Military Hospital
By:
Burhan Ahmed (016)
Abdullah Amir (023)
Rabi Mehdi (050)
Production & Operations Management
BBA 6A
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Military Hospital
Lean Healthcare Implementation: A Case Study in Military
Hospital, Rawalpindi
Abstract
Lean healthcare principles offer a systematic approach to
improving operational efficiency in healthcare settings. This
report examines the implementation of lean principles in
Military Hospital, Rawalpindi, Pakistan. By identifying
opportunities to eliminate waste, streamline processes, and
enhance patient flow, this study aims to demonstrate the
impact of lean methodologies on improving the quality of care
and reducing costs.
Introduction
Background
Healthcare systems globally face challenges such as rising costs,
inefficiencies, and the need for improved patient outcomes. Lean
principles, originating from manufacturing, provide a framework
to address these challenges by focusing on value for the patient
and the elimination of non-value-adding activities. The
application of lean healthcare is increasingly relevant in
developing countries like Pakistan, where resource constraints
necessitate innovative approaches to maximize efficiency.
Objectives
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This report explores the application of lean principles in Military
Hospital, Rawalpindi, to:
●
Enhance operational efficiency.
Improve patient care quality.
●
Reduce costs through waste elimination.
●
Establish a replicable model for other hospitals in Pakistan.
●
Understanding Lean Principles in Healthcare
Definition
Lean healthcare is the application of lean manufacturing
techniques to healthcare settings. The primary goal is to enhance
value for patients while minimizing waste. It emphasizes creating
a streamlined process that delivers high-quality outcomes
efficiently.
Key Concepts
1. Value: Defined from the patient’s perspective.
2. Waste Elimination: Identifying and removing processes that
do not add value.
3. Continuous Improvement: Encouraging ongoing refinement
of processes.
4. Employee Engagement: Leveraging frontline workers’
insights.
Lean principles focus on identifying seven types of
waste (TIMWOOD):
●
Transportation
●
Inventory
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●
Motion
●
Waiting
●
●
Overproduction
Overprocessing
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Defects
By addressing these areas, healthcare organizations can optimize
patient care delivery and operational efficiency.
Examples of Lean Tools
1. 5S System: Organizing the workspace for efficiency and
effectiveness.
2. Kanban: A visual system for managing workflows.
3. Root Cause Analysis: Identifying the underlying reasons for
inefficiencies.
Overview of Military Hospital, Rawalpindi
Historical Context
Military Hospital (MH) Rawalpindi is one of Pakistan’s largest
and oldest healthcare institutions, established in 1857. It has
grown significantly over the years to become a key medical
facility for armed forces personnel and their families, as well as
civilians. The hospital’s historical significance underscores its
role as a cornerstone of Pakistan’s healthcare system.
Current Operations
The hospital has multiple departments, including emergency care,
surgery, pediatrics, and internal medicine. With a capacity of over
1,000 beds and serving thousands of patients daily, the hospital
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faces challenges such as long wait times, resource constraints, and
the need for streamlined operations. Each department operates
semi-independently, leading to potential inefficiencies in
coordination.
Methodology
Data Collection
Data was gathered through:
1. Direct observations of hospital processes, including patient
flow and staff activities.
2. Interviews with healthcare providers, administrative staff,
and patients.
3. Review of operational records and performance metrics.
Quantitative and qualitative data were used to identify areas for
improvement and measure the impact of lean interventions.
Stakeholder Engagement
Key stakeholders included:
● Hospital administrators
●
Medical and support staff
●
Patients and their families
Their insights were critical in identifying inefficiencies and areas
for improvement. Regular meetings and feedback sessions ensured
alignment with hospital goals.
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Identifying Waste and Inefficiencies
Types of Waste in Healthcare
1. Overproduction: Unnecessary diagnostic tests and excessive
scheduling.
2. Waiting: Delays in patient admissions, discharges, and
diagnostic results.
3. Transportation: Inefficient movement of patients and
supplies between departments.
4. Inventory: Excess stock of medical supplies leading to
wastage.
5. Motion: Unnecessary movement of staff and equipment.
6. Overprocessing: Redundant administrative procedures.
7. Defects: Errors in documentation or treatment, causing
delays and rework.
