The LinCE Project – Lean for Outpatient Appointments – helped public hospitals reduce the waiting time for appointments from 72 to 40 days. “This was achieved by using 4 or 5 simple tools”, says Luís Matos, Department Chief of Surgery and Operating Rooms of Porto Hospital Center.
The LinCE Project (Lean in Outpatient Appointments) was the big winner of the Hospital of the Future Awards, in the Public Service category. How did you accept this accolade?
It is great to have public recognition for the work that was developed over more than one year. The award looks to recognize a good service to patients, which, from an internal perspective, had great organizational results.
Is this the merited recognition of the work developed in the scope of continuous improvement?
Definitely. Every award is good, encouraging. If we hadn’t gotten it, we would still be proud, because we are aware of the results we got. Of course, having this kind of recognition – when we are called to participate in conferences to present our results or to receive any award – all of that means that there is someone else, outside of our close team, who independently and of their own volition, acknowledges our good work. That motivates us. It’s a good impulse to continue the work we have been developing.
You said that, even if you had not received this award, you would still be confident of the good results of your work. Can you measure/quantify these results?
Yes. When we started, we knew that any patient would wait 72 days from the moment of soliciting an appointment to the moment he/she in fact attended that appointment. At the moment, we have shortened that waiting period to 40 days. In the area we work in, we get around 200 thousand patients, so 40 days is a good number – considering that the requests for appointments have also increased.
Can this model be replicated?
The model has to be adapted to the different realities that different hospitals live, but I do believe that people are becoming aware that this project can be applied - with the relevant adjustments - to other hospitals, healthcare centers and providers with relative ease. Using the same methods and tools, starting a project of this kind somewhere else will probably bring similar results.
When we presented our results, managers from the healthcare industry/sector asked us to send them any and every useful information so that they could show it at other hospitals. People are aware that this wasn’t coincidence and that what happened was in no way specific. I believe there probably are other hospitals implementing similar changes at the moment.
How did you arrive at the conclusion that a change was necessary and, from there, decide to implement a KAIZEN™ intervention?
It was easy to look around and see that we had papers everywhere, our offices were completely disorganized with piles and piles of clinical sheets – we were aware we needed to improve. We just didn’t know how nor where to start.
What kinds of measures were implemented to improve patient satisfaction?
The first and most important one pertains to response time. Thanks to the project, our hospital now has a reputation for answering patients requests fast. In terms of physical infrastructure, and keep in mind we are talking about 4 distinct hubs/centers, we have implemented a few measures to facilitate patient orientation. Relying on visual management, we now have better accesses, organized spaces and appropriate signage for our patients. We have also provided them with relevant information prior to their appointment.
How was it possible to reduce the waiting time to schedule an appointment in 44% in only 9 months?
It was a result of a rather simple data analysis. First of all, we had to understand the real size of the waiting list for first appointments. There were people there who were waiting indefinitely and would not be getting an answer anytime soon. We adopted a faster referencing process. Instead of getting a list once a week, the appointment manager who evaluates the appointment requests is now getting them on a daily basis, which in and of itself allows for a faster response. We started publicly telling people of available openings and response times. All of this through simple measures, some of them as small as changing the colour of the envelope where requests for appointments circulate.
Why are patients seeking you out more and more? What is changing?
People’s ages are changing, their needs as well. We have hospital stay units where the average age is between 82 and 85. People are older, problems are more complex. This is the result of development.
With so many new private hospitals, is there real competition between the private and public sectors?
We’re not at that stage yet. A part of the LinCE project is also related to that, with our ability to offer the same conditions to our patients. Obviously, for a hospital that has 2 thousand daily appointments, the conditions we can offer are different from those that attend to 50 people. Hospitals who receive 50 people have a hostess to greet people upon arrival, hospitals who receive 2 thousand have to resort to other means to make a patient feel welcomed. There are also completely different issues relating to size. The truth is, some private hospitals will be able to sustain their activity, others will have to close because they won’t have enough patients. Our life expectancy keeps increasing and the complex problems get brought to the public hospitals. We do transplants, we work oncology, among other things. Private hospitals will continue doing great work in a group of specific areas.
What projects do you have for the near future?
We’re looking at continuing the development of the Leanor Project – Lean Operation Room, which was started in September of 2009. The main goal of this project is to improve the profitability of the operating rooms and reduce patients’ waiting times. Actually, more than cutting down the waiting lists, our goal is to solve the problem of those patients that have been waiting for a long time. Through a better management of the occupation of the operation rooms we are looking to rationalize costs and making sure that waiting times are acceptable to patients. Our Pharmacy is also going to resort to these kinds of tools to improve.