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.