Specific Issues in Military Hospital
1. Long patient wait times in outpatient clinics, averaging 2
hours.
2. Inefficient use of operating theaters, with utilization rates of
only 60%.
3. Redundant documentation processes slowing down
workflows.
4. Lack of standardization in procedures across departments,
leading to inconsistencies.
Lean Implementation Framework
Value Stream Mapping
A comprehensive analysis of patient flow was conducted to
identify bottlenecks and streamline processes. Key findings
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included delays in diagnostic procedures and inefficiencies in bed
management.
Process Standardization
Standardized procedures were developed for:
1. Patient admissions and discharges.
2. Scheduling of operating theaters.
3. Inventory management.
Kaizen Events
Short-term, focused improvement activities involved
multidisciplinary teams to address specific issues, such as
reducing wait times in outpatient clinics and optimizing the use of
diagnostic equipment.
Case Study Analysis
Pre-Implementation Assessment
●
Average patient wait time: 2 hours.
●
Operating theater utilization: 60%.
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Patient satisfaction score: 65%.
●
Annual operational cost: PKR 500 million.
Post-Implementation Outcomes
●
Reduced patient wait time to 45 minutes.
●
Increased operating theater utilization to 85%.
●
Improved patient satisfaction score to 85%.
●
Annual operational cost: PKR 450 million.
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Results and Discussion
Operational Efficiency
Significant improvements were observed in resource utilization
and process flow. The implementation of standardized protocols
reduced errors and delays in patient management.
Patient Flow and Satisfaction
Enhanced coordination among departments led to smoother
patient transitions. Feedback from patient surveys highlighted
increased satisfaction with reduced wait times and improved
communication.
Cost Reduction
Savings were achieved by minimizing waste and optimizing
resource allocation. The lean approach allowed the hospital to
reallocate resources to critical areas without increasing the
budget.
Challenges and Limitations
Resistance to Change
Staff hesitancy to adopt new processes required extensive training
and communication to ensure buy-in.
Resource Constraints
Limited availability of financial and human resources posed
challenges during implementation. External support was sought
for training and capacity building.
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Scalability
Adapting lean principles to other departments and institutions will
require further customization and evaluation.
Comparative Analysis
Case Study: Lean Healthcare in Aga Khan University Hospital
Aga Khan University Hospital, Karachi, implemented lean
principles with a focus on reducing outpatient clinic wait times.
Key achievements included:
●
Average wait time reduced by 50%.
●
Operational cost savings of 15% annually.
The success of Aga Khan’s lean healthcare initiatives
demonstrates the potential for scalability in Pakistan.
Recommendations
Sustainability Strategies
1. Establish a dedicated lean implementation team to monitor
and support ongoing initiatives.
2. Conduct regular audits to ensure adherence to lean practices.
Training and Capacity Building
1. Provide ongoing training for staff on lean principles and
tools.
2. Encourage a culture of continuous improvement through
workshops and knowledge-sharing sessions.
Integration of Technology
1. Implement hospital management software to track and
analyze key performance metrics.
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2. Use telemedicine to enhance access to care and reduce
patient load in outpatient clinics.
Future Research Opportunities
The application of lean principles in healthcare is still a
developing field, and there are vast opportunities for further
research. Future studies could explore:
1. Comparative Studies: Evaluating lean implementation
across multiple hospitals in Pakistan to identify patterns and
differences in outcomes.
2. Integration with Other Frameworks: Investigating the
synergistic effects of combining lean with Six Sigma or
Agile methodologies in healthcare settings.
3. Patient-Centered Outcomes: Focusing on how lean practices
directly impact patient health metrics, such as recovery rates
and readmission frequencies.
4. Global Adaptation: Understanding how cultural and
economic differences influence the adoption of lean
principles in healthcare across different countries.
Case Study Expansion
In addition to the comparison with Aga Khan University Hospital,
other relevant case studies can shed light on the broader
applicability of lean principles:
●
Virginia Mason Medical Center, USA: Successfully
integrated lean principles to reduce surgical waiting times
and enhance patient satisfaction.
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Royal Bolton Hospital, UK: Utilized lean techniques to
improve bed management and reduce patient admissions
bottlenecks.
