Digitalization of Outpatient Services Based on Lean Management to Reduce Waiting Time in Government Hospital

Adila Kasni Astiena, Rika Ampuh Hadiguna, Acim Heri Iswanto, - Hardisman

Abstract


Hospital outpatient waiting times in Indonesia do not meet the standards. Lean management reduces waste, while digitalization plays a role in managing service complexity. Implementing lean in parallel with digitalization increases the opportunities for improvements, but empirical research on this is still limited. This study aimed to generate an analytical study of the impact of Lean application in reducing the waste of waiting time for outpatient services at a government hospital. The research design was pre- and post-intervention. The study was conducted in a regional government hospital with 80 people as a sample who was recruited by systematic random sampling. Data collection was carried out through observation and mapping the flow of patient service time from booking to completion of a doctor's consultation using the time stamp. Efforts to reduce waiting time are carried out through a simulation of the Lean-based digitalization model. The variables are the number of Service Steps, Lead Time, Waiting Time, Value-Added Activities, Non-Value-Added Activities and Value-Added Ratio (VAR). The results showed that lean-based service digitalization was able to reduce service steps from 10 to 4 steps, waste waiting from 5 to 2 steps, and Lead Time from 336 to 39 minutes (-88.4%), increasing the VAR from 5.1% to 20.5%. This research is limited to the implementation of lean digitally. It is important to statistically compare the impact of digital and non-digital lean implementation in some hospitals.

Keywords


Lean-based digitalization; waiting time; outpatient.

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References


R. Mehra and M. K. Sharma, "Measures of Sustainability in Healthcare," Sustain. Anal. Model., vol. 1, no. January 2021, p. 100001, 2021, doi: 10.1016/j.samod.2021.100001.

R. Agustina et al., "Universal health coverage in Indonesia: concept, progress, and challenges," Lancet, vol. 393, no. 10166, pp. 75–102, 2019, doi: 10.1016/S0140-6736(18)31647-7.

M. C. Ruhara, "Effect of Health Insurance on Demand for Outpatient Medical Care in Rwanda: An Application of the Control Function Approach," Rwanda J., vol. 3, no. 1, p. 77, Oct. 2016, doi: 10.4314/rj.v3i1.6b.

H. Adamu and M. Oche, "Determinants of patient waiting time in the general outpatient department of a tertiary health institution in North Western Nigeria," Ann. Med. Health Sci. Res., vol. 3, no. 4, p. 588, 2013, doi: 10.4103/2141-9248.122123.

Irwandy and A. C. Sjaaf, "Impact of the implementation of the National Health Insurance policy on hospital productivity levels in Indonesia," Enferm. Clin., vol. 30, pp. 412–415, 2020, doi: 10.1016/j.enfcli.2019.07.127.

R. Anggraeni, Irwandy, F. Rizki, and M. H. Basman, "Does the health insurance governance system support health care programs?," Enferm. Clin., vol. 30, pp. 13–16, 2020, doi: 10.1016/j.enfcli.2020.06.005.

R. Anggraeni et al., "The evaluation of national health assurance governance program in Makassar City and Gowa District of South Sulawesi Province," Enferm. Clin., vol. 30, pp. 17–20, 2020, doi: 10.1016/j.enfcli.2020.06.006.

R. Rachmawaty, A. W. Sinrang, E. Wahyudin, and A. Bukhari, "Evaluation of health care quality among insured patients in Indonesian mother & child hospital: A secondary data analysis," Gac. Sanit., vol. 35, pp. S613–S618, 2021, doi: 10.1016/j.gaceta.2021.10.100.

A. K. Astiena, R. A. Hadiguna, A. H. Iswanto, H. Hardisman, D. Irfan, and H. Hariselmi, “Sistem Penjadwalan Poliklinik Rawat Jalan Berbasis Manajemen Lean di RSUD Kota Padang,†J. War. Pengabdi. Andalas, vol. 27, no. 4, pp. 235–244, 2020, doi: 10.25077/jwa.27.4.235-244.2020.

