title: The effects of a lean transition on process times, patients and employees.
abstract: Purpose Treatment delays must be avoided, especially in oncology, to assure sustainable high-quality health care and increase the odds of survival. The purpose of this paper is to hypothesize that waiting times would decrease and patients and employees would benefit, when specific lean interventions are incorporated in an organizational improvement approach. Design/methodology/approach In 2013, 15 lean interventions were initiated to improve flow in a single radiotherapy institute. Process/waiting times, patient satisfaction, safety, employee satisfaction, and absenteeism were evaluated using a mixed methods methodology (2010-2014). Data from databases, surveys, and interviews were analyzed by time series analysis, χ2, multi-level regression, and t-tests. Findings Median waiting/process times improved from 20.2 days in 2012 to 16.3 days in 2014 ( p<0.001). The percentage of palliative patients for which waiting times had exceeded Dutch national norms (ten days) improved from 35 (six months in 2012: pre-intervention) to 16 percent (six months in 2013-2014: post-intervention; p<0.01), and the percentage exceeding national objectives (seven days) from 22 to 17 percent ( p=0.44). For curative patients, exceeding of norms (28 days) improved from 17 (2012) to 8 percent (2013-2014: p=0.05), and for the objectives (21 days) from 18 to 10 percent ( p<0.01). Reported safety incidents decreased 47 percent from 2009 to 2014, whereas safety culture, awareness, and intention to solve problems improved. Employee satisfaction improved slightly, and absenteeism decreased from 4.6 (2010) to 2.7 percent (2014; p<0.001). Originality/value Combining specific lean interventions with an organizational improvement approach improved waiting times, patient safety, employee satisfaction, and absenteeism on the short term. Continuing evaluation of effects should study the improvements sustainability.
authors.affiliation: Department of Radiation Oncology (MAASTRO), Faculty of Health, Medicine and Life Sciences, Maastricht University , Maastricht, The Netherlands.
authors.forename: Pascale
authors.initials: P
authors.lastname: Simons
authors.affiliation: Department of Radiation Oncology (MAASTRO), Maastricht, The Netherlands.
authors.forename: Huub
authors.initials: H
authors.lastname: Backes
authors.affiliation: Faculty of Business Economics, Hasselt University , Hasselt, Belgium.
authors.forename: Jochen
authors.initials: J
authors.lastname: Bergs
authors.affiliation: Department of Radiation Oncology (MAASTRO), Maastricht, The Netherlands.
authors.forename: Davy
authors.initials: D
authors.lastname: Emans
authors.affiliation: Healthcare Innovation, CZ Insurance, Tilburg, The Netherlands.
authors.forename: Madelon
authors.initials: M
authors.lastname: Johannesma
authors.affiliation: Department of Radiation Oncology (MAASTRO), School for Public Health and Primary Care-Health Services Research, Maastricht University Medical Centre (MUMC+) , Maastricht, The Netherlands.
authors.forename: Maria
authors.initials: M
authors.lastname: Jacobs
authors.affiliation: Faculty of Business Economics, Hasselt University , Hasselt, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Marneffe
authors.affiliation: Faculty of Health Sciences, Hasselt University , Hasselt, Belgium.|Faculty of Medicine and Health Sciences, Ghent University , Ghent, Belgium.
authors.forename: Dominique
authors.initials: D
authors.lastname: Vandijck
mesh_terms: D000041:Absenteeism; D001071:Appointments and Schedules; D002173:Cancer Care Facilities / Q000458:organization & administration*; D017598:Efficiency, Organizational; D006801:Humans; D007588:Job Satisfaction; D009369:Neoplasms / Q000532:radiotherapy; D009426:Netherlands; D015279:Organizational Culture; D061214:Patient Safety; D017060:Patient Satisfaction; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration; D058996:Quality Improvement / Q000458:organization & administration; D017749:Total Quality Management / Q000458:organization & administration*; D014850:Waiting Lists
keywords: Change management; Continuous quality improvement; Incident reporting; Job satisfaction; Lean management; Lean thinking; Patient flow; Patient safety; Waiting time