A Simulation Model As A Lean Tool To Improve Patient Flow And Utilization of Resources In Kenya’s Public Hospitals: A Case Study of The Outpatient Department of Nyeri County Referral Hospital

Abstract

Abstract: Simulation model is descriptive in nature, and mimics characteristics of a real system offering a better understanding of the system performance. However, over the years, it has been adopted in hospitals for improving healthcare processes and optimizing resources, but it has not been linked directly to the concept of lean management. Despite public hospitals in Kenya focusing on improving structures, communication technologies and adopting modern medical equipment, they have lagged behind in improving patients’ preferences in relation to the care pathway processes and utilization of the available resources effectively. This paper reviews lean concept in healthcare, and how simulation can be adopted as a lean tool to improve patient flow in Kenya’s public hospitals using the case study of a public hospital. The main waste identified in the care pathway was long patient waiting times, where often, patients at consultation room one waited for 0.94hrs, while for the pediatric room, the patient waiting time was as long as 0.64 hrs before they could consult the clinical officers. In the laboratory, patients tended to wait for a period of 0.66 hrs before being tested. To address these shortcomings, several processes were re-engineered using simulation model with a view of optimizing patient flow processes and utilization of available resource. The re-engineered processes included centralization of cash payment points, adoption of adjustable a capacity system for clinical officers, and addition of more resources at specific cash payment points, which were linked to long waiting times. Moreover, re-engineering was proposed for the filtering rooms and the laboratory to improve the patient flow.