Lean production in healthcare: a simulation-based value stream mapping in the physical therapy and rehabilitation department of a public hospital

Assessing the quality and efficiency levels of healthcare organisations is important for effective health service delivery. The purpose of this study is to show how a healthcare organisation evaluates itself by using a pre-lean method, value stream mapping (VSM), and uses lean to become more efficient. The healthcare sector in Turkey was selected due to the very low number of studies available in the sector. A simulation-based VSM method was applied to the physical therapy and rehabilitation department of a public hospital. The current and the future states of the department were mapped using VSM. Simulation was then used to render dynamic the current and the future state maps. The results show that from the patient's point of view, the value added was low and there were many steps that could be seen as a waste of time. Steps which add no value for the patient were eliminated and lean patient flow was shown with a future state map. In order to observe how the proposed improvements affect the system, the current state and two different scenarios of future states were modelled using simulation. Patient length of stay was reduced by the proposed models. A considerable amount of non-value added time is reduced when the first proposed model is applied and it is totally eliminated in the second model. Both proposed models for the future state appear to be more stable than the current state. Finally, the limitations of this study and the potential for future research are considered.