Grove A L, Meredith J O, Macintyre M, Angelis J, Neailey K
WMG, The University of Warwick, Coventry CV4 7AL, UK.
Qual Saf Health Care. 2010 Oct;19(5):e43. doi: 10.1136/qshc.2009.039719. Epub 2010 May 28.
This paper presents the findings of a 13-month lean implementation in National Health Service (NHS) primary care health visiting services from May 2008 to June 2009.
Lean was chosen for this study because of its reported success in other healthcare organisations. Value-stream mapping was utilised to map out essential tasks for the participating health visiting service. Stakeholder mapping was conducted to determine the links between all relevant stakeholders. Waste processes were then identified through discussions with these stakeholders, and a redesigned future state process map was produced. Quantitative data were provided through a 10-day time-and-motion study of a selected number of staff within the service. This was analysed to provide an indication of waste activity that could be removed from the system following planned improvements.
The value-stream map demonstrated that there were 67 processes in the original health visiting service studied. Analysis revealed that 65% of these processes were waste and could be removed in the redesigned process map. The baseline time-and-motion data demonstrate that clinical staff performed on average 15% waste activities, and the administrative support staff performed 46% waste activities.
Opportunities for significant waste reduction have been identified during the study using the lean tools of value-stream mapping and a time-and-motion study. These opportunities include simplification of standard tasks, reduction in paperwork and standardisation of processes. Successful implementation of these improvements will free up resources within the organisation which can be redirected towards providing better direct care to patients.
本文介绍了2008年5月至2009年6月在国民医疗服务体系（NHS）初级保健健康访视服务中为期13个月的精益实施成果。
本研究选择精益方法是因为其在其他医疗组织中取得了成功。利用价值流图绘制参与健康访视服务的基本任务。进行利益相关者映射以确定所有相关利益者之间的联系。然后通过与这些利益相关者的讨论识别浪费流程，并绘制了重新设计的未来状态流程图。通过对该服务中选定数量的工作人员进行为期10天的时间与动作研究提供定量数据。对这些数据进行分析，以表明在计划改进后可从系统中消除的浪费活动。
价值流图显示，在所研究的原始健康访视服务中有67个流程。分析表明，这些流程中有65%是浪费流程，可在重新设计的流程图中去除。基线时间与动作数据表明，临床工作人员平均进行15%的浪费活动，行政支持人员进行46%的浪费活动。
在研究期间，使用价值流图和时间与动作研究等精益工具已确定了大幅减少浪费的机会。这些机会包括简化标准任务、减少文书工作和流程标准化。成功实施这些改进将释放组织内的资源，这些资源可重新用于为患者提供更好的直接护理。
