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When studying for a doctoral degree (PhD), candidates submit a thesis that provides a critical review of the current state of knowledge of the thesis subject as well as the student’s own contributions to the subject. The distinguishing criterion of doctoral graduate research is a significant and original contribution to knowledge.
Once accepted, the candidate presents the thesis orally. This oral exam is open to the public.
Critical issues in hospitals include prolonged wait times and soaring healthcare expenditures due to a growing number of patients. While Lean methods appear to be a solution to these issues, Lean implementations are difficult to replicate in different healthcare settings because of a lack of well-established methodologies. Therefore, this thesis applies a unified Lean approach to create transformation frameworks for three major types of hospital departments that are facing different challenges attributed to their underlying characteristics.
The first part of this thesis discusses a framework for schedule-based and treatment-oriented outpatient departments. The framework identifies the best patient mix, schedule, and staffing levels to reduce wait times and improve the utilisation of critical resources. After implementing the framework, an oncology department can run under a one-day regime while reducing patient visit time by 36.3% and increasing the number of daily chemotherapy treatments by 38.6%. The second part of this thesis describes a framework for shared processes in outpatient departments in which scheduled and unscheduled patients coexist. The framework analyses system capability and devises efficient patient and staff schedules to meet demand with supply in a timely fashion. Implementing the framework in a radiology department results in a 21.4% increase in the number of elective patients and 77.1% and 37.2% decreases in the lead times of emergency patients and elective patients, respectively. The final part of this thesis demonstrates a framework for emergency departments receiving unscheduled patient visits. The framework manages the discharge process and plans staffing and materials to alleviate crowding. The estimated results in a case emergency department are a 50.8% reduction in patient length of stay and 41.5% decrease in occupancy rate of stretchers.
The major theoretical contribution of this thesis is its adaptation of several tools, which are organised into a series of structured activities towards Lean systems for different types of hospital departments. In practice, each framework is a comprehensive and step-by-step guideline for hospital managers to follow in their application of Lean to serve more patients, decrease wait time, and use their resources more efficiently. Furthermore, the frameworks are expected to foster a culture of continuous process improvement and facilitate a hospital-wide Lean transformation.