“Just-In-Time” Protocols Reduce Patient Wait Times

A new study shows that an inventory management process first popularized by Toyota (Toyota City, Aichi, Japan) can substantially reduce patient wait times and possibly improve the training of interns and residents.

Researchers at Johns Hopkins Hospital (JHH; Baltimore, MD, USA) and the Johns Hopkins Carey Business School (Baltimore, MD, USA) conducted a study to investigate the effect of “Just-In-Time” (JIT) methodology on patient waiting times by having medical trainees and attending physicians review patient cases prior to clinic hours. The hypothesis was that JIT protocols would reduce waiting times, flow times, and use of overtime, without reducing patient/doctor contact time and clinical session completion times.

The study involved two attending physicians who processed 504 patient visits over a total of four months at a specialty pain clinic within the JHH Outpatient Center. Trainees were assigned to cases the day before the patient visit, and reviewed each case with the attending physicians before each clinic session. The results showed that after JIT was implemented, the investment of 25–42 minutes by the attending physician in advance of the clinic hours resulted in a 175-minute reduction in total patient waiting time, and a 28-minute reduction in overtime operations. The study was published early online on September 6, 2014, in Pain Medicine.

“The new process reduces waits and avoids overtime, because residents, attending faculty members and patients spent less time waiting for each other to get up to speed,” said lead author Kayode Williams, MD, MBA, medical director of the Blaustein Pain Treatment Center at JHH. “That kind of transfer and sharing of information gives residents what they need in a timely way.”

“Not only did patients wait for less time, but residents were better prepared to treat patients,” added study coauthor Prof. Maqbool Dada, PhD, of the Carey Business School. “This results in more on-time performance, and the clinic faculty does not feel pressure to shorten patient interactions, since fewer patients are delayed.”

JIT is a production strategy that strives to improve a business' return on investment by reducing in-process inventory and associated carrying costs. The methodology exploits the idea that processes can be streamlined and sped up if important resources are available when they are needed. In the case of car production, for example, long-term storage of inventory and parts wasted time, money and space, and created bottlenecks on the assembly line.

Related Links:
Toyota
Johns Hopkins Hospital
Johns Hopkins Carey Business School