A mixed model study evaluating lean in the transformation of an Orthopaedic Radiology service

ObjectiveThe purpose of the study was to explore the proposition that lean is an effective methodology for service improvement within healthcare by using it to evaluate and implement change in a poor service.DesignA mixed model approach was used with data being collected before and after change.SettingThe orthopaedic radiology out-patient pathway in a large district general hospital was receiving increasing numbers of complaints with long waiting times and poor levels of satisfaction amongst patients and staff.ParticipantsData were collected in the form of qualitative and quantitative data taken from questionnaires completed by staff and patients, and quantitative data extracted from the Radiology Information System. A proportionate stratified random sampling method was used to collect data from the patients and a theoretical sample was used for the staff.InterventionThe pre-implementation data was collected during a lean event in which a value stream map of the pathway was created. From this information, changes were planned and implemented, before collecting the post-implementation data using the same methods.Main outcome measuresThe aims of the study were to compare pre-implementation and post-implementation data related to patient journey time, patient experience and staff and patient satisfaction. The quantitative data were analysed using Levene's test for equality of variance and a 2-sample t-test to test for comparison of the means. Descriptive statistics were used to analyse data collected from the polar and the selected response questions from the questionnaires, whilst thematic analysis was used to analyse the qualitative data.ResultsResults demonstrated that the new service offered a better quality of patient experience with higher levels of staff satisfaction whilst enabling an improvement in productivity.ConclusionsThe author proposes that these findings support the proposition that lean is an effective methodology for service improvement within a healthcare setting.