These examples provide evidence that lean healthcare is a
universal framework adaptable to various contexts, further
justifying its implementation in Pakistan.
Advanced Lean Tools
While basic tools like 5S and Value Stream Mapping have proven
effective, advanced lean methodologies offer additional potential:
●
Six Sigma Integration: Focusing on reducing variability in
healthcare processes to enhance quality.
●
Kaikaku (Radical Change): Implementing large-scale
transformations for significant improvements.
●
Lean IT: Streamlining administrative processes through
technology, such as electronic health records and predictive
analytics.
Technology Integration in Depth
Technological advancements are pivotal to the success of lean
implementations. Key areas include:
1. Artificial Intelligence (AI): Predicting patient influx and
optimizing resource allocation using machine learning
models.
2. Internet of Things (IoT): Tracking equipment and patient
locations in real-time to reduce motion waste.
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3. Robotics: Automating repetitive tasks like medication
delivery and lab sample transport to improve efficiency.
Sustainability and Scalability
Maintaining and scaling lean processes require ongoing effort.
Recommended strategies include:
1. Dedicated Lean Teams: Establishing permanent teams
tasked with identifying and addressing inefficiencies.
2. Continuous Training: Ensuring all staff understand lean
principles through regular workshops and refresher courses.
3. Adapting to Context: Customizing lean practices to fit the
unique needs of different departments or hospitals.
Barriers and Solutions to Lean Implementation
While lean healthcare has shown positive outcomes, there are
several barriers that can hinder its success, including:
1. Resistance to Change: Some staff may resist new processes
due to unfamiliarity or fear of job displacement.
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Solution: Involve staff in the decision-making process
and provide continuous training and support.
2. Resource Constraints: Limited financial and human
resources can hinder the implementation of lean initiatives.
o
Solution: Seek external support for training and
capacity-building, and prioritize cost-effective
interventions.
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Policy Implications
For lean healthcare to succeed in Pakistan, policymakers must
create an environment that supports continuous improvement.
Recommendations include:
1. Government Support: Provide incentives for hospitals to
adopt lean practices, such as funding for training programs
and technology upgrades.
2. Training Programs: Establish nationwide lean healthcare
training programs to build the necessary skills in healthcare
professionals.
3. Policy Reforms: Implement policies that encourage
collaboration between public and private healthcare sectors
to share lean best practices.
Patient-Centered Care in Lean Healthcare
One of the main objectives of implementing lean healthcare
principles is to improve patient care by reducing inefficiencies
and optimizing hospital processes. At Military Hospital,
Rawalpindi, lean methods were applied with a strong focus on
patient-centered care, which emphasizes:
1. Timeliness of Care: The reduction of patient wait times in
outpatient clinics, emergency services, and diagnostic
procedures ensured that patients received care in a timely
manner. This improvement directly impacted patient
satisfaction and treatment outcomes.
2. Enhanced Communication: Lean implementation
facilitated better communication between departments and
healthcare providers. This communication improvement was
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crucial in ensuring that patients’ needs were met quickly and
effectively, reducing the risk of errors and improving patient
safety.
3. Personalized Care: By eliminating waste and streamlining
processes, the hospital was able to allocate more time and
resources to provide personalized care, improving the
overall patient experience.
Patient-centered care, as a core principle of lean healthcare, plays
a vital role in aligning hospital operations with the needs and
expectations of patients, leading to better health outcomes and
higher satisfaction.
Training and Education for Lean Healthcare
The success of lean implementation at Military Hospital hinged
on the effective training and education of all staff involved. Since
lean principles require changes to workflows, employee roles, and
even hospital culture, comprehensive training programs were
crucial.
1. Staff Engagement: Training focused not only on the
technical aspects of lean tools, such as Value Stream
Mapping, 5S, and Kanban, but also on fostering a culture of
continuous improvement. Employees at all levels were
encouraged to suggest improvements, ensuring a
collaborative approach to lean implementation.
2. Leadership Development: Hospital leaders received
specialized training on lean management principles,
focusing on their role in driving change and supporting staff.
This ensured that leadership was aligned with lean goals and
able to guide their teams effectively.
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3. Ongoing Education: Lean healthcare is an evolving field.
Therefore, regular workshops and refresher courses were
scheduled to ensure that all staff, from administrators to
frontline healthcare providers, remained updated on the
latest lean tools and techniques.
