Exploring the case of adopting Lean to potentially enhance the flow of patients with diabetes in Primary Healthcare Centres in Kuwait. Exploring the case of adopting Lean to potentially enhance the flow of patients with diabetes in Primary Healthcare Centres in Kuwait

Abstract

Similar to other healthcare systems worldwide, Kuwait faces challenges of increased demand and cost while trying to operate with constrained resources. There are some data suggesting that Lean methodology, first used by Japanese car manufacturer Toyota, could improve system efficiency or flow by waste elimination, may be useful in addressing some of the challenges found in healthcare. Lean has so far not been used in Kuwaiti primary healthcare centres. This thesis explores the case for using Lean in Kuwait by examines issues around diabetes, as Kuwait rank the six highest in the world. In Kuwait, patients with diabetes are mainly managed in primary healthcare centres. The case for using Lean was explored across five interrelated studies which are summarised below: Study 1 involved a review of the literature which found that Lean tools have been used mostly in hospital settings without any rigorous evaluation and with little or no attention paid to primary healthcare or in developing countries. Study 2 was a systematic documentary review of the challenges facing the healthcare system of Kuwait. In Kuwait, expenditure on healthcare services is expected to double within five years. Life expectancy is increasing, while the percentage of the elderly population is growing, leading to increasing demand of services to treat non-communicable disease such as diabetes. Kuwait still sends many of its patients overseas for treatment. Currently, 10 mega projects worth approximately 2 billion Kuwaiti Dinar are being constructed in Kuwait that will result in a doubling of the bed capacity. However, the average occupancy rate between 2006 to 2015 was 63.6%, which is considered low compared to the average occupancy rate in European Union countries. Study 3 sought the views of Kuwaiti healthcare leaders about Lean and challenges facing the healthcare system of Kuwait. The key findings were: (1) Most leaders agreed that the current healthcare system in Kuwait faces difficult challenges and needs to change its management approach; (2) Lean as a management approach is considered a new concept among leaders of Kuwaiti healthcare organisations; (3) They did not have adequate knowledge regarding Lean but were willing to support any future Lean improvement initiatives. Study 4 explored the knowledge of Healthcare Workers regarding Lean within Kuwait’s primary healthcare centres through a cross-sectional survey in four primary healthcare centres. Only 11% of participants were familiar with Lean. None of the participants were involved or had an ongoing Lean initiative or project but 80% of participants were willing to be involved in future Lean initiatives. Study 5 mapped the flow of patients with type 2 diabetes in primary healthcare centres to identify potential waste and make recommendations for improvement. Patients with type 2 diabetes typically visit their General Practitioner at least every two months for a review appointment. When a blood test is required to monitor blood sugar levels, three more visits are required, involving the blood test, collection of test results by the patient and a review of the results with the general practitioner. Four potential improvements were identified: using point of care testing, the posting of laboratory results to general practitioner computer systems, the introduction of guidelines that standardise the practice for the patient’s visit and permitting the general practitioner to prescribe medication that will last four months. The process map of patients with type 2 diabetes has highlighted waste and improvement suggestions that may reduce workload, enhance patient satisfaction, avoid unnecessary visits, enhance the timeliness of laboratory testing, improve communication between and across departments and minimise the use of resources without undermining the quality of care. These suggestions, if implemented on the national level, could bring tremendous benefits but still need to be rigorously evaluated. The thesis concludes by noting that there is considerable potential in adopting Lean to improve the healthcare services in Kuwait, but further work is required to implement the changes and rigorously evaluate them.