Simons Pascale, Backes Huub, Bergs Jochen, Emans Davy, Johannesma Madelon, Jacobs Maria, Marneffe Wim, Vandijck Dominique
Department of Radiation Oncology (MAASTRO), Faculty of Health, Medicine and Life Sciences, Maastricht University , Maastricht, The Netherlands.
Department of Radiation Oncology (MAASTRO), Maastricht, The Netherlands.
Int J Health Care Qual Assur. 2017 Mar 13;30(2):103-118. doi: 10.1108/IJHCQA-08-2015-0106.
Purpose Treatment delays must be avoided, especially in oncology, to assure sustainable high-quality health care and increase the odds of survival. The purpose of this paper is to hypothesize that waiting times would decrease and patients and employees would benefit, when specific lean interventions are incorporated in an organizational improvement approach. Design/methodology/approach In 2013, 15 lean interventions were initiated to improve flow in a single radiotherapy institute. Process/waiting times, patient satisfaction, safety, employee satisfaction, and absenteeism were evaluated using a mixed methods methodology (2010-2014). Data from databases, surveys, and interviews were analyzed by time series analysis, χ, multi-level regression, and t-tests. Findings Median waiting/process times improved from 20.2 days in 2012 to 16.3 days in 2014 ( p<0.001). The percentage of palliative patients for which waiting times had exceeded Dutch national norms (ten days) improved from 35 (six months in 2012: pre-intervention) to 16 percent (six months in 2013-2014: post-intervention; p<0.01), and the percentage exceeding national objectives (seven days) from 22 to 17 percent ( p=0.44). For curative patients, exceeding of norms (28 days) improved from 17 (2012) to 8 percent (2013-2014: p=0.05), and for the objectives (21 days) from 18 to 10 percent ( p<0.01). Reported safety incidents decreased 47 percent from 2009 to 2014, whereas safety culture, awareness, and intention to solve problems improved. Employee satisfaction improved slightly, and absenteeism decreased from 4.6 (2010) to 2.7 percent (2014; p<0.001). Originality/value Combining specific lean interventions with an organizational improvement approach improved waiting times, patient safety, employee satisfaction, and absenteeism on the short term. Continuing evaluation of effects should study the improvements sustainability.
目的 必须避免治疗延误，尤其是在肿瘤学领域，以确保可持续的高质量医疗保健并提高生存几率。本文的目的是假设，当将特定的精益干预措施纳入组织改进方法时，等待时间将会减少，患者和员工都将受益。 设计/方法/途径 2013年，一家放疗机构启动了15项精益干预措施以改善流程。使用混合方法（2010 - 2014年）对流程/等待时间、患者满意度、安全性、员工满意度和旷工率进行了评估。通过时间序列分析、χ检验、多层次回归和t检验对来自数据库、调查和访谈的数据进行了分析。 结果 中位等待/流程时间从2012年的20.2天改善至2014年的16.3天（p<0.001）。等待时间超过荷兰国家规范（十天）的姑息治疗患者比例从35%（2012年六个月：干预前）降至16%（2013 - 2014年六个月：干预后；p<0.01），超过国家目标（七天） 的比例从22%降至17%（p = 0.44）。对于根治性治疗患者，超过规范（28天）的比例从17%（2012年）降至8%（2013 - 2014年：p = 0.05），超过目标（21天）的比例从18%降至10%（p<0.01）。报告的安全事件从2009年到2014年减少了47%，而安全文化、意识以及解决问题的意愿有所改善。员工满意度略有提高，旷工率从4.6%（2010年）降至2.7%（2014年；p<0.001）。 原创性/价值 将特定精益干预措施与组织改进方法相结合，在短期内改善了等待时间、患者安全、员工满意度和旷工率。对效果的持续评估应研究这些改进的可持续性。
