LEAN Rural Healthcare: Improving Rural Critical Access Hospital Laboratory Workflow to Optimize Processes

Abstract

Background: Many studies have demonstrated the effect of Kaizen events in manufacturing, and research can be found of the implementation of Lean practices in a healthcare system. Healthcare systems currently studied are generally larger systems and the feasibility of implementing lean practices at a facility with less resources, including rural Critical Access Hospitals (CAH), has not be explored widely. Methods: A before-after analysis of a Lean Kaizen event project at a clinical laboratory within a rural CAH was conducted over a 2-week time period with a longer-term follow-up of 6 months. The project followed the Plan-Do-Check-Act (PDCA) cycle and the research team interviewed project members throughout the lifecycle. The Kaizen event improved turnaround time in the laboratory setting, assisted by tracking and eventually improving patient record management, and reduced travel time within the CAH’s laboratory setting. Results: The rural CAH had 18,514 tests over the course of December 2022 to November 2023. The turnaround time (TAT) for the current state was 111 minutes on average per order. Additionally, the laboratory had an 83% non-compliance rate for patient records management in the laboratory. The weighted average time went from 111 minutes to 44 minutes after the laboratory layout was changed. Routine orders went from 140 min to 41 minutes, and Timed orders went from 61 to 48 minutes. All processes had a positive change in TAT time for all three sets of orders. Conclusion: A rural CAH demonstrated significant improvement using a 2-week Kaizen event with a 6-month longitudinal follow-up. Important for CAH reimbursement and patient follow-up 83% of inspected patient records were in non-compliance rate from a 149-record sample size. After the implementation plan, the non-compliance rate fell to just 6% using Pareto, 5S and quality control using proper storage locations staff training on newly implemented procedures and workflows. Given the scarcity of time and personnel in CAHs, this project demonstrated dramatic improvements with just 2 personnel using rapid project implementation over a 14-day time period with follow-ups.