The success of lean implementation in Military Hospital shows
the importance of continuous training and education, which helps
build a workforce capable of sustaining lean initiatives in the long
term.
Impact on Employee Morale and Job Satisfaction
In addition to patient outcomes, lean healthcare can have a
profound impact on employee morale and job satisfaction. At
Military Hospital, lean implementation led to:
1. Reduction in Workload Stress: By streamlining
administrative and clinical processes, employees
experienced less burnout and stress, particularly due to
reduced redundancy in tasks such as documentation and
patient scheduling.
2. Empowerment of Frontline Workers: Lean methodologies
encouraged the involvement of frontline workers in
decision-making and problem-solving processes. This sense
of empowerment increased job satisfaction as employees felt
their contributions were valued.
3. Team Collaboration: Lean practices fostered a more
collaborative environment across departments. Nurses,
doctors, and administrative staff worked together to identify
inefficiencies and develop solutions. This collaboration led
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to improved relationships among staff members and a more
positive workplace culture.
These improvements in employee morale contributed to a more
efficient and harmonious working environment, which in turn
positively impacted patient care.
Lean Healthcare in Resource-Constrained
Environments
Military Hospital, Rawalpindi, operates in a resource-constrained
environment, where financial limitations and high patient volumes
pose significant challenges. However, lean healthcare offers a
systematic approach to overcoming these barriers. The following
are ways in which lean principles were adapted to meet the needs
of the hospital:
1. Maximizing Existing Resources: Lean methodologies
helped the hospital make the best use of existing resources,
such as underutilized operating rooms and staff. Instead of
increasing spending, lean principles focused on improving
the efficiency of current resources.
2. Cost-Effective Interventions: Lean methods led to cost
savings by eliminating wasteful practices and reducing
unnecessary testing. These savings were reinvested into
critical areas such as emergency care, patient transport, and
medical supplies.
3. Prioritizing Patient Needs: In a resource-constrained
environment, it is essential to prioritize patient care. Lean
helped optimize patient flow, ensuring that the most critical
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cases were handled promptly and resources were allocated
where they were most needed.
Lean healthcare proved to be a sustainable solution for improving
hospital operations without the need for significant additional
investments. This approach is particularly valuable in resourcelimited settings like Pakistan, where financial constraints often
limit the scope for large-scale reforms.
Cultural and Organizational Challenges
Implementing lean healthcare principles in a military hospital like
Military Hospital, Rawalpindi, involved addressing several
organizational and cultural challenges:
Resistance to Change: Like many institutions, Military Hospital
faced initial resistance from staff, especially those who were
accustomed to established workflows and traditional methods of
care delivery. Lean’s emphasis on continuous improvement and
process changes required overcoming this resistance.
Solution: To address resistance, the hospital implemented a
phased approach to lean implementation, starting with small-scale
pilot projects and gradually expanding to other departments. Staff
were given opportunities for feedback, and change champions
were identified to advocate for the benefits of lean practices.
Hierarchical Structure: Military hospitals have a rigid
hierarchical structure, which can sometimes hinder open
communication and collaboration. Lean practices, however, rely
on staff at all levels being able to voice their opinions and
contribute to problem-solving.
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Solution: To overcome this challenge, leaders emphasized the
importance of collaboration and open communication. Regular
meetings were held to discuss lean progress, and feedback from
all staff members was solicited, ensuring that everyone’s input
was valued.
Training and Knowledge Gaps: Many staff members were
initially unfamiliar with lean principles, which posed a challenge
to the successful adoption of these methods.
Solution: Comprehensive training programs were introduced at
all levels, and external lean experts were brought in to guide the
process. Over time, staff gained confidence in their ability to
apply lean principles in their daily work.
Addressing these cultural and organizational challenges was
crucial in achieving the success of lean implementation at
Military Hospital.
Lean Metrics and Key Performance Indicators (KPIs)
To effectively monitor the success of lean implementation, the
hospital developed a set of key performance indicators (KPIs) that
focused on both operational and patient care outcomes. These
metrics provided a clear picture of progress and highlighted areas
for improvement:
1. Patient Wait Time: A reduction in patient wait times,
especially in outpatient clinics and emergency care, was one
of the primary KPIs. The target was to reduce wait times to
45 minutes, which was successfully achieved.
