术前评估精益实施的框架:来自意大利一家高复杂性医院的证据。

IF 1.6 Q3 HEALTH POLICY & SERVICES Health Services Management Research Pub Date : 2023-08-23 DOI:10.1177/09514848231194853
Giulia Goretti, Martina Pisarra, Maria Rosaria Capogreco, Patrizia Meroni
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引用次数: 0

摘要

目的:常规术前评估被认为是无效和低效的。尽管精益思维在医疗保健领域得到广泛应用,但在术前入院方面,为了减少“无增值”活动,几乎没有成功的经验证据。开发了一个报告驱动因素(诊所、工具、创新、组织和治理)和影响(患者、效率、可持续性、时间、学习和成长)的概念框架。方法:借鉴意大利一家高复杂性医院的经验,通过报告证据对如何在术前评估中实施精益以及如何评价所取得的积极结果进行案例分析。结果:应用精益原则,价值识别通过创建40个个性化途径提高了护理的适当性;价值流使“无增值时间”从37%减少到28%,胸部x光从41%减少到14%,心脏检查从49%减少到37%;通过创新追求持续流动有助于增加数字化的使用;新的拉动式组织有助于将每年平均花费的时间减少1.5小时;通过对结果的治理,保证了持续的改进。结论:所提出的框架应通过采用精益驱动因素来成功实施并报告其影响,以提高术前入院的护理质量。
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A framework for lean implementation in preoperative assessment: Evidence from a high complexity hospital in Italy.

Purpose: A routine preoperative assessment is considered both ineffective and inefficient. Despite the widespread application of lean thinking in healthcare, there is little evidence of successful experiences in preoperative admissions in order to reduce "No value added" activities. A conceptual framework reporting the drivers (clinic, tools, innovation, organization, and governance) and impacts (patient, efficiency, sustainability, time, learning and growth) was developed. Methodology: Drawing on the experience of an Italian high complexity hospital, this paper analyzes the case study by reporting evidence on how to implement lean in preoperative assessment and how to evaluate the positive results obtained. Results: Applying lean principles, the identification of value improved the appropriateness of care by creating 40 personalized pathways; the value stream resulted in a reduction of "No Value Added Time" from 37% to 28%, chest X-rays from 41% to 14% and cardiac visits from 49% to 37%; the pursuit of continuous flow through innovation contributed to increase the use of digitalization; the new pull organization helped to reduce the average time spent per year by 1.5 h; the continuous improvement was ensured through the governance of results. Conclusion: The proposed framework should be used to improve the quality of care in preoperative admissions by adopting the lean drivers for successful implementation and reporting the impacts.

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来源期刊
Health Services Management Research
Health Services Management Research HEALTH POLICY & SERVICES-
CiteScore
4.00
自引率
4.80%
发文量
33
期刊介绍: Health Services Management Research (HSMR) is an authoritative international peer-reviewed journal which publishes theoretically and empirically rigorous research on questions of enduring interest to health-care organizations and systems throughout the world. Examining the real issues confronting health services management, it provides an independent view and cutting edge evidence-based research to guide policy-making and management decision-making. HSMR aims to be a forum serving an international community of academics and researchers on the one hand and healthcare managers, executives, policymakers and clinicians and all health professionals on the other. HSMR wants to make a substantial contribution to both research and managerial practice, with particular emphasis placed on publishing studies which offer actionable findings and on promoting knowledge mobilisation toward theoretical advances.
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