title: Impact of Lean on patient cycle and waiting times at a rural district hospital in KwaZulu-Natal.
abstract: BACKGROUND
  Prolonged waiting time is a source of patient dissatisfaction with health care and is negatively associated with patient satisfaction. Prolonged waiting times in many district hospitals result in many dissatisfied patients, overworked and frustrated staff, and poor quality of care because of the perceived increased workload.
  
  
  OBJECTIVE
  The aim of the study was to determine the impact of Lean principles techniques, and tools on the operational efficiency in the outpatient department (OPD) of a rural district hospital.
  
  
  METHODS
  The study was conducted at the Catherine Booth Hospital (CBH) - a rural district hospital in KwaZulu-Natal, South Africa.
  
  
  METHODS
  This was an action research study with pre-, intermediate-, and post-implementation assessments. Cycle and waiting times were measured by direct observation on two occasions before, approximately two-weekly during, and on two occasions after Lean implementation. A standardised data collection tool was completed by the researcher at each of the six key service nodes in the OPD to capture the waiting times and cycle times.
  
  
  RESULTS
  All six service nodes showed a reduction in cycle times and waiting times between the baseline assessment and post-Lean implementation measurement. Significant reduction was achieved in cycle times (27%; p &lt; 0.05) and waiting times (from 11.93 to 10 min; p = 0.03) at the Investigations node. Although the target reduction was not achieved for the Consulting Room node, there was a significant reduction in waiting times from 80.95 to 74.43 min, (p &lt; 0.001). The average efficiency increased from 16.35% (baseline) to 20.13% (post-intervention).
  
  
  CONCLUSIONS
  The application of Lean principles, tools and techniques provides hospital managers with an evidence-based management approach to resolving problems and improving quality indicators.
authors.forename: Logandran
authors.initials: L
authors.lastname: Naidoo
authors.affiliation: Discipline of Public Health Medicine, University of KwaZulu-Natal. mahomedo@ukzn.ac.za.
authors.forename: Ozayr H
authors.initials: OH
authors.lastname: Mahomed
mesh_terms: D017598:Efficiency, Organizational; D006767:Hospitals, District / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D058996:Quality Improvement / Q000458:organization & administration* / Q000706:statistics & numerical data; D013019:South Africa; D014850:Waiting Lists