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Citation

Kelendar H, Mohammed M & McIntosh B (2018) Improving Diabetic Patient Flow in Kuwait Primary Healthcare Centres by utilising Lean Philosophy. International Forum on Quality and Safety in Healthcare 2018, 02.05.2018-04.05.2018.

Abstract
Background Kuwait government has been constantly vigilant about their healthcare system. Their healthcare system is facing challenges and has opportunities. Ageing population, chronic diseases, increase demand, new technology and expensive services made organisations under pressure. In this era, providing health services in high quality and achieving patient expectation with minimum resources considers as a challenge. Therefore a new way of providing the healthcare services must be adopted. Lean philosophy could be the solution as it promises to provide more with less. The principal notion behind the lean is to eliminate waste and only provided what the customers value with minimum resources. Despite lean has the potential for providing benefits to developing countries healthcare system, there is a shortage of extensive research in that context. The researcher aims to explore the case of lean in Kuwait healthcare system by applying lean to diabetic patient’s flow in Primary Healthcare Centres. Methods A survey and interviews with healthcare workers in different levels and departments will be conducted to explore the existing state of lean initiative within Kuwait Primary Healthcare Centres. A mixed methodology will be used where sometimes the researcher required to meet different parties or visits different places or sometime to observe certain processes and activates. For both the assessment of existing problems and proposed solutions to improve diabetic patient flow, an application of a mixture of lean techniques and tools across the selected Primary Healthcare Centres to tackle a collection of problems. These related to appointment scheduling, waiting time, unclear processes and roles, lap request processes, miscommunication, outpatient clinic layout, no show, care and activities coordination and others. Starting with drawing the current process map, moving to waste identification and developing the future map, where several ideas and solutions will be proposed and implemented. Outcome The measurement of improvement including waiting time, the length of the patient journey, number of patient visits per year and patient satisfaction. The expected outcome of lean implementation is improving patient flow, safety and experience while also enhance system efficiency and effectiveness with better service quality and staff wellbeing. Bringing patient perspective, involving frontline worker and buy in the leadership support together help understand the reasons of poor patient flow and the sources of waste. The published research within the litterateur concerning lean initiatives within healthcare sector failed to prove their effect on patient satisfaction. Therefore, bringing the patient voice for the future research before, during and after lean improvement project implementation is fundamental. Even that first claimed published study regarding lean implementation in healthcare is 15 years old, the research and knowledge of lean management is just at the infant stage. Conclusion As the healthcare system consists of many departments and specialities, there is an obvious fragmentation in the process where each party is not aware of the impact of their works on the other units or service provider. This leads to the disintegration of the services provided leading to delay, duplications, errors, waiting time, improper procedure, overproduction, unnecessary transportation and as a result low-quality services. Lean has the potential yet inconsistent benefit on process outcomes like Patient Flow (PF). The following are some gapes in the lean application: -Lacks rigorous evaluation. -Missing of a control group. -Superficial input from patients. -Not explored in primary care. -Not explored in developing countries. -Lack of Leadership support. Also, the follow-up of diabetic patient is a long life journey where a medical doctor, along with other healthcare providers will see the patient on a regular basis. Therefore, looking at improving the diabetic PF is worthwhile.