A UCT Graduate School of Business (GSB) professor is working with staff
at four of the country’s worst performing hospitals in Gauteng to improve flow,
reduce waste and overall waiting times and ultimately boost service delivery in
Speaking at the GSB on Friday, Emeritus Professor, Norman Faull, founder
of the Lean Institute Africa explained details of the hospital turnaround programme
at Chris Hani Baragwanath, Leratong, Sebokeng and Kopanong hospitals during
2014-15. He said waiting times were reduced by between 19-65%, resulting in
massive improvements for patients.
Despite many bureaucratic and departmental hitches, Faull said the
programme was a big success with many hospital staff requesting more training
and further coaching.
Averaging the results at the four hospitals, waiting times were reduced
by 56% for the amount of time it took to get patient files, 45% in waiting
times and up to 50% faster service was achieved in the pharmacies.
Faull said the patient folder situation at some hospitals were in a
“lamentably disordered state” and often requires significant daily walking by
staff to retrieve and return folders. At one community health centre he
estimated the daily walking back and forth with folders involved a daily
distance of 56km.
“That is a Two Oceans marathon!” he said.
In such a situation an improved layout eased staff’s workload and
speededservice to the patients.
Last year Faull was appointed as an advisor for the Department of
Performance Monitoring and Evaluation (DPME) within the Presidency.
Independently, in 2014 he was asked to implement the principles of lean
management at four of Gauteng’s largest hospitals.
According to Faull, three months after being initiated into the
programme one hospital CEO said: “I am beginning to understand how my hospital
works.” And there was no irony in his statement. The executive had begun to ‘Go
See’ the frontline activities for himself – a key message of the programme.
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“There are parts of the public sector where abnormal has become normal.
Staff don’t expect things to work and broken equipment remains so for months;
people make commitments with little intention of keeping
to them. Time keeping is a particular area of ‘abnormality’ whether it’s doctor
punctuality at clinics or officials attending a workshop. It is an
extraordinary situation,” Faull said.
He added that this did not mean that there weren’t also very
conscientious and competent people in the public sector who themselves are
frustrated and worn down by the state of affairs.
Lean management theory has its roots in the Japanese automotive industry
(The Toyota Way) and focuses on eliminating unnecessary procedures,
time-wasting efforts and ensuring fluent operations. Faull has 30 years of
teaching experience in the field and has worked with a consulting agency
started by some of his former students, which has worked in over 70 countries,
establishing a wealth of research about the benefits of lean management, how it
builds capacity, improves efficiency and improves staff morale.
One of the biggest concerns Faull encountered in his work in the public
sector and with public sector officials was the “disconnection by leadership”.
And said he saw this in the gap between the commitment of MECs and facility
heads; the officials in the gap fail to take ownership of the actual
improvement process, not even attending crucial facility-level meetings or in
one instance, government officials were unable to agree on a date for a training
“Lean management works. There is an overwhelming amount of research that
shows this. But it has to be a rhythm of management practice: daily, weekly,
monthly follow-ups and so on. It is an issue of practice and habit-formation.
If we want to make real progress with problems in the public sector, these
principles have to become part of the daily routine, not something done once or
for a few weeks and never again,” Faull said.
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