Information and Knowledge Management using ArcGIS ModelBuilder

Soudabeh Khodambashi and Maryati Mohd Yusof
One of the primary steps of Lean which is also important is known as the Value Stream Mapping
(VSM) (Vinodh et al., 2010). In Lean methodology, patient pathway is considered as a value stream.
VSM is a structured diagram, originated by Toyota which includes steps that are all key activities such
as resources, people, information, and material flow is mapped graphically in a clear and explicit
manner (Singh et al., 2010). VSM is used to identify and track all types of waste and process flow
integration to increase process efficiency by reorganizing and redesigning the system (Schweikhart
and Dembe, 2009, Singh et al., 2010, Vinodh et al., 2010, McDonald et al., 2002, Lasa et al., 2008).
3. Lean application in healthcare
Application of Lean in healthcare focuses on eliminating wastes (delays) and repeated errors and
inappropriate procedures (Liptak and Patras, 2007). Lean supports users to improve their process
around the customer requirements, values, and expectations. In the healthcare environment, the
customer can be a patient, their family, a physician, a nurse, an administrator or any other stakeholder
in the process.
Since one of the important objectives of HIS is to assist physicians and nurses to trace most of the
activities in automatic clinical workflow, identifying all the steps which are involved in HIS should be
documented and reviewed. VSM creates a holistic schema of all the processes and workflows to
understand interdependency of functions, departments and even the whole unit over another. Once
the value stream is mapped, the next step is to identify the critical path. Possible improvements
should also be studied to improve value stream (Singh et al., 2010). When improvements in VSM are
identified, the future VSM state should be created to show how a process should work after it is
redesigned. If redesigning is implemented in the VSM, smaller number of steps and also shorter
waiting time between steps could be achieved. As a result, HIS will fit into the clinical pathways if VSM
is implemented in advance.
Most studies on HIS implementation, reported efficiency in their processes. For example, medical
error reduction, especially drug interaction and other prescription errors, increased patient safety and
foster just in time approach could achieved by integrating IT system such as electronic medical
records (Liptak and Patras, 2007). Based on the literature, Lean method has been implemented in
many hospitals in their clinical workflow such as histology laboratories, operating room and
emergency department. Buesa (2009) reported that workflow improvement is attributed by 40%
reduction of operational costs in technical personnel, increased productivity and decrease bottleneck
as a result of Lean implementation in fifteen histology laboratories. Other studies reported process
improvement in terms of reduced patient waiting time and other turnaround time (DelliFraine et al.,
2010b).
A number of challenges have been identified from the pertinent literature. One important issue in
improving the VSM is that isolated improvements within one department or part of the system that
belongs to one department increased the risk of sub optimization that helps the individual
departments but harms the overall system. In order to consider limited time and budget when a VSM
as a starting point of Lean is designed, problems should identified, prioritized and solved according to
their impact on patients and the other stakeholders. In addition, physician resistance exists during
quality improvement process. Thus, employee involvement and empowerment in suggesting and
making changes could be helpful. As a result, a Lean project team could prepare a draft of
documentation, then, the entire department can provide their inputs and comments in the draft.
Furthermore, formalizing of methods would be helpful for better management and improving of the
workflow. To achieve quality improvement, culture and creative thinking should be given more
attention. While traditional management tries to blame individuals for errors, Lean mindset shows that
94% of errors “belong to the system” (Graban, 2008, Deming, 1994). When we learn from errors, we
can use knowledge to prevent future errors (Black, 2005). There are so many companies that failed in
Lean implementation especially in the stage of cultural changes (Yamamoto and Bellgran, 2010). On
the other hand, training through standardized work decreases the risk of verbal training. Even with
external expert in Lean, internal stakeholders also are needed to translate Lean from general tools to
local context (Holden, 2010).
4. Discussion and conclusion
Lean has potential to healthcare process and applicable in healthcare as it increases efficiency,
reduces medical errors, increases patient safety, reduces operational cost and decrease bottleneck.
By using Lean, we aim to improve and increase collaboration and team work across departments, so
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