摘要
随着我国医药卫生体制改革的逐步深化,国内医疗市场竞争日益激烈。社会经济的不断发展,患者对医疗护理服务期望值不断提高,需求呈现多元化发展趋势。医院面临正在发生变化的内外部环境,只有提升医疗护理服务质量,提高管理效能降低运营成本,才能赢得核心竞争力,实现经济和社会效益双丰收。
手术室是医院的核心部门,是外科系统运转的枢纽,流程的瓶颈。手术室建设成本高,医疗资源密集,如何充分利用和有效运转手术室有限的人力与物力资源,提高手术室医疗护理工作质量,为患者提供增值的医疗护理服务,提高患者满意度；大幅度减少手术室人力、物力和设备的闲置时间,手术周转时间,减少库存和流程中的浪费现象,降低手术室的运营成本,成为手术室乃至医院管理工作的当务之急。
本文的研究目的在于利用精益管理的理论和方法,针对SC医院手术室运营现状进行分析并实施改进；对SC医院实施精益管理提升手术室效率的实践及效果进行分析,从而为SC医院更好的应用精益管理提升手术室效率提供建议,并为其他医院手术室效率提升的管理提供经验借鉴。
本文将综合运用调查研究、文献研究、专家访谈及精益管理的技术和工具,简化SC医院手术室工作中的相关流程,消除一切浪费,节约手术室资源,有效减少手术患者的等待时间,缩短手术患者无效住院时间,降低患者费用,提高医院床位周转率和劳动效率。
通过实施精益管理,识别和消除管理浪费点,优化和完善管理流程,手术医护人员责任更明确、工作更规范；首台手术准点下刀率从68%提高到90%；接送患者平均时间从40分钟减少到20分钟；手术护士为完成手术的平均准备时间较改善前缩短了约15分钟；术后手术患者滞留手术间现象得到了缓解；在未增加手术室人力物力资源的情况下,完成的手术量提高了6.65%；手术室护士、医生与患者的满意度显著提高(P<0.01)；手术室护士在参与精益化管理实践中,逐步树立起了“消灭浪费、精益做事、持续改善”的精益思想和质量意识,提高了他们发现问题、解决问题的能力,激发了他们的管理活力,提升了手术室工作效率。
SC医院手术室通过运用精益管理,很好地优化了手术室接台手术流程,提高了手术室护士工作积极性和协调性,改善了全体员工的满意度。通过本项目的实践,我们认为精益管理应用于手术室效率的改善,既能产生明显的改善效果,又具有较强的操作性。
Along with the gradually deepening the reform of medical health system, the domestic medical market competition is increasingly fierce. Patients with the continuous development of social economy, the expected value of medical care service is improving continuously, the demand for present diversified development trend. Hospitals facing is changing internal and external environment, only improving the quality of medical care services, improve management efficiency to reduce operating costs, to win the core competitiveness, achieve economic and social benefits double harvest.
Operating room is the core of the hospital, is a hub of the surgical system work, the process bottleneck. Operating room construction cost is high, the medical resource, how to make full use of the efficient and effective operation and the operating room limited human and material resources, improve medical care quality of work, provide value-added services, medical care for patients to improve patients' satisfaction; Greatly reduce human, material and equipment idle time, turnaround time, reduce inventory and waste phenomenon in the process, reduce the operating costs of the operating room, operating room and the priority of hospital management.
The purpose of this study lies in the use of lean management theory and method, in view of the SC hospital operating room operation present situation carries on the analysis and implementation of improvement; For SC hospital implementation of lean management, promote efficiency of operating room and effect were analyzed, and the practice of hospital is better for SC provides Suggestions for the application of lean management, promote efficiency of operating room, and for other hospitals to provide experience for the management of operating room efficiency.
This article will combination of survey research, literature research, expert interview and lean management techniques and tools to simplify the SC in the work of the hospital operating room related processes, eliminate all waste, save operating resources, effectively reduce the waiting time for surgery patients, shorten the surgery patients with invalid length of hospital stay, reduce the cost of patients, improve the efficiency of hospital beds turnover and labor.
Through the implementation of lean management to identify and eliminate waste management, optimize and improve the management process and operation staff responsibility more clear and work specifications; The first calibration point cut rate increased from68%to90%; Transport in patients with an average time reduced from40minutes to20minutes; Average surgery nurse to complete the preparation time is shorten by about15minutes before the improvement; Postoperative surgical patients eased stranded phenomenon between surgery; Without any increase in the operating room human resources, complete since increased by6.65%; Operating room nurses, doctors and patients' satisfaction increased significantly (P<0.01); In operating room nurses participate in lean management practice, gradually set up a "elimination of waste, the lean work, continuous improvement" of the lean thinking and quality consciousness, improve their ability to find and solve problems, stimulate their management vitality, improve the working efficiency of the operating room.
