 12(2), 264-292. https://doi.org/10.1108/ijlss-07-2019-0084
Persis, D. J., Sunder M, V., Sreedharan, V. R., & Saikouk, T. (2022). Improving patient care at a multi-speciality hospital using lean six sigma. Production Planning & Control, 33(12), 1135-1154. https://doi.org/10.1080/09537287.2020.1852623
Rahul, G., Samanta, A. K., & Varaprasad, G. (2020, July). A Lean Six Sigma approach to reduce overcrowding of patients and improving the discharge process in a super-specialty hospital. In 2020 International Conference on System, Computation, Automation and Networking (ICSCAN) (pp. 1-6). IEEE. https://doi.org/10.1109/icscan49426.2020.9262393
Rathi, R., Vakharia, A., & Shadab, M. (2022). Lean six sigma in the healthcare sector: A systematic literature review. Materials Today: Proceedings, 50, 773-781. https://doi.org/10.1016/j.matpr.2021.05.534
Saporito, A., Tassone, C., Di Iorio, A., Barbieri Saraceno, M., Bressan, A., Pini, R., ... & La Regina, D. (2023). Six Sigma can significantly reduce costs of poor quality of the surgical instruments sterilization process and improve surgeon and operating room personnel satisfaction. Scientific Reports, 13(1), 14116.https://doi.org/10.1038/s41598-023-41393-x
Sayeed, Z., Anoushiravani, A., El-Othmani, M., Barinaga, G., Sayeed, Y., Cagle Jr, P., & Saleh, K. J. (2018). Implementation of a hip fracture care pathway using lean six sigma methodology in a level I trauma center. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 26(24), 881-893. https://doi.org/10.5435/jaaos-d-16-00947
Tretiak, В. (2024). Implementing Lean Management Principles to Optimize Healthcare Facility Operations. Економіка Та Суспільство, 62. https://doi.org/10.32782/2524-0072/2024-62-84
Widiwati, I. T. B., Liman, S. D., & Nurprihatin, F. (2024). The implementation of Lean Six Sigma approach to minimize waste at a food manufacturing industry. Journal of Engineering Research. https://doi.org/10.1016/j.jer.2024.01.022
Yadav, G., & Desai, T. N. (2016). Lean Six Sigma: a categorized review of the literature. International Journal of Lean Six Sigma, 7(1), 2-24. https://doi.org/10.1108/ijlss-05-2015-0015
Zhang, J., Bradshaw, F., Hussain, I., Karamatzanis, I., Duchniewicz, M., & Krkovic, M. (2024). The Epidemiology of Lower Limb Fractures: A Major United Kingdom (UK) Trauma Centre Study. Cureus, 16(3). https://doi.org/10.7759/cureus.56581
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