1. Using LEAN concept to increase efficiency in Diabetic
clinic service, Public Health Center 67 Taweewatthana
Suthee Saritsiri, MD Director of Public Health Center 67
big_bossboom@hotmail.com

2. • Public Health Center 67 was established in 2007.
• DM clinic opened service in 2008.
Background
-
6,445
*100
8,843
*122
12,339
*172
15,221
*214
20,600
*295
Patients * Registered DM patients
2008 2009 2010 2011 2012

3. By
1. Providing accurate, fast, through, and fair (good Governance)
service
2. Development benefits to the organization and society.
3. Monitoring and evaluation of customer satisfaction.
4 Potential mechanisms of management within the
organization.
Strengthen the personnel and the potential quality of life and
pride. Allocate the necessary resources.
12 years Development Plan
Bangkok Metropolitan Administration’s Policy
5th Strategy: Develop a model management system of sustainable
metropolis

4. LEAN concept
Be better

5. Using LEAN concept to increase efficiency service .
DM
Patients
Visit
monthly
NPO for
DTX
Unsatisfie
d emotion
Well glycemic control
Healthcare providers may not be tired.
Loss F/U
Increased risk
of
complications
morbidity
mortality
Win – Win: Between patient and staff satisfaction

6. Research question
Can LEAN concept increase efficiency in DM clinic
service?

7. Metodology of the study
1. Pre LEAN February 2012
2. Root Cause Analysis
3. Using LEAN Concept
4. Evaluate comparison Pre LEAN and Post LEAN March 2013
External Customer need
SWOT Analysis

8. Outcome evaluation
Quantitative Qualitative
1.Physical environment:
No. of service points
2. Human Resources:
No. of Healthcare providers
3. Process:
No. of steps in services
4. Time and Length:
in each steps of services
(start to the end)
1.Efficiency of service %
= value Time x 100
Total Time
2. Satisfaction:
DM patients and Healthcare
providers

9. Implement LEAN concept
1. Physical environment

10. Door
Nursing room
2 Medical record
room
Pharmacy
room
Finance
room
Exam
room.
Exam
room.
counseling
room
Health
education room
preparing
Cue cards
Elevator
Waiting
Point Service
Cue cards
Medical records
room
preparing
Nursing room
Examination
room
Counseling room
Finance room
Pharmacy
Pre Lean

11. Door
Nursing room
Medical records
room Pharmacy
room
Finance
room
Exam
room
Exam
room 2
counseling
room
Health education
room
preparing
Cue cards
1
Elevator
Waiting
7
8
Floor 1
Post Lean

12. Blood
exam
counseling
room
X-ray room
3
5
Elevator
Waiting
preparing
4
2
6
Screen
Floor 2
Poi
nt
Service
1
Cue
cards
2
Screen
BW BP
3 Blood
4 Preparing
5
Exam
room
6
Counselin
g room
7
Finance
Exam
room
Post Lean

13. 2. Human Resources

14. Evaluate complication on Diabetes’ Day
Post - LEAN

15. • Prepare appointed OPD card in advance
• Self completion in each service point
3. Concised Process

16. 4. Developed tools
• Medical reconciliation sheet
• Colored checklist sheet

18. Educational tools and
• Mutimedia educational channels

19. Result
Measure Pre LEAN Goal Post LEAN Outcome
Service points 8 - 8 same
Human Resources 12 - 11 decreased
Steps in service 27 3 step 24 3 step
Time taken (Minute) 141.2 10 % 62.2 55.95 %
Length (Meter) 111 10 % 77 30 63 %
Quantitative

20. Measure Pre LEAN Goal Post LEAN Outcome
Efficiency service (%) 33.36 10 % 65.90 32 54
Satisfaction
High to Highest level
- External customer
(n=50)
- Internal customer
(n=50)
84.77
81.55
increased
increased
93.22
92.21
increased
increased
Result
Qualitative

21. Diabetic patients’Satisfaction (n=50) Mean Score
Pre LEAN Post LEAN p-value*
Convenience and speed in service
The speed of the process is available (From visit to go home) 3.44 4.10 < 0.001*
System managed service is a first (Queue system) 4.36 4.56 0.219
Providing a quick and easy dispensing 3.62 4.24 < 0.001*
Quality in service
Available tools 4.04 4.26 0.063
Personnel have knowledge and talent in service 4.04 4.58 < 0.001*
Doctor followed by Clinical Practice Guidelines 4.60 4.64 0.753
Courtesy and empathy
Personnel have service mind 4.76 4.86 0.307
Personnel attention and caring as well 4.68 4.72 0.752
Personnel advice in good verbal and polite 4.60 4.80 0.064
Give information about health care and service
Give in patients’ need 4.56 4.60 0.756
The pharmacist explains how to use each drug clearly 4.28 4.28 1.000
Adequate information and channels 4.04 4.48 0.005*
Service charges and costs
Delight in the service charges and costs 4.80 4.74 0.587
Compare between cost and services received. Worth? 4.82 4.90 0.377
Building and facilities
Separate property. Easy to use 4.74 4.86 0.244
Safety 4.82 4.84 0.841

22. Conclusion
• Utilizing LEAN concept can lead to substantial
improvement in quality and efficiency of healthcare
service (DM clinic)
• Key success factor:
Lean concept technique and Good teamwork

23. Thank you