Blijleven Vincent, Koelemeijer Kitty, Jaspers Monique
Nyenrode Business University, Straatweg 25, 3621 BG Breukelen, The Netherlands; Department of Medical Informatics, Academic Medical Center, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands.
Nyenrode Business University, Straatweg 25, 3621 BG Breukelen, The Netherlands.
Int J Med Inform. 2017 Nov;107:40-47. doi: 10.1016/j.ijmedinf.2017.08.005. Epub 2017 Aug 24.
Mismatches frequently occur between information system (IS) dictated workflows and actual workflows of IS users. The resulting impeded workflows negatively influence the efficiency with which goods or services are produced and delivered to customers. Within a healthcare context, impeded workflows can additionally have a negative impact on the safety and effectiveness of care delivered to patients.
This study evaluates the impact of an electronic health record system of a large university hospital on workflows of healthcare professionals from a lean management waste perspective. Workflow mismatches were identified from direct observations and follow-up semi-structured interviews with physicians and nurses and assessed in terms of waste generated.
In total, 241 manifestations of waste were identified and classified according to 8 types of waste. Furthermore, noteworthy relationships among the identified manifestations of waste were found. These include differences in frequency per type of waste, certain types of waste having a cascading effect, and waste proliferating as a result of mimicked and routinized behavior.
The knowledge obtained from this study can support (re)design of IS to better match workflows which may subsequently lead to more safe, effective and efficient patient care.
信息系统（IS）规定的工作流程与IS用户的实际工作流程之间经常出现不匹配的情况。由此产生的受阻工作流程会对产品或服务的生产及交付给客户的效率产生负面影响。在医疗环境中，受阻的工作流程还会对提供给患者的护理的安全性和有效性产生负面影响。
本研究从精益管理浪费的角度评估了一家大型大学医院的电子健康记录系统对医疗专业人员工作流程的影响。通过对医生和护士的直接观察以及后续的半结构化访谈确定工作流程不匹配情况，并根据产生的浪费进行评估。
总共识别出241种浪费表现形式，并根据8种浪费类型进行了分类。此外，还发现了已识别的浪费表现形式之间的显著关系。这些包括每种浪费类型的频率差异、某些类型的浪费具有级联效应以及由于模仿和常规行为导致浪费增加。
从本研究中获得的知识可以支持信息系统的（重新）设计，以更好地匹配工作流程，这可能随后带来更安全、有效和高效的患者护理。
