Process Redesign for Health Care Using Lean Thinking: A Guide for Improving Patient Flow and the Quality and Safety of Care

is a response to a simple, but hard to answer, question and is the result of the experiences of a working doctor who was also the chief safety and quality officer of an Australian teaching hospital. At this hospital, he observed that the Emergency Department was staff by talented, well-trained, and respected doctors and nurses. The facilities were modern, and the work load unexceptional, but the department was close to melt down. Bad things were happening to patients, everyone was blaming each other, lots of things had been tried but nothing was getting better and no one could explain why. The problem was not a lack of technical knowledge or expertise, the problem was that no one stood back and said, "what’s the best way to move 200 or 300 patients a day through the complicated and varying, sequence of steps needed to sort out the many different problems that bring patients to our department?"

These challenges are faced by hospitals and health services all over the world. There are difficulties with patient flow, congestion, queues, inefficient utilization of resources, problems engaging clinical staff in improvement programs, adverse incidents, and budget constraints.

Lean thinking and value stream analysis gives hospitals and health services struggling with these issues the insights they need to help themselves. This book provides a method that systematically turns those insights into working programs of service and system redesign.

The book is divided into two sections. The first section gives the background to the approach, and systematically works through the Process Redesign methodology, step-by-step. The second section is a series of case studies that show the methodology in action, what worked and what didn’t work. The goal of any process redesign is simple: the right care, for the right person, at the right time, in the right place, and right the first time. This book helps the people who work in hospitals and health services realize these goals by working together.

Dr. David Ben-Tovim is a psychiatrist and Clinical Epidemiologist by background. He trained in medicine and psychiatry in London, at the Middlesex and St Georges University Hospital, and later in Clinical Epidemiology at the Institute of Psychiatry, also in London. He worked for three years in Botswana before migrating to South Australia where he has lived and worked in 1984. In 1998, whilst continuing part-time practice as a psychiatrist, he became the Director of the Clinical Epidemiology Unit at the Flinders Medical Centre, and in 2000, became Director of Clinical Governance. He initiated the Redesigning Care program at Flinders in 2004, and continued as the Director of the Redesigning Care and Clinical Epidemiology Units until 2014.Whilst Director of the Redesigning Care Unit, Dr. Ben-Tovim became involved in teaching, training, and the development of programs of flow improvement, and process redesign, in all the Australian states and territories, in New Zealand, Singapore, the Middle East (including Dubai, Oman and Saudi Arabia) and South Africa, as well as various parts of Europe and occasionally, the U.S.A.

He is the chairman and co-founder of the Australasian Lean Healthcare Network . Since 2005 the Network has put on annual Redesigning Care Summits in conjunction with Lean Enterprise Australia. The Summits draw participation from across the region.

Dr. Ben-Tovim has a PhD as well as medical qualifications. He has been an active clinical researcher throughout his career. He is currently Professor, Clinical Epidemiology and Process Redesign, Flinders University Centre for Epidemiology and Biostatistics and the Department of Primary Care. Currently, he concentrates on training and research in Redesign and Process Improvement, and on measurement and evaluation of indicators of healthcare safety and quality.

Dr. Ben-Tovim has published on a range of topics in the peer reviewed literature, including a series of frequently quoted articles on Lean Thinking and Redesign in Healthcare. He has also co-authored a textbook of psychiatry for developing countries, and a book about his work in Botswana, published by Tavistock /Routledge.