Jenei István

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István Jenei: Lean transformation of hospital processes – Structuring foreign and Hungarian experiences, PhD Dissertation, Corvinus University of Budapest, Doctoral School in Business Administration service is 8.8%; its adequacy rate is 91.2%, and the rate of fatal error is 0.6% (adequacy: 99.4%). In the other services, a quality rate of even 99.9% (which would require the reduction of all problem cases to 88 th of the current number and the number of fatal cases to one-sixth of the current value at the hospitals) is already unacceptable: it is inconceivable, for example, to have two dangerous landing events at O’Hare international airport or a daily 32,000 debit transactions posted to the wrong accounts in the US (Leape, 1994). As addendum to the above, it is worth getting acquainted with the results of a research project which observed the activity of 26 nurses in 9 hospitals for a total of 239 hours. Records were kept of errors made (i.e. of nonconforming activities, such as portioning of medication first, inspection of patient data to check over-sensitivity to the given substance afterwards), and of problems incurred (i.e. external reasons preventing the personnel to do their work, such as delayed arrival of the ordered medicine or breakdown of equipment). Data analysis yielded the far-from-surprising result that the number of problems exceeded by far that of the errors. The rate was 167/24 (Tucker and Edmondson, 2003). However, one must not forget that, as indicated by West (2000, cited: New et al., 2008, p.4): “… major problems are generated by the uncontrolled accumulation of many minor things.” Hence for example a data form put at the wrong place, a puddle left without supervision or a phone message noted down inaccurately may have significant consequences. To get a realistic picture of the rate of the daily occurrence of problems which hinder the activity of the medical staff, but which have never been in the centre of attention, although they deteriorate service quality and, not in the last, financial efficiency, the frequency-of-errors data must be complemented with these observations. The example of the US is not unique among the advanced countries as far as quality problems are concerned. Surveys carried out in the National Health Service hospitals in the United Kingdom showed that one of every 10 hospital patients is the victim of a negative event of some kind: they get the wrong medication, fall down or off something, suffer infection or are given the wrong diagnosis (National Audit Office, 2005; Fillingham, 2007). The situation seems even more serious, considering the research results of Tucker and Edmondson (2003): “…despite intensified attention to - 35 -
István Jenei: Lean transformation of hospital processes – Structuring foreign and Hungarian experiences, PhD Dissertation, Corvinus University of Budapest, Doctoral School in Business Administration these problems, it seems that the hospitals do not learn from the problems and errors encountered by the staff during their everyday work.” (p.56.). Burgess et al. (2009) and NHSIII (2007) warn of efficiency deficiencies on the basis of their experiences at the NHS hospitals (e.g. multiple recording of patient data, multiple patient movements due to lack of organisation, long waiting times for doctors/nurses, indiscretion, lengthier hospital stay due to lack of co-ordination in the discharge procedure etc.) Although no precise data are available on the Hungarian situation, the results of surveys initiated by the SE Health Services Manager Training Centre confirm that, in terms of undesirable events, the Hungarian hospitals are no exception: the list includes development of decubitus, falls, wound infections, medication errors (Belicza, 2008), with direct impact on the state of the patient, and events which deteriorate “only” the (production) efficiency of hospital operation; e.g. cancelled operations (Belicza, 2008; Kránicz et al., 2008). Furthermore, presumably, this sector is not exempt from malpractice in Hungary either: “Estimates, albeit not adequately checked ones, suggest that …annually … in Hungary, 3-6000 people die due to incorrect treatment, undesirable events, malpractice.” (Varga et al., 2005, p.199.). Deficiencies impacting on patient security as well as errors of care are related to low process efficiency (Tucker, 2004; Tucker and Edmondson, 2003; New et al., 2008). Based on own research, New et al. (2008) state that, with stable processes, the staff has more time to care for patients. Thus, for instance, if medicines are arranged in some order and stored separately from liquids, nurses will probably spend less time finding what they are looking for. Health care processes typically include a significant proportion, up to 35%, of non-value-adding elements (Murphy, 2003). According to Mezőfi (2007), in Hungarian emergency patient care, 28 minutes of patient care on average is associated with 119 minutes of patient waiting time, that is, only one fifth of the time spent by the patient in the system is useful. Jimmerson et al. (2005) suggest that the reason of these low rates is the frequent lack of task specifications which, in turn, leads to inconsistencies in care provision, to reduced service reliability, and unplanned events which often disturb the work of the staff. These circumstances, of course, imply higher costs, lower efficiency, higher error rates and, last but not least, a frustrated staff (Jimmerson et al., 2005). In - 36 -
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Jenei István

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