Transformation in healthcare services at Mataró Hospital

The Mataró University Hospital, part of the Consorci Sanitari del Maresme (CSdM), has been recognized for its commitment to continuous improvement and innovation in healthcare delivery. Thanks to the implementation of projects based on Lean Healthcare methodologies, the hospital has successfully optimized its operational processes, reduced patient wait times, and enhanced patient safety.

Commitment to innovation and excellence in healthcare

With over 25 years of experience, the hospital serves a population of 279,000 people and offers a wide range of primary and specialized healthcare services. However, the hospital faced challenges in optimizing critical processes, notably in the sample collection and laboratory unit and in the management and use of mechanical restraints (CCMM).

To address these challenges, continuous improvement methodologies such as Lean Healthcare have been implemented with the aim of optimizing operational efficiency and improving the experience of both patients and healthcare professionals.

“The structured improvement model with Lean Healthcare is a holistic approach combining culture, continuous improvement, and management tools.” – Carles Sivilla, process improvement unit.

Optimizing the use of mechanical restraints

The use of mechanical restraints at the Hospital de Mataró was identified as a critical area for improving patient safety and well-being. In order to reduce their use and improve the associated procedures, the hospital implemented a project focused on optimizing the use of these measures, ensuring their correct application, minimizing risks to patients, and ensuring compliance with healthcare standards and best practices.

Overcoming barriers in healthcare provision

The use of mechanical restraints was a significant concern, since, although they were intended to ensure patient safety, their effectiveness was not proven by scientific evidence. In addition, their use was associated with negative effects on patients, affecting both their well-being and their fundamental rights. In this context, it was decided to reduce the use of these restraints by adopting a “zero mechanical restraint” model, which sought more effective alternatives.

“We set out to implement an improvement project to resolve all the problems we had identified.” – Coral Marín, Mechanical restraint process leader.

Project objectives

The project, aligned with the 2025 Strategic Plan, focused on improving the patient experience, defined the following objectives:

1. Optimize mechanical restraint application: Establish clear safety indicators to ensure correct application.
2. Improve clinical records: Implement a standardized system for managing informed consent and enhancing clinical follow-up.
3. Establish a logistical standard: Optimize the availability and usage of materials needed for mechanical restraints.

The challenge represented a significant opportunity to improve the quality of healthcare by promoting a more patient-centered model and continuous assessment of the need to apply restraints.

Actions implemented for transformation

Several key actions were implemented to drive improvements:

• Creation of a multidisciplinary team: A team consisting of nursing professionals, assistants, and middle managers coordinated the improvements in mechanical restraint application;

Figure 1 – Multidisciplinary team

• Review and update of the CCMM protocol: The mechanical restraint protocol was updated in line with best practices and disseminated throughout the team.
• Continuous training system: An annual training program was developed to ensure that staff remained up-to-date on mechanical restraint application and clinical records.
• Logistical optimization: A Kanban system was introduced to manage the materials required for mechanical restraints, ensuring their availability.

Figure 2 – Example of the Kanban system

The implementation of these strategies not only reduced the use of mechanical restraint but also substantially improved clinical documentation and overall patient safety, ensuring that the measures adopted were the most appropriate.

Results that drive excellence

The mechanical restraints optimization project achieved tangible results, reflected in key indicators such as:

• Informed consent: The percentage of informed consents performed by the nursing team increased from 0% in 2022 to 98.3%, and 92.6% for family members.
• Correct mechanical restraint placement: Correct placement increased by 28.8%, from 67.9% in 2022 to 96.7%.
• Lead time reduction: The lead time for mechanical restraints was reduced from 3 to 1 day.
• Continuous evaluation of restraint need: Evaluation of the need to continue restraint increased by 12.5%, from 18.9% to 31.4%.
• Improvement in clinical records: The percentage of records completed by nursing staff increased by 10.2%, reaching 54.5%.

“We noticed a big difference.” – Sandra Gallardo, nursing team, mechanical restraints.

The results achieved prove the success of the implementation of improvements in restraint processes, highlighting the positive impact on patient safety and staff satisfaction, while improving the efficiency of the application of restraint procedures.

Optimizing the sample collection process

The sample collection process at Mataró Hospital, although essential for the diagnosis and treatment of patients, faced several operational challenges that compromised both efficiency and the user experience.

