Cook David, Thompson Jeffrey E, Habermann Elizabeth B, Visscher Sue L, Dearani Joseph A, Roger Veronique L, Borah Bijan J
Health Aff (Millwood). 2014 May;33(5):746-55. doi: 10.1377/hlthaff.2013.1266.
The full-service US hospital has been described organizationally as a "solution shop," in which medical problems are assumed to be unstructured and to require expert physicians to determine each course of care. If universally applied, this model contributes to unwarranted variation in care, which leads to lower quality and higher costs. We purposely disrupted the adult cardiac surgical practice that we led at Mayo Clinic, in Rochester, Minnesota, by creating a "focused factory" model (characterized by a uniform approach to delivering a limited set of high-quality products) within the practice's solution shop. Key elements of implementing the new model were mapping the care process, segmenting the patient population, using information technology to communicate clearly defined expectations, and empowering nonphysician providers at the bedside. Using a set of criteria, we determined that the focused-factory model was appropriate for 67 percent of cardiac surgical patients. We found that implementation of the model reduced resource use, length-of-stay, and cost. Variation was markedly reduced, and outcomes were improved. Assigning patients to different care models increases care value and the predictability of care process, outcomes, and costs while preserving (in a lesser clinical footprint) the strengths of the solution shop. We conclude that creating a focused-factory model within a solution shop, by applying industrial engineering principles and health information technology tools and changing the model of work, is very effective in both improving quality and reducing costs.
美国的全方位服务医院在组织架构上被描述为一个“问题解决工厂”，即认为医疗问题是无章可循的，需要专家医生来确定每一个治疗方案。如果普遍采用这种模式，会导致不必要的医疗差异，进而降低医疗质量并提高成本。我们特意对在明尼苏达州罗切斯特市梅奥诊所主导的成人心脏外科业务进行了变革，在该业务的“问题解决工厂”内创建了一个“聚焦工厂”模式（其特点是采用统一方法提供有限的一系列高质量产品）。实施新模式的关键要素包括绘制护理流程、对患者群体进行细分、利用信息技术清晰传达明确的期望，以及赋予床边的非医生医疗人员权力。根据一套标准，我们确定聚焦工厂模式适用于67%的心脏外科患者。我们发现该模式的实施减少了资源使用、住院时间和成本。差异显著降低，结果得到改善。将患者分配到不同的护理模式可提高护理价值以及护理过程、结果和成本的可预测性，同时（在较小的临床规模下）保留“问题解决工厂”的优势。我们得出结论，通过应用工业工程原理和健康信息技术工具并改变工作模式，在“问题解决工厂”内创建聚焦工厂模式在提高质量和降低成本方面非常有效。
