Bidassie Balmatee, Gunnar William, Starr Leigh, Van Buskirk George, Warner Lisa, Anckaitis Clifford, Howard Angela
Clinical Partnerships in Healthcare Transformation (CPHT), VA Center for Applied Systems Engineering (VA-CASE), Veterans Engineering Resource Center (VERC) Richard L. Roudebush, Indianapolis, Indiana, USA.
VHA National Surgery Office (10NC2), US Department of Veterans Affairs, Washington, District of Columbia, USA.
Int J Health Care Qual Assur. 2018 May 14;31(4):283-294. doi: 10.1108/IJHCQA-03-2017-0053.
Purpose During years 2014-2016, Veterans Health Administration National Surgery Office conducted a surgical flow improvement initiative (SFII) to assist low-performing surgery programs to improve their operating room efficiency (ORE). The initiative was co-sponsored by VHA National Surgery Office and VHA Office of Systems Redesign and Improvement. The paper aims to discuss this issue. Design/methodology/approach An SFII algorithm, based on first-time-start (FTS), cancellation rate (CR), lag time (LT) and OR utilization, assigned an ORE performance Level (1-low to 4-high) to each VA Medical Center (VAMC). In total, 15 VAMCs with low-performance surgery programs participated in SFII to assess the current state of their surgical flow processes and used redesign methods to focus on improvement objectives. Findings At the end of the project, 14 VSAs, 40 RPIWs, 45 "90-day projects" and 73 Just-Do-It's were completed with 65 percent (158/243) improvement actions and 86 percent sites improving/sustaining all four ORE metrics. There was a statistically significant difference in improvement across the three stages (baseline, improvement, sustain) for FTS (45.6-68.7 percent; F=44.74; p<0.000); CR (16.1-9.5 percent; F=34.46; p<0.000); LT (63.1-36.3 percent; F=92.00; p<0.000); OR utilization (43.4-57.7 percent; F=6.92; p<0.001) and VAMC level (1.7-3.65; F=80.11; p<0.000). The majority developed "fair to excellent" sustainment (91 percent) and spread (82 percent) plans. The projected annual estimated return-on-investment was $27,949,966. Originality/value The SFII successfully leveraged a small number of faculty, coaches, and industrial engineers to produce significant improvement in ORE across a large national integrated health care network. This strategy can serve healthcare leaders in managing complex healthcare issues in their facilities.
目的 在2014年至2016年期间，退伍军人健康管理局国家外科办公室开展了一项手术流程改进计划（SFII），以协助表现不佳的手术项目提高其手术室效率（ORE）。该计划由退伍军人健康管理局国家外科办公室和退伍军人健康管理局系统重新设计与改进办公室共同发起。本文旨在探讨这一问题。设计/方法/途径 一种基于首次开始时间（FTS）、取消率（CR）、延迟时间（LT）和手术室利用率的SFII算法，为每个退伍军人医疗中心（VAMC）分配了一个ORE绩效水平（1 - 低至4 - 高）。共有15个手术项目表现不佳的VAMC参与了SFII，以评估其手术流程的当前状态，并使用重新设计方法专注于改进目标。发现 在项目结束时，完成了14项VSAs、40项RPIWs、45个“90天项目”和73项“立即执行”任务，65%（158/243）的改进措施得以实施，86%的站点在所有四个ORE指标上得到改善或维持。在FTS（45.6 - 68.7%；F = 44.74；p < 0.000）、CR（从16.1%降至9.5%；F = 34.46；p < 0.000）、LT（63.1 - 36.3%；F = 92.00；p < 0.000）、手术室利用率（43.4 - 57.7%；F = 6.92；p < 0.001）以及VAMC水平（1.7 - 3.65；F = 80.11；p < 0.000）的三个阶段（基线、改进、维持）中，改进存在统计学上的显著差异。大多数机构制定了“良好至优秀”的维持（91%）和推广（82%）计划。预计年度估计投资回报率为27,949,966美元。原创性/价值 SFII成功利用了少数教员、教练和工业工程师，在一个大型全国性综合医疗网络中实现了ORE的显著改进。这种策略可为医疗保健领导者管理其机构中的复杂医疗问题提供帮助。
