Santibáñez Pablo, Aristizabal Ruben, Puterman Martin L, Chow Vincent S, Huang Wenhai, Kollmannsberger Christian, Nordin Travis, Runzer Nancy, Tyldesley Scott
British Columbia Cancer Agency, Vancouver, Canada.
Jt Comm J Qual Patient Saf. 2012 Dec;38(12):541-53. doi: 10.1016/s1553-7250(12)38071-9.
Clinical complexity, scheduling restrictions, and outdated manual booking processes resulted in frequent clerical rework, long waitlists for treatment, and late appointment notification for patients at a chemotherapy clinic in a large cancer center in British Columbia, Canada. A 17-month study was conducted to address booking, scheduling and workload issues and to develop, implement, and evaluate solutions.
A review of scheduling practices included process observation and mapping, analysis of historical appointment data, creation of a new performance metric (final appointment notification lead time), and a baseline patient satisfaction survey. Process improvement involved discrete event simulation to evaluate alternative booking practice scenarios, development of an optimization-based scheduling tool to improve scheduling efficiency, and change management for implementation of process changes. Results were evaluated through analysis of appointment data, a follow-up patient survey, and staff surveys.
Process review revealed a two-stage scheduling process. Long waitlists and late notification resulted from an inflexible first-stage process. The second-stage process was time consuming and tedious. After a revised, more flexible first-stage process and an automated second-stage process were implemented, the median percentage of appointments exceeding the final appointment notification lead time target of one week was reduced by 57% and median waitlist size decreased by 83%. Patient surveys confirmed increased satisfaction while staff feedback reported reduced stress levels.
Significant operational improvements can be achieved through process redesign combined with operations research methods.
临床复杂性、日程安排限制以及过时的手动预约流程导致加拿大不列颠哥伦比亚省一家大型癌症中心的化疗诊所频繁出现文书返工、治疗等待名单过长以及患者预约通知延迟的情况。开展了一项为期17个月的研究，以解决预约、日程安排和工作量问题，并开发、实施和评估解决方案。
对日程安排实践进行审查，包括流程观察和映射、历史预约数据分析、创建新的绩效指标（最终预约通知提前期）以及进行基线患者满意度调查。流程改进包括通过离散事件模拟评估替代预约实践方案、开发基于优化的日程安排工具以提高日程安排效率，以及为实施流程变更进行变更管理。通过分析预约数据、后续患者调查和员工调查来评估结果。
流程审查揭示了一个两阶段的日程安排流程。等待名单过长和通知延迟是由于第一阶段流程缺乏灵活性所致。第二阶段流程既耗时又繁琐。在实施了修订后的、更灵活的第一阶段流程和自动化的第二阶段流程后，超过一周最终预约通知提前期目标的预约中位数百分比降低了57%，等待名单中位数规模减少了83%。患者调查证实满意度有所提高，而员工反馈表明压力水平有所降低。
通过流程重新设计结合运筹学方法可实现显著的运营改进。
