Lean management in pre-hospital emergency health services: The case of Ordu province

Aim: The primary aim of this study is to analyze the current state of lean management practices in pre-hospital emergency health services and to develop recommendations to enhance the effectiveness of lean management. In doing so, the study seeks to contribute to the improvement of both service quality and patient satisfaction Material and Method: This study is a retrospective and descriptive research based on secondary data. The study population consists of emergency medical service data related to a total of 519 607 emergency cases that occurred in Ordu Province between 2018 and 2024. Within the scope of the data, processes such as emergency call response time, the intervention time of the command and control center, the departure time of ambulance teams, and their arrival time at the scene were examined and evaluated from a lean management perspective. The research data were transferred into Microsoft Excel, and frequency and percentage distributions of pre-hospital data were calculated. The relationships between variables and the levels of statistical significance were analyzed using the SPSS software. Results: When the periods before and after the transition to the 112 Emergency Call Center (ECC) system were compared; it was found that the time for emergency calls to be transmitted to ambulance teams decreased by an average of 39.48 s after the transition to the ECC system, and was 36.87% faster compared to the previous period. It was found that the case response time of ambulance teams decreased by 23.71% after ECC, and the teams intervened in cases an average of 10.75 s faster. While the number of calls per unit case was 5.03 in the Command Control Center (CCC) period, it was found that it decreased by 53.63% to 2.33 in the Health Command Control Center (HCCC) period. It was found that the response rate to emergency calls, which was 89.10% in 2018, increased to 98.53% in 2024. While the distance covered per case was 27.61 km in the CCC period, it decreased by 4.16 km in the HCCC period, and 15.07% distance efficiency was achieved. It was found that the on-time delivery rate in urban cases increased from 93.94% to 98.43%, and the on-time delivery rate in rural cases increased from 82.15% to 89.21%. While the average patient load coefficient per staff member was 12.03 per month in the CCC period, it was found to increase slightly to 12.14 in the HCCC period. This difference was not found to be statistically significant, and it was found that the workload remained constant despite the increase in the number of cases. Conclusions: In line with the findings, it has been determined that the transition to the 112 ECC system during the HCCC period enabled the effective management of call and case density from a lean management perspective and was statistically significantly efficient in the use of time and resources. When the years 2018-2024 were compared, it was determined that there was no significant increase in human resources despite the increase in the number of cases. Keywords: Emergency, Health, 112, Lean Management, Ambulance, Ordu