Radhakrishnan Nila S, Singh Hardeep, Southwick Frederick S
Department of Medicine, University of Florida, Gainesville, FL, USA.
Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA.
Diagnosis (Berl). 2019 Jun 26;6(2):179-185. doi: 10.1515/dx-2018-0081.
Background Diagnostic waste, defined as the ordering of low value tests, increases cost, causes delays, increases complexity, and reduces reliability. The Toyota Production System (TPS) is a powerful approach for process improvement that has not been applied to the diagnostic process. We describe a curriculum based on tools and principles of TPS that provides medical students with an approach for reducing diagnostic waste and improving patient management. Methods A 2-day elective course "Fixing Healthcare Delivery" was offered to medical students at the University of Florida, Gainesville. A section within the course had three learning objectives related to TPS: (1) define value in health care; (2) describe how diagnostic waste leads to time delays and diagnostic errors; and (3) apply sequential and iterative value streams for patient management. Instruction methods included videos, readings, and online quizzes followed by a 2-h seminar with facilitated discussion and active problem solving. Results During the 3 years the course was offered students (n = 25) achieved average scores of 95% on a pre-seminar test of manufacturing principles applied to the diagnostic and management process. Course evaluations averaged 4.94 out of 5 (n = 31). Conclusions Students appreciated the application of the TPS principles to the diagnostic process and expressed the desire to apply these manufacturing principles in their future diagnostic and management decision-making.
背景 诊断性浪费被定义为安排低价值的检查，它会增加成本、导致延误、增加复杂性并降低可靠性。丰田生产系统（TPS）是一种强大的流程改进方法，但尚未应用于诊断流程。我们描述了一门基于TPS工具和原则的课程，该课程为医学生提供了一种减少诊断性浪费和改善患者管理的方法。方法 为位于盖恩斯维尔的佛罗里达大学的医学生提供了一门为期2天的选修课程“改善医疗服务”。该课程中的一个部分有与TPS相关的三个学习目标：（1）定义医疗保健中的价值；（2）描述诊断性浪费如何导致时间延误和诊断错误；（3）将顺序和迭代的价值流应用于患者管理。教学方法包括视频、阅读材料和在线测验，随后是一场为期2小时的研讨会，研讨会有引导式讨论和积极的问题解决环节。结果 在该课程开设的3年期间，学生（n = 25）在应用于诊断和管理流程的制造原则的研讨会前测试中平均得分95%。课程评估平均得分为4.94分（满分5分，n = 31）。结论 学生们赞赏将TPS原则应用于诊断流程，并表示希望在未来的诊断和管理决策中应用这些制造原则。