Figure 3 – Example of sample collection process

Challenges in optimizing healthcare processes

The sample collection process had notable inefficiencies, such as long wait times, inadequate manual scheduling, and disorganized patient distribution in waiting areas. These issues negatively affected patient satisfaction and healthcare team efficiency.

“We needed to start a project to understand what improvements we could make in the service.” – Cruz Hernández, Leader of the sample collection process.

Objectives for excellence in care

In order to improve efficiency and service quality, the hospital has defined three strategic objectives to optimize the sample collection process. These objectives are:

• Reduce patient wait times: Cut the average wait time by 50%, from 15 to 7 minutes.
• Optimize patient scheduling: Manage 250 to 280 daily requests without increasing the number of healthcare professionals (nurses).
• Improve staff satisfaction: Balance the workload and prevent employee burnout

Actions redefining healthcare delivery

The project included the following actions:

Optimizing workflow

The first unnecessary queue was eliminated, allowing patients to collect tickets and validate requests simultaneously, reducing wait times.

The layout of the spaces was also reorganized to improve patient flow and facilitate patient call-up via digital screens.

Planning and resource management

A dynamic scheduling system was implemented that adjusts sample collections to daily demand, taking into account vacation periods, holidays, and long weekends. An annual nursing staff calendar was also established to optimize task distribution and ensure adequate coverage.

A schedule was defined for additional sample collections (preoperative, urgent), and it was established that, if it were necessary to add extraordinary appointments, these would be scheduled after 10:30 a.m. to avoid overloading the most sought-after times of the shift.

Technology and digitalization

Additional tablets were introduced to facilitate real-time sample validation and eliminate manual processes. The queue manager was also adjusted to reduce ticket issuance time from 90 to 60 minutes before the appointment, which improved patient management efficiency.

Procedure review and communication

A standard schedule was drawn up for sample collection appointments, and instructions for special tests, such as urine or stool samples, were also revised, which improved communication with patients.

The provision of information to patients was also improved through a visual management system that guides patients through the sample collection process (posters, lines on the floor).

Optimizing personnel allocation

Variability in staff assignments was reduced, ensuring that employees were mostly those who were regularly on duty in order to improve familiarity with procedures and reduce waiting times. In the event of unexpected absences, auxiliary staff were brought in to ensure permanent coverage.

Quality management improvement

The 5S methodology was applied to organize spaces and standardize processes, creating a more efficient and sustainable work environment.

Figure 4 – Application of the 5S

Measurements and analyses of incidents and impacts were carried out to monitor the effectiveness of the actions implemented.

These actions, focused on optimizing workflows, dynamic resource scheduling, and technology integration, aim to improve operational efficiency and the experience of both patients and professionals, ensuring more agile, accurate, and higher quality care.

Results that make a difference

Reduced waiting time

Waiting times were reduced by 50%, from 15 to 7 minutes, which significantly improved the patient experience.

“We had perfect patient management with a seven-minute wait time.” – Sandra Cortijo, laboratory administrator, sample collection.

Optimization of human resources

Scheduling made it possible to respond to between 250 and 280 requests per day without the need to increase the number of professionals, which improved operational efficiency.

It is important to note that this increase in team capacity was achieved by eliminating or reducing tasks with no added value. In other words, it was not a question of working harder, but rather of working in a more focused way on activities with greater added value, mainly in patient care, which translates into greater consistency between the activity performed and the achievement of the unit’s goal, thus increasing staff satisfaction.

Staff satisfaction

The workload was distributed evenly, resulting in a significant improvement in staff satisfaction, according to the results of internal surveys.

The application of continuous improvement principles proved to be an effective tool for improving processes without resorting to increasing human resources. These principles can be replicated in other contexts and hospital units, with similar results in terms of efficiency and satisfaction, both for users and professionals.

Transformational and sustainable Impact

The implementation of Lean Healthcare methodologies in both projects resulted in significant improvements in operational efficiency, patient care quality, and healthcare professionals’ experience. These projects not only optimized available resources but also laid the foundation for continuous improvement in the hospital.

These developments show that, with the right approach and the involvement of the entire team, it is possible to significantly transform care delivery processes and achieve high-impact results, both operationally and in terms of patient and professional satisfaction.