Applying lean production system philosophy to reduce patient waiting time in healthcare services: Simulation-based optimization and validations through experiment

Value stream mapping (VSM) is an initial and critical tool for deploying lean concepts in the manufacturing and service sectors, including hospitals. Therefore, the aim of this research is to analyze the current working environment of a radiology department, identify the wastes in the operations by mapping the current patient flow, and test the best possible improvement plan with the help of discrete event simulation modeling using the Arena platform to develop an optimum future map to mitigate the wastes. Therefore, the current patient flow in the x-ray section of a radiology department was mapped using VSM for two types of patients named routine (RP) and procedure (PP). VSM results highlighted a high waiting time (TWT) of 188 and 3732 min for RP and PP. A total of seven scenarios were developed and analyzed to determine the impact of changes on five key performance indicators. Simulation results of the current scenario showed that there were 567 patients coming out of the system with a lead time of 200 and 926 min for RP and PP. Total waiting time obtained for RP and PP was 177 and 860 min, with a maximum wait time of 31 min/patient and an average of 43 patients in the system (WIP). The simulation results of the seventh scenario provided the best results, with 6% improvement in the number of patients getting out of the system and 75% and 55% decreased lead time for RP and PP. Total waiting time for RP and PP was reduced by 80% and 60%, with WIP falling by 62%. Arena Optimizer showed that by adding a technician and radiologist to the system, the optimum patient waiting time in the queue would be 6 min, and the lead time for RP and PP would be (160) and (884 min), respectively. Based on it, a future VSM was created; it provided a reduction of 72% and 60% in (TWT) for RP and PP, which could improve the number of patients to be entertained by the radiology services without adding any new x-ray machines. The results of the present case provide healthcare planners with a road map to discover the waste in operations since the monetary investment and organizational dedication required drive out non-value activities. Therefore, simulation helps to select the best possible improvement strategy for the system without pausing and making physical changes in busy and complex units of hospitals.