Development of Medical Technical Service Systems in Diabetes and Hypertension Clinics through Application of Lean at Chaturaphak Phiman Hospital, Roi Et Province

Abstract

Purposes: To investigate current service delivery challenges in the medical laboratory services for diabetes and hypertension clinic patients, develop an improved patient service system through Lean methodology implementation, and evaluate post-implementation service performance to reduce patient waiting times at Chaturapak Hospital.

Study Design: Research and Development (R&D) methodology.

Materials and Methods: The study included 200 patients receiving clinical services, selected through random sampling calculated using the Taro Yamane formula. The study was conducted in two phases: Phase 1 (pre-Lean implementation) from May 1-31, 2024, and Phase 2 (post-Lean implementation) from July 1-31, 2024. The development process comprised three stages: 1) Preparation phase - data collection on service delivery times and patient satisfaction; 2) Development phase - application of Lean tools to eliminate waste and redesign service systems; and 3) Implementation and evaluation phase - pilot testing and outcome assessment. Data collection utilized time recording forms and patient satisfaction questionnaires. Statistical analysis employed descriptive statistics (frequency, percentage, mean, standard deviation) and paired t-tests with 95% confidence intervals.

Main findings: (1) Current situation analysis revealed a continuous annual increase in diabetes and hypertension patient volumes, resulting in elevated demand for laboratory diagnostic services and increased laboratory workload. This led to service delays, extended patient waiting times beyond established standards, overcrowding in service areas, and decreased patient satisfaction. Additionally, these factors potentially impacted quality of care and continuity of chronic disease management. (2) The developed medical laboratory service system was structured into 5 main processes: registration point, blood collection point, blood centrifugation and urine preparation point, analysis point, and results reporting point, comprising 23 sub-processes according to established standards. Post-implementation results demonstrated: 1) reduction of sub-processes from 23 to 20 steps; 2) significant decrease in mean service time from 126.31 minutes to 76.10 minutes (p-value <0.001); and 3) substantial improvement in patient satisfaction scores, with a 29.15% increase reaching high satisfaction levels.

Conclusions and Recommendations: The analysis demonstrates that Lean system implementation significantly reduced waiting times, resulting in enhanced patient satisfaction. Therefore, this service system should be adopted to address overcrowding and prolonged waiting times across all hospital levels. The findings support the scalability of Lean healthcare methodologies in improving operational efficiency and patient experience in clinical settings.