F. Hemmati, G. Mahmoudi, F. Dabbaghi, F. Fatehi, and E. Rezazadeh, "The factors affecting the waiting time of outpatients in the emergency unit of selected teaching hospitals of tehran," Electron. J. Gen. Med., vol. 15, no. 4, 2018, doi: 10.29333/ejgm/93135.

X. Pan, N. Geng, X. Xie, and J. Wen, "Managing appointments with waiting time targets and random walk-ins," Omega (United Kingdom), vol. 95, 2020, doi: 10.1016/j.omega.2019.04.005.

D. A. Martinez et al., "Prolonged wait time is associated with increased mortality for Chilean waiting list patients with non-prioritized conditions," BMC Public Health, vol. 19, no. 1, Feb. 2019, doi: 10.1186/s12889-019-6526-6.

T. C. for S. Economics, "The Economic Cost of Wait Times in Canada The Centre for Spatial Economics Assessing past, present and future economic and demographic change in Canada," 2006.

L. T. Lot, A. Sarantopoulos, L. L. Min, S. R. Perales, I. de F. S. F. Boin, and E. C. de Ataide, "Using Lean tools to reduce patient waiting time," Leadersh. Heal. Serv., vol. 31, no. 3, pp. 343–351, 2018, doi: 10.1108/LHS-03-2018-0016.

S. M. Shortell, J. C. Blodgett, T. G. Rundall, R. M. Henke, and E. Reponen, "Lean Management and Hospital Performance: Adoption vs. Implementation," Jt. Comm. J. Qual. Patient Saf., vol. 47, no. 5, pp. 296–305, May 2021, doi: 10.1016/j.jcjq.2021.01.010.

J. C. C. Teixeira, F. A. Bernardi, R. P. C. L. Rijo, and D. Alves, "Proposal for a health information management model based on Lean thinking," Procedia Comput. Sci., vol. 181, pp. 1097–1104, 2021, doi: 10.1016/j.procs.2021.01.306.

S. C. Skeldon et al., "Lean methodology improves efficiency in outpatient academic uro-oncology clinics," Urology, vol. 83, no. 5, pp. 992–998, 2014, doi: 10.1016/j.urology.2013.11.048.

M. Beaulieu and O. Bentahar, "Digitalization of the healthcare supply chain: A roadmap to generate benefits and effectively support healthcare delivery," Technol. Forecast. Soc. Change, vol. 167, no. March 2020, p. 120717, 2021, doi: 10.1016/j.techfore.2021.120717.

M. J. Sousa and Ã. Rocha, "Digital learning: Developing skills for digital transformation of organizations," Futur. Gener. Comput. Syst., vol. 91, pp. 327–334, 2019, doi: 10.1016/j.future.2018.08.048.

E. Martínez-Caro, J. G. Cegarra-Navarro, and F. J. Alfonso-Ruiz, “Digital technologies and firm performance: The role of digital organisational culture,†Technol. Forecast. Soc. Change, vol. 154, no. June 2019, p. 119962, 2020, doi: 10.1016/j.techfore.2020.119962.

F. Ciampi, M. Faraoni, J. Ballerini, and F. Meli, "The co-evolutionary relationship between digitalization and organizational agility: Ongoing debates, theoretical developments and future research perspectives," Technol. Forecast. Soc. Change, vol. 176, p. 121383, Mar. 2022, doi: 10.1016/j.techfore.2021.121383.

S. Jing, Y. Feng, and J. Yan, "Path selection of lean digitalization for traditional manufacturing industry under heterogeneous competitive position," Comput. Ind. Eng., vol. 161, no. December 2020, p. 107631, 2021, doi: 10.1016/j.cie.2021.107631.

G. L. Tortorella, F. S. Fogliatto, T. A. Saurin, L. M. Tonetto, and D. McFarlane, "Contributions of Healthcare 4.0 digital applications to the resilience of healthcare organizations during the COVID-19 outbreak," Technovation, 2021, doi: 10.1016/j.technovation.2021.102379.

