Tibor Laura C, Schultz Stacy R, Menaker Ronald, Weber Bradley D, Ness Jay, Smith Paula, Young Phillip M
Department of Radiology, Mayo Clinic, Rochester, Minnesota.
Department of Radiology, Mayo Clinic, Rochester, Minnesota.
J Am Coll Radiol. 2017 Mar;14(3):353-358. doi: 10.1016/j.jacr.2016.11.014. Epub 2017 Jan 13.
The aim of this study was to increase efficiency in MR enterography using a time-driven activity-based costing methodology.
In February 2015, a multidisciplinary team was formed to identify the personnel, equipment, space, and supply costs of providing outpatient MR enterography. The team mapped the current state, completed observations, performed timings, and calculated costs associated with each element of the process. The team used Pareto charts to understand the highest cost and most time-consuming activities, brainstormed opportunities, and assessed impact. Plan-do-study-act cycles were developed to test the changes, and run charts were used to monitor progress. The process changes consisted of revising the workflow associated with the preparation and administration of glucagon, with completed implementation in November 2015.
The time-driven activity-based costing methodology allowed the radiology department to develop a process to more accurately identify the costs of providing MR enterography. The primary process modification was reassigning responsibility for the administration of glucagon from nurses to technologists. After implementation, the improvements demonstrated success by reducing non-value-added steps and cost by 13%, staff time by 16%, and patient process time by 17%. The saved process time was used to augment existing examination time slots to more accurately accommodate the entire enterographic examination. Anecdotal comments were captured to validate improved staff satisfaction within the multidisciplinary team.
This process provided a successful outcome to address daily workflow frustrations that could not previously be improved. A multidisciplinary team was necessary to achieve success, in addition to the use of a structured problem-solving approach.
本研究的目的是使用基于时间驱动作业成本法提高磁共振肠道造影的效率。
2015年2月，组建了一个多学科团队，以确定提供门诊磁共振肠道造影的人员、设备、空间和供应成本。该团队绘制了当前状态图，完成了观察，进行了计时，并计算了与该过程每个要素相关的成本。该团队使用帕累托图来了解成本最高和最耗时的活动，集思广益寻找机会，并评估影响。制定了计划-执行-研究-行动循环来测试这些变化，并使用运行图来监测进展。流程变更包括修订与胰高血糖素准备和给药相关的工作流程，于2015年11月完成实施。
基于时间驱动作业成本法使放射科能够开发出一个更准确识别提供磁共振肠道造影成本的流程。主要的流程修改是将胰高血糖素给药的责任从护士重新分配给技术人员。实施后，改进措施取得了成功，减少了非增值步骤，成本降低了13%，员工时间减少了16%，患者流程时间减少了17%。节省的流程时间用于增加现有的检查时间段，以更准确地安排整个肠道造影检查。收集了轶事评论以验证多学科团队中员工满意度的提高。
该流程成功解决了以前无法改善的日常工作流程问题。除了使用结构化的解决问题方法外，还需要一个多学科团队才能取得成功。
