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Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide

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Lean thinking: using 6S and visual management for efficient adverse event closure.

Ziad Alzahrani¹

¹Main Adminstration, National Guard Health Affairs, Riyadh, Saudi Arabia ziader00@gmail.com.

BMJ Open Quality

|January 27, 2021

Summary

Implementing a visual process map significantly reduced incident closure times in an adult oncology department. This improvement in safety reporting systems enhances communication and efficiency for healthcare teams.

Keywords:

continuous quality improvement incident reporting lean management process mapping quality improvement

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Area of Science:

Healthcare Management
Patient Safety
Process Improvement

Background:

An Adult Oncology Department with over 130 staff, including 70 physicians, faced challenges with incident reporting.
A multidisciplinary committee managed reported incidents, comprising physicians, nurses, pharmacists, and safety/quality specialists.

Purpose of the Study:

To address concerns regarding increased reported incidents, delayed report closure, unclear roles, and errors in the safety reporting system (SRS).
To develop a visual aid, specifically a functional process map, to clarify team roles and streamline adverse event closure procedures.

Main Methods:

Introduction of Lean principles (5S and Safety) and identification of eight Lean wastes in May 2016.
Application of these principles during SRS committee meetings over a 3-year period.
Development and utilization of a visual process map to guide incident closure.

Main Results:

Average closure time for medication incidents decreased from 67 days (2016) to 37 days (2018).
Average closure time for non-medication incidents reduced from 134 days (2016) to 61 days (2018).
The process map helped bring medication incident closure times within the 45-day target.

Conclusions:

The developed process map served as an effective communication tool, clarifying activities and roles.
Streamlining the process through visual aids improved efficiency and reduced closure times.
Visual aids are beneficial for enhancing communication and operational efficiency in healthcare settings.