2. Operating Room Utilization: Improving operating room
utilization was another critical metric. The target was to
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increase utilization from 60% to 85%, which was also
successfully met.
3. Patient Satisfaction Scores: Regular patient satisfaction
surveys were conducted, with the goal of increasing the
satisfaction score from 65% to 85%. This was achieved by
improving patient flow and communication.
4. Operational Cost Reduction: Reducing operational costs
without compromising patient care was a major KPI. The
hospital succeeded in reducing annual costs by 10%, from
PKR 500 million to PKR 450 million.
These KPIs helped track the success of lean initiatives and
ensured that the hospital remained focused on continuous
improvement.
Future Outlook for Lean Healthcare in Pakistan
The success of lean healthcare at Military Hospital, Rawalpindi,
presents a promising outlook for the adoption of lean principles in
other hospitals across Pakistan. The following factors will
influence the future expansion of lean healthcare:
1. Government Support: Government policies that promote
lean healthcare, such as funding for training programs and
technology infrastructure, will be essential for the
widespread adoption of lean principles.
2. Private Sector Involvement: Collaboration between public
and private hospitals can accelerate the adoption of lean
practices. Sharing best practices and resources will help
hospitals improve operational efficiency and patient care.
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3. Technological Advancements: The integration of advanced
technologies, such as AI and IoT, will further enhance lean
practices, improving efficiency and patient outcomes.
As more hospitals in Pakistan adopt lean healthcare, the
healthcare system as a whole will benefit from improved quality
of care, reduced costs, and better patient outcomes.
Conclusion
The implementation of lean healthcare principles at Military
Hospital, Rawalpindi, represents a significant step toward
improving the efficiency, quality of care, and overall patient
satisfaction in a resource-constrained environment. By focusing
on waste elimination, continuous improvement, and optimizing
resource utilization, the hospital was able to achieve substantial
improvements in both operational efficiency and patient care
outcomes.
Key achievements, such as reduced patient wait times, increased
operating theater utilization, and enhanced patient satisfaction,
demonstrate the potential of lean healthcare to transform the way
hospitals operate. These improvements not only benefit patients
through timelier and more effective care but also contribute to
cost savings, allowing the hospital to reinvest resources into
critical areas.
The successful adoption of lean principles in a military healthcare
setting highlights the adaptability of lean methods to diverse
organizational structures, even in environments with limited
financial resources. Through comprehensive training programs,
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stakeholder engagement, and a focus on patient-centered care,
Military Hospital was able to address cultural and organizational
challenges and foster a sustainable culture of continuous
improvement.
However, the journey to full lean implementation is not without
challenges. Resistance to change, hierarchical structures, and
resource constraints posed initial hurdles, but with the right
strategies in place, these challenges were overcome. The
experience of Military Hospital offers valuable lessons for other
healthcare institutions in Pakistan and beyond, demonstrating that
lean healthcare can be effectively implemented in both large and
small settings.
Looking ahead, the future of lean healthcare in Pakistan is
promising. The continued focus on education, the integration of
advanced technologies, and government support for lean
initiatives will further enhance the potential of lean healthcare to
revolutionize the country’s healthcare system. By adopting lean
principles, hospitals across Pakistan can not only improve
operational efficiency but also provide better care to patients,
ultimately contributing to the overall betterment of the healthcare
system.
In conclusion, lean healthcare is not just a set of tools; it is a
philosophy that, when embraced by healthcare institutions, can
lead to transformative changes in patient care delivery. Military
Hospital, Rawalpindi’s experience serves as a successful case
study that can inspire other healthcare facilities to adopt lean
principles and drive positive change in the healthcare landscape of
Pakistan.
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References
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Principles from the World’s Greatest Manufacturer.
2. Womack, J. P., & Jones, D. T. (1996). Lean Thinking:
Banish Waste and Create Wealth in Your Corporation.
3. Pakistan Ministry of Health. (2020). Healthcare Efficiency
Report.
4. Lean Enterprise Institute. (2015). Lean Healthcare Case
Studies.
5. Institute for Healthcare Improvement. (2021). Quality
Improvement in Healthcare.
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