Like all public hospitals, TTSH has been under pressure to do more with less, a situation exacerbated by the ageing population and the large influx of expatriate workers into Singapore in recent years, putting greater strain on the healthcare system.
In addition, competition from private hospitals offering faster patient services, such as same-day appointments, compelled TTSH to find ways to match such excellence or face losing its share of more lucrative higher-income/employer funded patients.
Having decided to embrace Lean, the management team made onsite visits to observe a number of successful Lean hospitals in the UK and the US. Recognizing the importance of strong clinical support, leadership identified and worked closely with a group of senior doctors and nurses to bring them on board, sending them on training programs in the US in late 2006.
This clinical team was then augmented in 2007 with a permanent Kaizen Office of dedicated Lean facilitators, to support standardization efforts and provide vital training and coaching. To qualify, candidates must be at least deputy director level with five years’ experience within TTSH. To expand the pool of advocates, staff from around the hospital are regularly seconded to this office. Junior staff also receive training, and continuous improvement has become an integral part of all staff appraisals.
Meanwhile, to overcome a general misconception that Lean meant cutting staff levels, the program was re-labeled ‘MyCare,’ with the broad philosophy that everyone can play a part and everyone can be a problem solver. Ongoing road shows help to spread the message, while Lean successes are broadcast, with key participants publicly acknowledged.
“We are very concerned about sustainability,” explains Clarice Woon Lai Lin, Deputy Director for the Lean Kaizen Office: “every Lean program has 30, 60 and 90-day follow-ups for senior managers, who are also encouraged to walk the floors and discuss the impact of Lean with those on the frontline.”
The CEO is a visible Chairman of the Lean task force and sets the direction for the Kaizen Office; he and the other board members also attend most key Lean events, and ensure that funding and resources are available for essential programs.
Tan Tock Seng Hospital has made many impressive improvements, with stays of orthopaedic fracture patients reduced through simple innovations such as moving x-ray facilities closer to the ward, and simplified family consent procedures for operations.
As Chief Executive Officer Professor Philip Choo remarks: “Today we have a high level of clinician involvement in our Lean improvement efforts and several members of our clinician leadership team are active supporters of our Lean efforts. We would never have got this far without their strong support.”
The early achievements of applying Lean principles to healthcare have been useful.