Appropriateness and efficiency: lean thinking implementation of a rural hospital

Background We focused on the main hospital (“Nottola”) of Local Health Authority (LHA)—7 of Siena in which the lean organizational model has been implemented. In addition to the cultural shift, that involved the personnel, some of the most important structural changes were: reduction of beds, increasing the Day Hospital service; realization of a sub-intensive unit and of a “decompression area” for patients not ready for discharge, etc. The aim of this study was to investigate whether these organizational changes have brought improvements of efficiency and effectiveness. Methods We carried out a descriptive analysis of some of the main indicators of process and outcome, comparing hospital activity before (year 2011) and after the hospital reorganization (year 2013), that lasted the whole year 2012. We specifically analyzed: the number of admissions; the percentage of Day Hospital discharges; the average days of hospitalization; occupancy rate, turn over index, rotation index of beds. Results Comparing year 2013 versus 2011, in “Nottola” Hospital: the number of admissions decreased to 5362 (−2335; −31%) while the number of Day Hospital discharges increased to 25,4% (+7,5%); the average days of hospitalization decreased to 6,12 (−0,07; −2,1%). At the same time the occupancy rate of beds increased to 90,53% (+18,4%); the turn over index increased to 0,63 (+0,05; +7,4%); the rotation index increased to 45,23 (+5,13; +11,2%). Conclusions The improvements described (reduction of hospital admissions and of average days of hospitalization, linked to the increase in Day Hopital activity) will free up resources within the organisation which can be redirected towards providing better direct care to patients.