Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Brighton, United Kingdom (Mss Rizan and Harden, Dr Low, and Messrs Groves, Das, and Bhutta); Mayfield House, University of Brighton, Falmer, Brighton, United Kingdom (Ms Flaherty); and Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, United Kingdom (Dr Welland).
Qual Manag Health Care. 2020 Oct/Dec;29(4):201-209. doi: 10.1097/QMH.0000000000000267.
Streamlining patient pathways within health care systems is a complex and challenging process. While frontline clinicians often have an abundance of ideas, these rarely translate into real-world change due to nonadoption or early abandonment.
The aim of this article is to provide frontline clinicians with a blueprint for developing a business case for a streamlined pathway while guiding the practical implementation of this blueprint.
The key steps outlined in streamlining a patient pathway are as follows: step 1-identify problems with the patient pathway; step 2-identify the potential to streamline; step 3-forecast the benefits of the streamlined pathway; step 4-gain approvals; step 5-plan the practicalities; step 6-implement and monitor the streamlined pathway; and step 7-monitor the streamlined pathway. Within these steps, Lean management techniques are introduced (including value stream mapping, Pareto charts, Ishikawa diagrams, demand and capacity calculations, role lane mapping) and strengthened by other methods (retrospective audit, systematic review, patient questionnaires, and cost analysis).
This roadmap is contextualized using a case study, demonstrating how streamlining pathways can result in statistically significant reductions in referral to treatment time, the number of steps in the pathway, lead time (pathway duration), and handoff (transfer of patients between health care professionals). This can be achieved while increasing patient contact time, improving patient satisfaction, and reducing costs.
This blueprint demonstrates a comprehensive method for streamlining patient pathways, using Lean management techniques complemented by additional methods. This approach was developed by frontline clinicians and can be replicated by others, translating quality improvement ideas into sustainable change in practice. It enables the design of streamlined pathways that confer significant benefits to patients, health care service providers, and the health economy.
在医疗保健系统中简化患者流程是一个复杂而具有挑战性的过程。尽管一线临床医生通常有很多想法，但由于未被采用或早期放弃，这些想法很少能转化为现实世界的改变。
本文旨在为一线临床医生提供制定简化路径的商业案例的蓝图，同时指导该蓝图的实际实施。
简化患者路径的关键步骤如下：步骤 1-确定患者路径中的问题；步骤 2-确定简化的潜力；步骤 3-预测简化路径的收益；步骤 4-获得批准；步骤 5-规划实际情况；步骤 6-实施和监测简化路径；步骤 7-监测简化路径。在这些步骤中，引入了精益管理技术（包括价值流映射、帕累托图、石川图、需求和产能计算、角色车道映射），并通过其他方法（回顾性审核、系统评价、患者问卷和成本分析）加以强化。
本路线图通过案例研究进行了背景化处理，展示了如何通过简化路径来显著减少转诊治疗时间、路径步骤数、前置时间（路径持续时间）和交接（医疗保健专业人员之间的患者转移）。这可以在增加患者接触时间、提高患者满意度和降低成本的同时实现。
该蓝图展示了一种使用精益管理技术并辅以其他方法的全面简化患者路径的方法。这种方法是由一线临床医生开发的，可以被其他人复制，将质量改进的想法转化为实践中的可持续变革。它能够设计出为患者、医疗保健服务提供者和卫生经济带来重大利益的简化路径。
