Lean organization: the experience of the Accident and Emergency Department (A&E) of Perugia

Premise: the Accident and Emergency Department of Perugia, together with the Umbria School of Public Administration, recently hosted an innovative workshop on the theory and practice of “rapid improvement” strategy, developed on the new organizational model known as “lean organization” (Toyota method). The underlying aim of this method is to address a department's priority problems in a fast, decisive and time-saving manner. Aims: the aim of this paper is to illustrate the experiences of the “rapid improvement week”: assumptions, operating modalities and results. Materials and methods: during the “rapid improvement week” a team of professionals (nurses and doctors), under the guidance of an expert in organizational engineering, conducted an analysis of the problems, identified the valuable and non-valuable activities, possible solutions, implementation of corrective interventions, and measurement of the outcomes. A follow-up was carried out after one month to evaluate the impact of the intervention. Results: the acceptable value between working time and time frame was fixed at 30%. Neurological problems = 25%, abdominal pain = 42.5%; cardiac problems = 63.3%. For green code abdominal pain and cardiac problems, values were well over the average. Neurological green codes proved to be below average in that the time-dependent neurological illnesses, classified as yellow codes are excluded. Conclusions: the Accident and Emergency Department of Perugia is capable of ensuring a service which is in line with the standards of rapidity of response, efficiency, safety and adequacy of the best national hospitals. This project aims to bring a further reduction of patient Wait Times before treatment and the amount of time spent under treatment in the Accident and Emergency department, with the aid of managerial methods which aim to save time (time span, Wait Times).