SC hospital operating room through the use of lean management, optimize the operating room after surgery process well, improve the operating room nurses working enthusiasm and coordination, improved the satisfaction of all employees. Through the project practice, we think the lean management is applied to the improvement of operating efficiency, can produce obvious improving effect, and has stronger operability.
引文
[1]James E, Stahl, Mark S, et al. Optimizing management and finan-cial performance of the teaching ambulatory care clinic[J]. JGIM,2003,18(4):266-274.
[2]宋萍.张际.李廷玉.充分利用手术室资源提高外科整体效能的研究[J].现代医院管理,2010,4(37)：44-46.
[3]Angela Testi, Elena Tanfani. Tactical and Operational Decisions For Operating Room Planning the improvement of the efficiency and welfare. Health Care Management Science,2009(12):363-373.
[4]Ruth E. Wachtel, Franklin Dexter. Tactical Increases in Operating Room Block Time for Capacity Planning Should Not Be Based on Utilization.2008 International Anesthesia Research Society,2008, Vol.106, No.1, January:215-26.
[5]Blake J T, Dexter F, Donald J. Operating Room Managers'Use of Integer Programming for Assigning Block time to Surgical Groups:A Case study [J]. Anesthesia & Analgesia, 2002,94:143-148.
[6]JebaliA, Alouane, Ladet P. Operating Rooms Scheduling [J]. Production Economics, 2005,99:52-62.
[7]Lebowitz P. Schedule the Short Procedure First to Improve Efficiency [J]. Association of Perioperative Registered Nurses Journal,2003,78(4):651-659.
[8]Cardoen B, Demeulemeester E, Belin J. Operating Room Planning and Scheduling:A Literature Review[J]. European Journal of Operational Research,2010,201:921-932.
[9]Gerchak et al., Reservation planning for elective surgery under uncertain and for emergency surgery, Management Science 1996,(42):321-333.
[10]Mehdi Lamiri, Xiaolan Xie, Alexandre Dolgui. A stochastic model for operating room planning with elective and emergency demand for surgery, European Journal of operational Research 2008, (185):1026-1037.
[11]Angela Testi, Elena Tanfani, Giancarlo Torre. A Three-phase Approach for Erating Theatre Schedules, Health Care Manage Sci,2007(10):163-172.
[12]舒文.罗利.基于目标规划的外科手术排程研究[J].技术与市场,2008(2)：42-43.
[13]严学勇.罗太波.罗利.三层动态手术计划模型的构建[J].《中国医院管理》,32(7)：15-18。
[14]宋烽.手术室人力资源的有效利用[J].中华现代医院管理杂志,2002,18(5)：307.
[15]何丽,绳宇,宋烽.弹性排班与手术室护士资源分配的研究[J].解放军护理杂志,2003,20(2)：37-38.
[16]刘素贞.手术室排班方法改进的体会[J].天津护理,2008,16(2)：98-99.
[17]赵逢玲.吕瑞华.提高手术室护士工作效率的排班方法研究及应用[J].中国实用护理杂志,2005,21(1A)：63-64.
[18]Friedman DM,Sokal SM,Chang Y,et al.Increasing operating room efficiency through parallel processing [J]. Annals of Surgery,2006,243(1):10-14.
[19]Dexter F. Impact on operating room efficiency of reducing turnover times and anesthesia-controlled times [J]. Annals of Surgery,2007,2 (2451):336-337.
[20]张兰梅.张秀平.欧少英等.提高手术室工作效率方法的探讨[J].现代临床护理,2010,9(6)：64-65.
[21]Gordon T, Paul S, Lyles A,et al. Surgical unit time utilization review:resource utilization and management implications. J Med Syst,1988,12(3):169-179.
[22]]李国涛.基于精益思想的医院放射检查流程改善研究[J].南方医科大学2006级硕士学位论文：1-5.
[23](美)涂尚德(John Toussaint).罗杰·杰勒德(Roger A. Gerard)精益医疗[M].机械工业出版社,2012-08.
[24]林聚奎,赵敏杰.医院试行精益服务的探索[J].中华医院管理杂志,1997,6：363-364.
[25]FehrmanEl,ThorJ.An example ofs ueeessful systematie im — provement work. Proeess management 1 improved routines and simplified alysisstarts Lakartidningen 2000,97:5920-5922
[26]nstitute for healtheare Improvement. Going Lean in Health Care White Paper[R].Boston, Paper[R].Boston MA:Institute for Healtheare ImProvement,January and February.2005.
