van Leijen-Zeelenberg Janneke E, Brunings Jan Wouter, Houkes Inge, van Raak Arno J A, Ruwaard Dirk, Vrijhoef Hubertus J M, Kremer Bernd
Department of Health Services Research , School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
Department of Otorhinolaryngology-Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
Laryngoscope. 2016 Apr;126(4):839-46. doi: 10.1002/lary.25741. Epub 2015 Nov 3.
OBJECTIVES/HYPOTHESIS: Although Lean Thinking has led to considerable improvement in a variety of healthcare settings, its effects on otorhinolaryngology remain underexposed. This study reports on how the implementation of Lean Thinking at an otorhinolaryngology outpatient clinic has affected patient and provider satisfaction, waste reduction, and organizational culture.
Prospective before-and-after design.
The 18-month prospective before-and-after design used mixed methods for data collection and analysis. A survey was conducted to measure satisfaction among patients and providers. Semistructured interviews were conducted to evaluate the effect of Lean Thinking on waste and organizational culture.
During the project, 69 issues were posted on the Lean board. Improvements were made on 36 inefficiency issues, not all concerning a specific type of waste. Employees reported considerable improvement in transportation, motion, and waiting. Patient satisfaction was high both at baseline and follow-up and did not change significantly. The effects on provider satisfaction were slight; satisfaction with autonomy and participation decreased significantly, but satisfaction with communication increased significantly.
The implementation of Lean Thinking at an otorhinolaryngology outpatient clinic reduced waste and increased provider satisfaction with communication. Although patient satisfaction did not change significantly, it cannot be concluded that the intervention had no effect on perceived quality of care. Other approaches to measure patients' perceptions should be considered.
NA.
目的/假设：尽管精益思维已在多种医疗环境中带来了显著改善，但其在耳鼻喉科的影响仍未得到充分探讨。本研究报告了在一家耳鼻喉科门诊实施精益思维如何影响患者和医护人员满意度、减少浪费以及组织文化。
前瞻性前后对照设计。
为期18个月的前瞻性前后对照设计采用混合方法进行数据收集和分析。进行了一项调查以衡量患者和医护人员的满意度。开展了半结构化访谈以评估精益思维对浪费和组织文化的影响。
在项目期间，69个问题被张贴在精益看板上。针对36个效率低下问题进行了改进，并非所有问题都涉及特定类型的浪费。员工报告在运输、动作和等待方面有显著改善。患者满意度在基线和随访时都很高，且没有显著变化。对医护人员满意度的影响较小；对自主权和参与度的满意度显著下降，但对沟通的满意度显著提高。
在耳鼻喉科门诊实施精益思维减少了浪费，并提高了医护人员对沟通的满意度。尽管患者满意度没有显著变化，但不能得出该干预对感知护理质量没有影响的结论。应考虑采用其他方法来衡量患者的看法。
无。