A. Irmagita and Y. Septorini, "Indonesian Dentists' Perception of the Use of Teledentistry," Int. Dent. J., vol. 0, pp. 1–8, 2022, doi: 10.1016/j.identj.2022.04.001.

B. Mohapatra, S. Tripathy, D. Singhal, and R. Saha, "Significance of digital technology in manufacturing sectors: Examination of key factors during Covid-19," Res. Transp. Econ., no. August 2020, p. 101134, 2021, doi: 10.1016/j.retrec.2021.101134.

S. Alexandra, P. W. Handayani, and F. Azzahro, "Indonesian hospital telemedicine acceptance model: the influence of user behavior and technological dimensions," Heliyon, vol. 7, no. 12, 2021, doi: 10.1016/j.heliyon.2021.e08599.

F. D. Cifone, K. Hoberg, M. Holweg, and A. P. Staudacher, "‘Lean 4.0’: How can digital technologies support lean practices?,†Int. J. Prod. Econ., vol. 241, no. June 2020, p. 108258, 2021, doi: 10.1016/j.ijpe.2021.108258.

R. Lorenz, P. Buess, J. Macuvele, T. Friedli, and T. H. Netland, Lean and Digitalization—Contradictions or Complements?, vol. 566, no. August. Springer International Publishing, 2019.

S. Schumacher, R. Hall, A. Bildstein, and T. Bauernhansl, “Toolbox Lean 4 . 0 – Development and Implementation of a Database Approach for the Management of Digital Methods and Tools,†Procedia CIRP, vol. 107, no. 2021, pp. 776–781, 2022, doi: 10.1016/j.procir.2022.05.061.

P. Serlenga, I. Leppavuori, I. Moraes, and M. Forlini, Digital Lean : a Guide To Manufacturing. Milan: Bain & Company, 2019.

G. Hoellthaler, F. Meister, S. Braunreuther, and G. Reinhart, “Function framework for describing digital technologies in the context of lean production,†Procedia CIRP, vol. 88, pp. 167–172, 2020, doi: 10.1016/j.procir.2020.05.030.

I. Wennman, E. Carlström, B. Fridlund, and H. Wijk, “Actions taken affecting lead time in the care pathway for low-priority patients with a suspected stroke: A critical incident study,†Int. Emerg. Nurs., vol. 60, no. December 2021, pp. 1–7, 2022, doi: 10.1016/j.ienj.2021.101105.

S. Kundgol, P. Petkar, and V. N. Gaitonde, “Implementation of value stream mapping (VSM) upgrading process and productivity in aerospace manufacturing industry,†Mater. Today Proc., vol. 46, pp. 4640–4646, 2021, doi: 10.1016/j.matpr.2020.10.282.

A. H. Iswanto, Problem Solving for Better & Faster Hospital, Using LEAN Concept, Tools and Methodology. Jakata: LAP Lambert Academic Publishing, 2017.

P. E. Dossou, P. Rafael, S. Cristiane, and C. J. Joao, “How to use lean manufacturing for improving a Healthcare logistics performance,†Procedia Manuf., vol. 51, pp. 1657–1664, 2020, doi: 10.1016/j.promfg.2020.10.231.

L. Naidoo and O. H. Mahomed, “Impact of Lean on patient cycle and waiting times at a rural district hospital in KwaZulu-Natal,†African J. Prim. Heal. Care Fam. Med., vol. 8, no. 1, pp. 1–9, 2021, doi: 10.4102/phcfm.v8i1.1084.

Y. Sun, Z. Wu, and W. Zhu, “When do firms benefit from joint price and lead-time competition?,†Eur. J. Oper. Res., 2022, doi: 10.1016/j.ejor.2022.01.008.

T. L. Jackson, Lean Tools for Healthcare Series : Mapping Clinical Value Stream. Boca Raton: Taylor & Francis Group, 2013.

