It used to be quite normal for a patient visit to Quebec’s Centre de santé et de services sociaux de Trois-Rivières hospital (CSSSTR) to stretch into a gruelling 17 hours, most of which was time spent waiting in between tests and consultations.
“Patients were not satisfied by it and we had a lot of complaints,” recalled Valery Garneau, chief of the emergency room at CSSSTR. The hospital deals with first-line emergency meaning that patients are not hospitalized, they are only admitted for emergencies and observation.
The hospital was limited in the number of patients it could receive and medical staff were stressed due to the patient load. The problem with the traditional process was that it centred on the doctor and not the patient, said Garneau.
Typically, an incoming patient goes through registration, then triage with a nurse to ascertain patient priority, a visit by the doctor who orders tests like X-rays and blood work, the tests are then done, and followed by another visit by the doctor.
“And all this takes hours because the waiting time in between each step is incredible,” said Camil Villeneuve, vice-president of the lean solutions group at Fujitsu Consulting Inc.
The traditional response in the past 20 years has been to demand more resources, “but the patient is still waiting,” said Villeneuve.
CSSSTR underwent a four-month implementation in December 2008 that introduced what Villeneuve calls a lean health care methodology, in a sense a business process for seeing patients. This required reorganizing the existing process based on patient needs and providing what is valuable from the patient’s viewpoint.
“So everything that is a clinical treatment that is helping me to resolve this problem is adding value to me,” said Villeneuve. “But anything else is not.”
A closer look at the activities performed by nurses and doctors revealed, for instance, that a mere 15 to 20 per cent of a nurse’s eight-hour shift was spent performing clinical activities on patients. By contrast, the benchmark to be achieved is 60 to 65 per cent, meaning that the same staff can treat 300 per cent more patients, said Villeneuve.
With the implementation of a leaner business process, Garneau said nurses can order tests on patients prior to seeing the doctor through an initial step termed “collective orders.” “So, (the doctor) only needs to see the patient once, not twice,” she said.
Patient visits are on average four hours long and the hospital now sees 40 per cent more patients in an eight-hour span, said Garneau. And, not only is the work environment less stressful, but nurses have a better opportunity to apply their medical knowledge through collective orders, and doctors can increase their income as a result of seeing more patients.
The lean approach has definitely brought about a reduction in costs, although it’s a little too early to say exactly how much, said Garneau. But for sure, shortening patient stay has meant a 50 per cent inventory reduction in medication and bed linen.
CSSSTR is only one of two hospitals in Quebec that has implemented such a lean approach. Garneau is optimistic that the positive changes at her hospital will spread to others in the province. “It will change a lot of things because we have good results,” she said.
Villeneuve doesn’t deny that implementing a lean approach can meet with resistance given the “concepts work against traditional logic.”
But the overall economic impact of streamlining the health care process is significant. It’s not just about reducing the cost of health care, the major gain for patients is greater accessibility to health care services, said Villeneuve.
“There are a lot of advantages we can attach to costs,” he said.