Improving Efficiency and Patient Satisfaction in a Peripherally Inserted Central Catheter Center Using Lean-Based Methodology

Background: The peripherally inserted central catheter implantation and maintenance process was optimized at Shanghai Fu Dan University Cancer Center using lean-based methodology. Problems addressed were coping with capacity limitations and streamlining the process of patient care to reduce potential complications associated with delays in catheter administration. These clinical processes were evaluated with regard to pretreatment areas—such as booking, waiting, and patient education—and solutions were recommended to the problems that were identified. Methods: Lean methodology was used under actual clinical settings to improve the clinical process, using observations, patient surveys, interviews, data analysis, and a kaizen workshop. Three tools were applied from lean methodology: value stream mapping, bottleneck calculation, and fishbone root cause analysis. The philosophy of kaizen was used to enhance teamwork, boost morale, and encourage all members of the frontline nursing team and administration leaders to contribute ideas and suggestions for improvement. Results: A value stream map and a redesigned future value stream map were plotted at the workshop to identify problems related to inefficiency and waste and to aid in proposing solutions. Implementation of these solutions resulted in smooth and steady patient distributions on days with the largest patient volume during a typical week and an increase of 30% in the number of patients that could be seen in a week. Conclusions: The economic methodology of lean manufacturing, especially value stream mapping, can be a powerful tool for visualizing and better understanding processes to reduce waste and reengineer a standardized workstream in settings where peripheral intravenous central catheters are placed.