LEANing for quality excellence

7/5/2023 9:08:00 AM | Stories from the Heart (NHCS)

The article is contributed/written by

Continuous improvement is crucial in healthcare. As the healthcare industry is constantly evolving, it is essential to continuously improve processes, systems, and practices to enhance patient care, safety, and outcomes. In NHCS, the Department of Process Transformation & Improvement (PTI), led by Lay Sock Yee, Senior Manager, plays a key role in facilitating process improvement and lean projects across the organisation and has always been at the forefront of driving quality improvement initiatives. For her remarkable efforts, Sock Yee has recently been conferred the SingHealth GCEO Excellence Award 2023.

Sock Yee (right) receives the GCEO Excellence Award for Outstanding Administrative and Ancillary Staff from Group CEO of SingHealth, Prof Ivy Ng.

Driving continuous improvement

Reminiscing the early days of her career, Sock Yee recalls working in a container office at Mistri Wing when she first joined NHCS in 2010. She was then working in the Quality Management unit under Operations – Management Information & Performance (MIP), but the team went through a reorganisation in 2021 and renamed the department as PTI.

Sock Yee (middle) with colleague Jacqueline Huo from PTI (left), and Amber Yeong, Chief Operating Officer.

Sock Yee shared that PTI’s core purpose is to foster staff participation in quality improvement (QI) activities and build a culture of continuous improvement in NHCS. Although her team did not undergo any formal training for the roles, Sock Yee’s previous background and experience in handling quality management and Lean techniques in the industrial system and engineering, have helped the team with similar concepts and applications to healthcare projects. Compared to optimising machines and systems, Sock Yee shared that she gains more fulfilment and satisfaction enhancing healthcare processes where patients are the ultimate beneficiary.

The department of PTI actively promotes two core QI programmes: Innovation and Quality Circles (IQC), and Lean. To help colleagues embark on their QI journey, the department developed in-house training programmes to equip staff with the necessary methodologies and tools. PTI also steps in to facilitate the projects to ensure that the project initiatives are aligned with the organisation’s objectives, which include patient safety, work efficiency and staff productivity.

“Embarking any QI or Lean initiative is like entering into uncharted waters, the process takes time, patience and hard work,” Sock Yee explained. For all projects, PTI will first initiate meetings with the project team to identify the scope of work and advise the team composition and roles. As the project progresses, PTI helps to review the methodologies and analyse the efficiency and results. When asked what was the biggest challenge of PTI’s role, Sock Yee said, “Sometimes, it takes a bit of convincing to get buy-in from stakeholders to start a QI or Lean project. Once the project starts, it can get challenging to sustain the efforts. However, we find that once stakeholders see the benefits the project reaps, they always agree that the efforts and time spent are worthwhile!”

Sock Yee shared a great example of a Lean project which has achieved positive and sustainable results with the collaborative efforts of the whole team.

Improving Bed Utilisation at CTICU

Cardiothoracic Intensive Care Unit (CTICU) was facing bed crunch issues due to increased patient volume, leading to manpower and operational stress, delays in patient transfers, and even the unfortunate cancellation of elective surgeries. The CITCU together with PTI got together to deep dive into the issues and applied Lean concepts to look at ways to improve the bed utilisation.

Visual Board: Putting things into perspective

Two critical issues were identified – there was a lack of visibility into patients' intensive care journey, and inadequate knowledge of the bed status in CTICU among doctors. Hence the team introduced a ‘visual board’ at the unit’s central station to provide real-time visibility of the beds, with updates to patients’ status and treatment plans with the use of intuitive icons and colour-coded indicators. This allowed the CITCU staff to have sight of the overall situation and eliminated the time required to refer to the clinical notes. In addition, this enabled the team to make informed decisions on the suitable patients to discharge to a step-down ward, and to cater to those in need.

A sample of the “visual board” at CTICU’s central station where colours indicated the different length of stay, and icons showed the type of care support patient would need.

Sock Yee shared that in the initial roll-out, it was not easy to get everyone to update the board conscientiously, as they had to learn a new routine. The constant activities in the ward, for example, doctors having to conduct ward rounds earlier than usual due to an early morning operation, or new patients being admitted overnight, made it more challenging for updates to take place.

More improvements were made along the way as the department got used to the momentum. Instead of the previous ward huddles with the registrar on-call, the team introduced the initiative of having the registrar on-call to review patients early in the morning and then to update the ward members of the final bed status by 7am. The information which is shared in secured communication channels, gives an accurate picture of bed situation before the first operation of the day. This initiative is now a standard practice, and has shown to be effective for the team to get timely updates on bed status which also aids decision-making and promotes collaboration among stakeholders.

Members of the project team planned the visual board together with PTI. Members include Asst Prof Tan Teing Ee, Asst Prof Philip Pang and Asst Prof Mathew C. Jose from Department of Cardiothoracic Surgery, SNM Yeoh Lee Shien from CTICU, and SNM Ng Lay Hwa from Operating Theatres.

The project saw positive outcomes with a significant 40% reduction in the number of surgery cancellation due to bed crunch. When ingrained into CTICU as a daily practice, updating the visual board helped stakeholders better assess the situation at a glance, and improved coordination and decision-making. Implementing standardised work process of having the registrar on-call to update the team on overall bed situation has also fostered better communication and a more proactive approach to patient management.

Transforming healthcare delivery in NHCS

The application of LEAN principles for the CTICU project is just one of the many examples of how fostering a culture of operational excellence and quality improvement can enhance patient outcomes and overall organisational efficiency.

Sock Yee added that thus far, NHCS has completed seven LEAN projects with positive results such as improved patient waiting time, resource utilisation, discharge practices and operational efficiency. These encouraging results have been possible with the support of clinicians, nursing, allied health as well as administrative and operational staff working together collaboratively.