A Value Stream Mapping Analysis to improve patient flow in a Tunisian outpatient department.

INTRODUCTION: Waiting time is often viewed as the main source of dissatisfaction in public healthcare organizations in general and outpatient departments in particular. To address this issue, one alternative is to accelerate the patient flow by identifying and reducing bottlenecks. METHODS: The Value Stream Mapping (VSM) of the patient care process in a pneumology outpatient department in Tunisia allows to (i) model the process by representing its activities and the corresponding flows, (ii) identify and quantify non-value-added activities and (iii) measure the global performance by calculating the patients length of stay as well as the total percentage of added value of the process. RESULTS: The current Value Stream Mapping (VSM) identified and quantified waiting times and patient movements leading to a total added value rate below 11%. The analysis revealed three root causes: an ineffective directional signage, an inappropriate appointment scheduling and an inefficient management of medical records. CONCLUSIONS: The results of this study help managers to identify improvement opportunities that can accelerate patient flow. By including this study as part of a continuous improvement approach, it would be possible to periodically evaluate the performance of the process in order to monitor the outpatient pneumology department in a more efficient manner.

Performance Indicators and Dashboard for an Emergency Department of a Teaching Hospital.

INTRODUCTION: The quality assessment of the provided cares is an ongoing challenge for public healthcare organizations. According to a systemic overview, the performance evaluation of any system requires the identification as well as the evaluation of each of its main processes. However, addressing the performance of an emergency department is often limited to its mission of patient care. AIM: The objective of this work is to propose a tool that continually evaluates the performance of an emergency department within a teaching hospital by simultaneously considering its both vocations: (i) health care delivery to patients and (ii) skill training for learners. RESULTS: In line with the principles of continuous improvement drive andmanagement by objectives, appropriate performance indicators have been proposed for each of the two processes. In addition, a dashboard has been implemented to provide decision makers with a synthetic overview of the department performance measures. CONCLUSION: One of the major shortcomings of dashboards is the issue of data collection, input and updating. To overcome this shortcoming, it is recommended to integrate it into an information and decision-making support system that manages the entire emergency department.