LEAN HEALTHCARE IMPLEMENTATION IN MALAYSIAN SPECIALIST HOSPITALS: CHALLENGES AND PERFORMANCE EVALUATION

Received 2020-08-17; Accepted 2021-06-02; Published 2021-10-07

Abstract

Hospital overcrowding is a major issue in Malaysia which has led to increased patient waiting times. Lean healthcare initiative, which focuses on identifying and eliminating non-value-added activities in work processes, was introduced by the government to tackle congestion by improving day-to-day work efficiency while optimising the use of resources at Emergency Departments and Medical Wards. This paper reports on Lean initiatives applied in major and minor specialist hospitals, their performances and challenges faced. Performances of 36 major and minor specialist Ministry of Health hospitals were analysed using four outcome variables: arrival to consultation (ATC), length of stay (LOS), bed waiting time (BWT) and discharge time (DT). The median difference in minutes between pre- and post-Lean implementation at six months and one year, as well as post-Lean at six months and one-year implementation, were
compared using the Wilcoxon-Signed Ranks Test. Significant time reduction (p<0.05) was evident in DT for both major and minor specialist hospitals post six months and one year of Lean implementation. For BWT and LOS, significant reduction was seen only in major specialist hospitals post six months and post one year, respectively. There was no significant time reduction in ATC for both major and minor specialist hospitals. The results indicated that Lean healthcare is important. However, it is not the sole determinant for measuring the hospitals’ performance; other challenges including different departments’ silo mentality, staff’s resistance to change, financial constraints and IT system, also play important roles in Lean implementation.