A. H. Iswanto, “Lean Implementation in the Outpatient Unit†in Lean Implementation in Hospital Departements: How to Move from Good to Great Services, 1st ed. New York: Routledge Taylor & Francis Group, 2019.

A. H. N. Aziati and N. S. N. S. B. Hamdan, “Application of queuing theory model and simulation to patient flow at the outpatient department,†Proc. Int. Conf. Ind. Eng. Oper. Manag., vol. 2018-March, no. January, pp. 3016–3028, 2018.

C. Stechert and H. P. Balzerkiewitz, “Digitalization of a Lean Product Development Organization,†Procedia CIRP, vol. 91, pp. 764–769, 2020, doi: 10.1016/j.procir.2020.02.232.

N. Durão, M. J. Ferreira, C. S. Pereira, and F. Moreira, “Current and future state of Portuguese organizations towards digital transformation,†in Procedia Computer Science, 2019, vol. 164, pp. 25–32, doi: 10.1016/j.procs.2019.12.150.

J. M. Mas and A. Gómez, “Social partners in the digital ecosystem: WWill business organizations, trade unions and government organizations survive the digital revolution?,†Technol. Forecast. Soc. Change, vol. 162, Jan. 2021, doi: 10.1016/j.techfore.2020.120349.

D. Zhou, M. Kautonen, W. Dai, and H. Zhang, “Exploring how digitalization influences incumbents in financial services: The role of entrepreneurial orientation, firm assets, and organizational legitimacy,†Technol. Forecast. Soc. Change, vol. 173, Dec. 2021, doi: 10.1016/j.techfore.2021.121120.

J. Baptista, M. K. Stein, S. Klein, M. B. Watson-Manheim, and J. Lee, “Digital work and organisational transformation: Emergent Digital/Human work configurations in modern organisations,†J. Strateg. Inf. Syst., vol. 29, no. 2, Jun. 2020, doi: 10.1016/j.jsis.2020.101618.

H. W. Volberda, S. Khanagha, C. Baden-Fuller, O. R. Mihalache, and J. Birkinshaw, “Strategizing in a digital world: Overcoming cognitive barriers, reconfiguring routines and introducing new organizational forms,†Long Range Plann., vol. 54, no. 5, Oct. 2021, doi: 10.1016/j.lrp.2021.102110.

H. Li, Y. Wu, D. Cao, and Y. Wang, “Organizational mindfulness towards digital transformation as a prerequisite of information processing capability to achieve market agility,†J. Bus. Res., vol. 122, pp. 700–712, Jan. 2021, doi: 10.1016/j.jbusres.2019.10.036.

S. Chanias, M. D. Myers, and T. Hess, “Digital transformation strategy making in pre-digital organizations: The case of a financial services provider,†J. Strateg. Inf. Syst., vol. 28, no. 1, pp. 17–33, 2019, doi: 10.1016/j.jsis.2018.11.003.

J. Konopik, C. Jahn, T. Schuster, N. Hoßbach, and A. Pflaum, “Mastering the digital transformation through organizational capabilities: A conceptual framework,†Digit. Bus., vol. 2, no. 2, p. 100019, 2022, doi: 10.1016/j.digbus.2021.100019.

Y. Li, T. Xiang, and W. Y. Szeto, “Home health care routing and scheduling problem with the consideration of outpatient services,†Transp. Res. Part E Logist. Transp. Rev., vol. 152, no. August 2020, p. 102420, 2021, doi: 10.1016/j.tre.2021.102420.

P. Baudier, G. Kondrateva, C. Ammi, V. Chang, and F. Schiavone, “Technovation Digital transformation of healthcare during the COVID-19 pandemic : Patients ’ teleconsultation acceptance and trusting beliefs,†Technovation, no. January, p. 102547, 2022, doi: 10.1016/j.technovation.2022.102547.




DOI: http://dx.doi.org/10.18517/ijaseit.12.6.17212

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