Toward Lean Hospital through Value Stream Mapping: A Pilot Study in NICU

Introduction: The purpose of this study is to propose a novel waste-finding framework to facilitate implementing Lean hospitals and examine the capability of the framework in a real situation. Methods: This research utilized a constructive research approach to develop the proposed framework. The data were collected through several sources, including annual hospital performance report, observation and timing using chronometer, and designed forms. The pilot study was conducted in Hazrat Zeinab Hospital in Shiraz city. A total of 15 hospital experts and employees in the NICU of the hospital participated in the study. TOPSIS and value stream mapping (VSM) methods were used to analyze the data. To achieve this purpose, we used MS Excel and eVSM software. Results: The proposed framework consists of three phases, including (I) selecting a ward, (II) mapping the value stream, and (III) identifying the wastes. To select the ward for implementing Lean initiatives, the criteria are comprised of bed admission ratio, bed occupancy ratio, bed turnover, and bed turnover interval. The weights of the criteria are considered 10%, 30%, 10%, and 50%, respectively. The results of the TOPSIS method revealed that NICU was the best ward in the hospital for implementing Lean initiatives. The VSMs of the five main processes of NICU uncovered the wastes, 20 of which were confirmed. They waste approximately 119 man-hours per month. Conclusion: According to the results, the proposed framework is able to select a suitable ward and uncover the wastes. It implies that Lean efforts must be guided through incremental initiatives.