title: Lean thinking transformation of the unsedated upper gastrointestinal endoscopy pathway improves efficiency and is associated with high levels of patient satisfaction.
abstract: BACKGROUND
  Upper gastrointestinal (UGI) endoscopy is a routine healthcare procedure with a defined patient pathway. The objective of this study was to redesign this pathway for unsedated patients using lean thinking transformation to focus on patient-derived value-adding steps, remove waste and create a more efficient process. This was to form the basis of a pathway template that was transferrable to other endoscopy units.
  
  
  METHODS
  A literature search of patient expectations for UGI endoscopy identified patient-derived value. A value stream map was created of the current pathway. The minimum and maximum time per step, bottlenecks and staff-staff interactions were recorded. This information was used for service transformation using lean thinking. A patient pathway template was created and implemented into a secondary unit. Questionnaire studies were performed to assess patient satisfaction.
  
  
  RESULTS
  In the primary unit the patient pathway reduced from 19 to 11 steps with a reduction in the maximum lead time from 375 to 80 min following lean thinking transformation. The minimum value/lead time ratio increased from 24% to 49%. The patient pathway was redesigned as a 'cellular' system with minimised patient and staff travelling distances, waiting times, paperwork and handoffs. Nursing staff requirements reduced by 25%. Patient-prioritised aspects of care were emphasised with increased patient-endoscopist interaction time. The template was successfully introduced into a second unit with an overall positive patient satisfaction rating of 95%.
  
  
  CONCLUSIONS
  Lean thinking transformation of the unsedated UGI endoscopy pathway results in reduced waiting times, reduced staffing requirements and improved patient flow and can form the basis of a pathway template which may be successfully transferred into alternative endoscopy environments with high levels of patient satisfaction.
authors.affiliation: Department of Gastroenterology and Endoscopy, Portsmouth Hospitals Trust, Southwick Hill, Portsmouth PO6 3LY, UK.
authors.forename: Theresa
authors.initials: T
authors.lastname: Hydes
authors.forename: Navjyot
authors.initials: N
authors.lastname: Hansi
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Trebble
mesh_terms: D019091:Critical Pathways / Q000458:organization & administration / Q000592:standards*; D017598:Efficiency, Organizational; D016099:Endoscopy, Gastrointestinal / Q000379:methods / Q000592:standards*; D006801:Humans; D017060:Patient Satisfaction; D011785:Quality Assurance, Health Care; D011795:Surveys and Questionnaires; D013997:Time Factors; D014850:Waiting Lists