Evaluation Methods

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Thepurpose of evaluation is to determine whether the set ofpre-determined goals have been achieved following the implementationof a given program. In the case of Salem Hospital, the evaluationprocess was conducted to determine whether the implementation of leanand Kaizen philosophies helped the health care facility to enhanceconditions in its emergency department. The evaluation program wasconducted by comparing the goals of implementing the two philosophiesand their actual outcomes.

Theevaluation team identified three measures of success for the twophilosophies, including a reduction in the length of stay,door-to-doc time, and the percentage of patients who leave the EDwithout being seen or served by the health care professionals.Therefore, the aim of the evaluation process was to determine whetherthe Salem Hospital had managed to reduce the average values of thethree indicators of success to at least the national average figures.Some of the key measures of quality improvement that the hospital wasexpected to meet include six dimensions of quality, including safety,patient-centeredness, effectiveness, timeliness, efficiency, andequity (McHugh, Van Dyke, McClelland, &amp Moss, 2012). Theevaluation process was implemented in two phases, including sixmonths and one year after the onset of the implementation process andthe outcome of each evaluation period presented as shown in Table 1.

Table1: Outcome of the evaluation process

Length of Stay

Door to Doc Time

% Left without being seen

National (mean)

185 minutes1

58 minutes2

1 to 2 %3

Salem Health3 (Before the implementation of philosophies)

248 minutes

83 minutes


Salem Hospital (After six months of implementation)

226 minutes

67 minutes

3.66 %

Salem Hospital (After one year of implementation)

207 minutes

50 minutes

2.09 %

Total change

41 minutes

33 minutes

3.19 %

Source:Goodwin (2016)

Theresults of the evaluation process contained in Table 1 show that theimplementation of lean and Kaizen philosophies helped Salem Hospitalachieve tremendous succeed in the three indicators of patientsatisfaction and improvement in the delivery of care in the ED.However, the hospital managed to lower the door-to-doc time (50minutes) to less than the national average, while the length of stay(207 minutes) and the percentage of patients that left the ED withoutbeing seen (2.09 %) remained above the national mean. In overall, theresults of the evaluation process indicate that Salem Hospital saved41 minutes by reducing the patient’s length of stay, 33 minutes indoor-to-doc time, and lower the percentage of patients who left thedepartment of emergency without being seen by 3.19 % following thesuccessful implementation of the lean and Kaizen philosophies.

Theimpact of the improvements achieved following the implementation ofthe new changes was evaluated by measuring changes in the level ofpatient satisfaction. Prior to the implementation of the new changesin the year 2013, the level of patient experiences was 84.0 % (71thpercentile). The two philosophies resulted in a significant increasein the level of client experience to 85.68 % (68thpercentile) in 2014) and 87.1 % (92 th percentile) in 2015 (Goodwin,2016). The increase in the level of satisfaction was mainlyattributed to a significant improvement in the flow of patents in theED compared to initial condition. Moreover, the management of SalemHospital could be able to manage any case of an increase in thenumber of patients visiting the ED on a daily basis. In addition, thelean philosophy allowed the stakeholders in the ED to monitorconditions on a real-time basis, which helped the health careprofessionals make the right and timely decisions. In overall, theoutcome of the evaluation process indicates that the implementationof the lean and Kaizen philosophies at Salem Hospital helped thefacility achieve some of its goals and enhance patient satisfaction.


SalemHospital, similar to other health care facilities that have emergencydepartments, has been struggling with the issues of decline inpatient satisfaction. A low level of patient satisfaction isassociated with poor quality of care and a slow flow of clients inthe ED. Although the health care facilities with ED have beenoperating at or over their recommended capacity, the lack ofphilosophies has been a major challenge that has limited theircapacity to meet the expectations of their patients. Patients expectto be served as soon as they reach the ED, given their criticalhealth condition that requires an immediate attention of the healthcare providers. However, the exponential increase in the number ofclients in need of emergency care reduces the capacity of thehospital to meet patient expectations in the six dimensions ofquality, including safety, patient-centeredness, effectiveness,timeliness, efficiency, and equity. For example, the increase in thelength of stay is directly associated with the crowding at ED sincethe health care professionals are unable to deliver quality care to alarge number of patients in the absence of effective philosophies toguide their operations.

However,the present case study of Salem Hospital revealed that a successfulimplementation of lean management and Kaizen philosophy can help thehealth care facility to address the bottlenecks that limit itscapacity to improve all dimensions of quality. This is confirmed bythe successful implementation of the two philosophies, which helpedSalem Hospital reduce the length of stay by 41 minutes, door-to-doctime by 33 minutes, and the proportion of patients who leave thedepartment without being seen by the health care professionals by3.19 %. Based on these findings, it can be concluded that leanmanagement and Kaizen philosophy are effective strategies that canhelp health care facilities enhance the level of quality in their ED.


Goodwin,D. (2016). &nbspCase Study: Emergency Department (ED) ThroughputImprovement Through Lean. &nbspLeanBlog.Retrieved August, 12, 2016 fromhttp://www.leanblog.org/2016/03/case-study-emergency-department-ed-throughput-improvement/

McHugh,M., Van Dyke, K., McClelland M., &amp Moss D. (2012). &nbspImprovingPatient Flow and Reducing Emergency Department Crowding: A Guide forHospitals. AHRQPublication.Retrieved August, 12, 2016fromhttp://www.ahrq.gov/sites/default/files/publications/files/ptflowguide.pdf

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