Increasing service performance in the physical therapy and rehabilitation department of a health institution by using lean techniques

Healthcare services both in Turkey and in other countries encounter similar problems. As in other sectors, the presence of non-value added activities in the healthcare service sector leads to delays, difficulties and patient dissatisfaction. The main solution of these problems is to provide diagnosis, treatment and all other services to the patients as soon as possible and in the most appropriate way. Lean practices have been used for the last twenty years to improve healthcare services in this direction throughout the world. The first appplications of lean healthcare services had been implemented in England and in the USA around 2000s, and it has started to become widespread in Turkey recently. Lean philosophy is a discipline that aims to reduce the waste points, and eliminate them wherever possible, by identifying the root problems, and continuously increasing system efficiency. Although this idea was first applied in the automotive manufacturing sector, it has become more comprehensive today and has started to be applied in the service based enterprises. The necessity to use lean philosophy especially in healthcare institutions stems from the importance of increasing the satisfaction of the patients by meeting their expectations and urgent needs. Otherwise, it is obvious that health institutions cannot take part in the health market under increasing competitive conditions. In this thesis, the examination process of the Physical Therapy and Rehabilitation (PTR) department of a health institution in Ankara was monitored using the Value Stream Mapping (VSM) technique, which is the first step of lean philosophy. VSM technique is widely used to analyze and visualize value added activities and non-value added activities in the system. In this context, many undesirable situations such as bottlenecks, insufficiency of the resources, customer delays, obligatory overtime needs, patients who are left at the end of the day, have been identified and 35 alternative scenarios have been proposed to improve the efficiency of the system. The scenarios mentioned were run in the ARENA program and results of performance criteria were obtained for each scenario. Using the performance criteria results of the scenarios; the importance weights of performance criteria were determined with the Criteria Importance Through Intercritera Correlation (CRITIC) Method, which is one of the Multiple Criteria Decision Making (MCDM) techniques. By considering criteria importance weights, "The Combinative Distance-based Assessment" (CODAS) and "Evaluation based on Distance from Average Solution" (EDAS) approaches, the prioritization of the scenarios was obtained in a two different ways. Accordingly, the improvement scenario that should be implemented is determined and presented to the health institution management.