Optimizing Clinical Operations as Part of a Global Emergency Medicine Initiative in Kumasi, Ghana: Application of Lean Manufacturing Principals to Low‐resource Health Systems
dc.contributor.author | Carter, Patrick M. | en_US |
dc.contributor.author | Desmond, Jeffery S. | en_US |
dc.contributor.author | Akanbobnaab, Christopher | en_US |
dc.contributor.author | Oteng, Rockefeller A. | en_US |
dc.contributor.author | Rominski, Sarah D. | en_US |
dc.contributor.author | Barsan, William G. | en_US |
dc.contributor.author | Cunningham, Rebecca M. | en_US |
dc.date.accessioned | 2012-04-04T18:43:39Z | |
dc.date.available | 2013-05-01T17:24:43Z | en_US |
dc.date.issued | 2012-03 | en_US |
dc.identifier.citation | Carter, Patrick M.; Desmond, Jeffery S.; Akanbobnaab, Christopher; Oteng, Rockefeller A.; Rominski, Sarah D.; Barsan, William G.; Cunningham, Rebecca M. (2012). "Optimizing Clinical Operations as Part of a Global Emergency Medicine Initiative in Kumasi, Ghana: Application of Lean Manufacturing Principals to Low‐resource Health Systems." Academic Emergency Medicine 19(3). <http://hdl.handle.net/2027.42/90580> | en_US |
dc.identifier.issn | 1069-6563 | en_US |
dc.identifier.issn | 1553-2712 | en_US |
dc.identifier.uri | https://hdl.handle.net/2027.42/90580 | |
dc.description.abstract | Background: Although many global health programs focus on providing clinical care or medical education, improving clinical operations can have a significant effect on patient care delivery, especially in developing health systems without high‐level operations management. Lean manufacturing techniques have been effective in decreasing emergency department (ED) length of stay, patient waiting times, numbers of patients leaving without being seen, and door‐to‐balloon times for ST‐elevation myocardial infarction in developed health systems, but use of Lean in low to middle income countries with developing emergency medicine (EM) systems has not been well characterized. Objectives: To describe the application of Lean manufacturing techniques to improve clinical operations at Komfo Anokye Teaching Hospital (KATH) in Ghana and to identify key lessons learned to aid future global EM initiatives. Methods: A 3‐week Lean improvement program focused on the hospital admissions process at KATH was completed by a 14‐person team in six stages: problem definition, scope of project planning, value stream mapping, root cause analysis, future state planning, and implementation planning. Results: The authors identified eight lessons learned during our use of Lean to optimize the operations of an ED in a global health setting: 1) the Lean process aided in building a partnership with Ghanaian colleagues; 2) obtaining and maintaining senior institutional support is necessary and challenging; 3) addressing power differences among the team to obtain feedback from all team members is critical to successful Lean analysis; 4) choosing a manageable initial project is critical to influence long‐term Lean use in a new environment; 5) data intensive Lean tools can be adapted and are effective in a less resourced health system; 6) several Lean tools focused on team problem‐solving techniques worked well in a low‐resource system without modification; 7) using Lean highlighted that important changes do not require an influx of resources; and 8) despite different levels of resources, root causes of system inefficiencies are often similar across health care systems, but require unique solutions appropriate to the clinical setting. Conclusions: Lean manufacturing techniques can be successfully adapted for use in developing health systems. Lessons learned from this Lean project will aid future introduction of advanced operations management techniques in low‐ to middle‐income countries. | en_US |
dc.publisher | Wiley Periodicals, Inc. | en_US |
dc.publisher | Blackwell Publishing Ltd | en_US |
dc.title | Optimizing Clinical Operations as Part of a Global Emergency Medicine Initiative in Kumasi, Ghana: Application of Lean Manufacturing Principals to Low‐resource Health Systems | en_US |
dc.type | Article | en_US |
dc.rights.robots | IndexNoFollow | en_US |
dc.subject.hlbsecondlevel | Medicine (General) | en_US |
dc.subject.hlbtoplevel | Health Sciences | en_US |
dc.description.peerreviewed | Peer Reviewed | en_US |
dc.contributor.affiliationum | From the Department of Emergency Medicine, University of Michigan (PMC, JSD, RAO, WGB), Ann Arbor, MI; the Injury Center, Department of Emergency Medicine, University of Michigan, and Health Behavior and Health Education, School of Public Health (RMC), Ann Arbor, MI; Global REACH, University of Michigan Medical School (SR), Ann Arbor, MI; and the Accident and Emergency Department, Komfo Anokye Teaching Hospital (CA), Kumasi, Ghana. | en_US |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/90580/1/j.1553-2712.2012.01311.x.pdf | |
dc.identifier.doi | 10.1111/j.1553-2712.2012.01311.x | en_US |