[27]Jinunerson, WeberD, SobekDK. Reduein Waste and Errors:Pilotin Lean Prineiple. Intermountain Healtheare.2nd[J].2005,31 (5):249-257
[28]杨骅,陈剑伟.潘耀良.精益管理在大医院门诊检验流程改造中的应用与实践[J].中国医院管理,2010,30(7)：27-28
[29]胡学华.张冬梅.现代物流精益管理在手术室高价值耗材及器械管理的应用[J].临床误诊误治杂志,2010,23(5)：496-497。
[30]王晓宁.施莺莺.庞源芳.现代物流理念在手术室骨科植入物管理中的应用[J].护理研究,2008,22(10)：2603-2604
[31]周艳霞.蒋俊青.曹美嫦.用精益管理理论提高手术室效率的研究[J].护士进修杂志,2011,26(17)：1567-1569.
[32]王晓兰王群李惠聪.精益管理在优化护理工作流程的尝试[J].中国医院管理,2012,5(3)：54-56
[33]耿仁文.朱宏.廖四照等.运用精益理论研究影响平均住院日因素[J].中国医院,2008,12(10)：55-57.
[34]杨方.董高存.许亮等.精益管理在放射科数字化设备管的应用[J].医疗卫生装备,2008,10(10)：168-172.
[35]曲松涛.封平.张清芝.运用精益管理降低医院运营成本的实践[J].中国医院管理,2009,29(12)：80.
[36]邓国标.在医院门诊打造精益服务[J].中国医院管理,2006,26(7)：35-37.
[36]李枫林.现代服务管理理论与实践[M].武汉大学出版社.2010.2.
[37]刘志英.张素萍.王平.从护理改革谈护士长角色的转换[J].护理管理杂志,2002,2(3)：53-55.
[38]陆春梅.浅析提高手术室优质护理的措施与方法[J].中国卫生产业,2011,8(12)：154-155.
[39]刘晓荣.陈国良.袁长蓉等..护理人力资源利用与配置决策模型化研究[J].解放军护理杂志,2007,24(5)：79.
[40]张洪君.崔丽娟.骆金铠.护士岗位级别分类式排班的护理管理[J].中国护理管理,2009,9(12)：48.
[41]李晓敏.《护士执业资格考试办法》与《手术安全核查制度》贯彻实施及手术室护理技能培训指导[M].北京.人民卫生出版社,2010.
[42]邢春梅.宋效凤.手术患者应用音乐疗法的体会[J].黑龙江医学,2004,28(12)：930.
[43]]刘玮琳.叶文琴.国外护士三班排班与人力利用分析[J]..解放军护理杂志,2002,19(6)：42-43.
[44]李福宣.胡平.郭力克.运用5S理论规范手术间物品管理的效果评价[J].护士进修杂志,2008,23(21)：1948-1949.
[45]赵日磊.目标管理中的七个经典片断[J].新前程,2010,6.
[46]商临萍,徐娟.目标设置理论在护理硕士研究生临床实践中的应用[J].中华护理杂志,2009,44(3).
[47]蔡学联.郑芝芬.唐晓英.孙香爱.裘文娟.贾勤.杜丽萍.裘丹英.运用品管圈质量改进工具降低住院患者跌倒发生率的实践[J].中国护理管理,2011,11(12)：59-61.
[48]来玉民.许乐芬.牟善兰.医院门诊志愿服务组织体系的创建与效果[J].护理管理杂志,2011,12(12)：900---902.
[49]洪素菊.胡伟玲品管圈活动在术中一次性医用耗材管理中的应用[J].护士进修杂志2011,(26)：15601561
[50]刘星.龙德蓉.陈静.品质圈活动在降低输液查询频次中的应用[J].护理学杂志2009,24(14)：74-75.
[51]黄璐.熊永芳.朱立珍等.开展品质圈活动提高NICU护理卡书写质量[J].护理学杂志2011,26(7)：55-56
[52]方桂珍.在护理人员中推行品管圈活动的探讨[J].护理研究,2008,22(4)：1104.
[53]徐建鸣.丁万红.方亭妮等.应用品管圈实施患者跌倒管理的实践[J].中国护理管理杂志2012,12(1)：22-23.
[54]张晓萍.高春燕.羊海琴.整体论在手术室人力资源管理中的应用及效果[J].护理管理杂志,2009,9(8)：53-54.
[55]黄晓华.手术室人力资源管理探析[J].解放军护理杂志,2007,24(7B)：55-56.
[56]刘玉来.田继红.实行预约门诊服务的实践与思考[J].中国医院管理,2006,26(12)：45-47.
[57]王景明.依托信息化实现医院跨越式发展[J].中国医院管理,2008,28(1)：54-55.
[58]张晓.罗德林.刘新.电子商务与医疗卫生服务[J].中国医院管理,2008,28(4)：59-60.