From the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital; and the George Washington School of Medicine.
Plast Reconstr Surg. 2021 Mar 1;147(3):772-781. doi: 10.1097/PRS.0000000000007686.
As the cost of health care continues to rise, the role of medical providers has evolved to include the duties of an operations manager. Two theories of operations management can be readily applied to health care-lean management, the process of identifying and eliminating waste; and Little's law, the idea that throughput is maximized by changing the capacity to host patients or the time they spend in the system. Equipped with theories of operations management, providers are better able to identify and address flow limitations in their own practices.
Operations flow data were collected from three areas of care-clinic, surgical booking, and the operating room-for one provider. Variables of interest included visit or procedure characteristics and operations flow characteristics, such as different time points involved in the sector of care.
Clinic data were collected from 48 patients. Variables with a significant relationship to total clinic visit time included afternoon appointments (p = 0.0080) and visit type (p = 0.0114). Surgical booking data were collected for 127 patients. Shorter estimated procedure length (p = 0.0211) decreased time to surgery. Operating room data were collected for 65 cases. Variables with a significant relationship to total operating room time were patient age (p = 0.0325), Charlson Comorbidity Index (p = 0.0039), flap type (p = 0.0153), and number of flaps (p < 0.0001).
This brief single-provider study provides examples of how to apply operations management theories to each point of care within one's own practice. Although longitudinal data following patients through each point of care are the next step in operations flow analysis, this work lays the foundation for evaluation at each time point with the goal of developing practical strategies to improve throughput in one's practice.
随着医疗保健成本的持续上升，医疗服务提供者的角色已经发展为包括运营经理的职责。两种运营管理理论可以很容易地应用于医疗保健领域——精益管理，即识别和消除浪费的过程；以及 Little 法则，即通过改变容纳患者的能力或他们在系统中花费的时间来最大化吞吐量的想法。有了运营管理理论，提供者能够更好地识别和解决自己实践中的流程限制问题。
从三个护理领域——诊所、手术预约和手术室——为一名提供者收集运营流程数据。感兴趣的变量包括就诊或手术特征以及运营流程特征，例如护理领域涉及的不同时间点。
从 48 名患者收集了诊所数据。与总诊所就诊时间有显著关系的变量包括下午预约（p = 0.0080）和就诊类型（p = 0.0114）。为 127 名患者收集了手术预约数据。较短的预计手术时间（p = 0.0211）缩短了手术时间。为 65 例患者收集了手术室数据。与总手术室时间有显著关系的变量包括患者年龄（p = 0.0325）、Charlson 合并症指数（p = 0.0039）、皮瓣类型（p = 0.0153）和皮瓣数量（p < 0.0001）。
这项简短的单一提供者研究提供了如何将运营管理理论应用于自己实践中每个护理点的示例。虽然对每个患者在每个护理点的纵向数据是运营流程分析的下一步，但这项工作为每个时间点的评估奠定了基础，目的是制定改善实践吞吐量的实用策略。