dc.identifier.source | Academic Emergency Medicine | en_US |
dc.identifier.citedreference | Varkey P, Reller MK, Resar RK. Basics of quality improvement in health care. Mayo Clin Proc. 2007; 82: 735 – 9. | en_US |
dc.identifier.citedreference | Alagappan K, Schafermeyer R, Holliman CJ, et al. International emergency medicine and the role for academic emergency medicine. Acad Emerg Med. 2007; 14: 451 – 6. | en_US |
dc.identifier.citedreference | Kirsch TD, Holliman CJ, Hirshon JM, Doezema D. The development of international emergency medicine: a role for U.S. emergency physicians and organizations. SAEM International Interest Group. Acad Emerg Med. 1997; 4: 996 – 1001. | en_US |
dc.identifier.citedreference | Clarke ME. Emergency medicine in the new South Africa. Ann Emerg Med. 1998; 32: 367 – 72. | en_US |
dc.identifier.citedreference | Espinosa JA, Case R, Kosnik LK. Emergency department structure and operations. Emerg Med Clin North Am. 2004; 22: 73 – 85. | en_US |
dc.identifier.citedreference | Beach C, Haley L, Adams J, Zwemer FL Jr. Clinical operations in academic emergency medicine. Acad Emerg Med. 2003; 10: 806 – 7. | en_US |
dc.identifier.citedreference | Institute of Medicine. Hospital‐based Emergency Care: At the Breaking Point. Washington, DC: National Academies Press, 2007. | en_US |
dc.identifier.citedreference | Green LV, Soares J, Giglio JF, Green RA. Using queueing theory to increase the effectiveness of emergency department provider staffing. Acad Emerg Med. 2006; 13: 61 – 8. | en_US |
dc.identifier.citedreference | Callahan CD, Griffen DL. Advanced statistics: applying statistical process control techniques to emergency medicine: a primer for providers. Acad Emerg Med. 2003; 10: 883 – 90. | en_US |
dc.identifier.citedreference | Connelly LG, Bair AE. Discrete event simulation of emergency department activity: a platform for system‐level operations research. Acad Emerg Med. 2004; 11: 1177 – 85. | en_US |
dc.identifier.citedreference | Dickson EW, Anguelov Z, Vetterick D, Eller A, Singh S. Use of lean in the emergency department: a case series of 4 hospitals. Ann Emerg Med. 2009; 54: 504 – 10. | en_US |
dc.identifier.citedreference | Dickson EW, Singh S, Cheung DS, Wyatt CC, Nugent AS. Application of lean manufacturing techniques in the emergency department. J Emerg Med. 2009; 37: 177 – 82. | en_US |
dc.identifier.citedreference | King DL, Ben‐Tovim DI, Bassham J. Redesigning emergency department patient flows: application of Lean Thinking to health care. Emerg Med Australas. 2006; 18: 391 – 7. | en_US |
dc.identifier.citedreference | Huang RL, Donelli A, Byrd J, et al. Using quality improvement methods to improve door‐to‐balloon time at an academic medical center. J Invasive Cardiol. 2008; 20: 46 – 52. | en_US |
dc.identifier.citedreference | Liker JK. The Toyota Way: 14 Management Principles from the World’s Greatest Car Manufacturer. New York, NY: McGraw‐Hill, 2004. | en_US |
dc.identifier.citedreference | Liker JK. The Toyota Way Fieldbook: A Practical Guide for Implementing Toyota’s 4 Ps. New York, NY: McGraw‐Hill, 2006. | en_US |
dc.identifier.citedreference | Smith J, Haile‐Mariam T. Priorities in global emergency medicine development. Emerg Med Clin North Am. 2005; 23: 11 – 29. | en_US |
dc.identifier.citedreference | Holliman CJ, VanRooyen MJ, Green GB, et al. Planning recommendations for international emergency medicine and out‐of‐hospital care system development. Acad Emerg Med. 2000; 7: 911 – 7. | en_US |
dc.identifier.citedreference | Bayleygne TM, Shahar A, Tsadic AW, et al. An international training program to assist with establishing emergency medicine in Ethiopia. Ann Emerg Med. 2000; 36: 378 – 82. | en_US |
dc.identifier.citedreference | London JA, Mock CN, Quansah RE, et al. Priorities for improving hospital‐based trauma care in an African city. J Trauma. 2001; 51: 747 – 53. | en_US |
dc.identifier.citedreference | Hoeft S. Lean overview introduction, history, simulation prep. In: Lean Healthcare Center for Professional Development. Ann Arbor, MI: University of Michigan, 2009, pp 1 – 47. | en_US |
dc.identifier.citedreference | Wen LS, Geduld HI, Nagurney JT, Wallis LA. Africa’s first emergency medicine training program at the University of Cape Town/Stellenbosch University: history, progress, and lessons learned. Acad Emerg Med. 2011; 18: 868 – 71. | en_US |
dc.owningcollname | Interdisciplinary and Peer-Reviewed |
Files in this item
Remediation of Harmful Language
The University of Michigan Library aims to describe library materials in a way that respects the people and communities who create, use, and are represented in our collections. Report harmful or offensive language in catalog records, finding aids, or elsewhere in our collections anonymously through our metadata feedback form. More information at Remediation of Harmful Language.
Accessibility
If you are unable to use this file in its current format, please select the Contact Us link and we can modify it to make it more accessible to you.