Ph.D Thesis

Ph.D StudentAttias Judith
SubjectApplication of Engineering Methods in Standardization and
"Group Technology" for Chest-Pain Patients in
Emergency Room
DepartmentDepartment of Quality Assurance and Reliability
Supervisors PROFESSOR EMERITUS Amos Notea
PROF. Avi Caspi
Full Thesis textFull thesis text - English Version


Lean production is a multidimensional approach, using a variety of management practices, like standardization and cellular manufacturing to reduce variation. In the industrial world, these methods were found to increase efficiency. In the health care system, it is unclear whether these methods help improve patient care and cost reduction. The goal of this study was to investigate the possibility of using lean production for heart disease treatment. In this study we applied standardization and cellular manufacturing for chest pain patients-standardization in the Emergency Department (ED) and cellular manufacturing in the general ward. We checked the effect of these principles on the quality of the care provided to the patients and on the hospital expenses.

The study was done in three phases. In the first phase, we looked at the medical files of patients admitted to the ED in two different hospitals to learn what level of standardization existed between them. In the second phase, we introduced the standardization method in a third hospital's ED and studied the effects on the quality of care provided to the patients and on the cost of the treatment for the hospital. Before standardization, 259 patients were released from the ED and 153 more were hospitalized for follow up. After applying the standardization, 85 patients were released home after examination and 115 others were hospitalized. In the third phase, we applied cellular manufacturing principles for unknown heart disease patients hospitalized for chest pain in Internal Medicine Departments. Both the quality of care provided to the patients and the hospital expenses were compared to the results of the standardization phase, for the same population. The results show that hospitals do not have a standard method. Before standardization 13% of the patients returned to the ED within 60 days and the death rate was 0.4%. Standardization reduced revisiting to 8% and death to 0%. Additionally, a significant increase was found in the hospitalization percentage, revisit from hospitalization as well as a 41% increase in the hospital's expenses. The use of cellular manufacturing principles in the general wards, reduced patients revisit from 6% to 2.6%, increased catheterization used from 3% to 19% and the hospital cost by 80%.

In conclusion, the combination of two lean principles, each applied in one of two related departments led to an increase in the quality of care provided to the patients but also to an increase in the hospital expenses.