108 Military Central Hospital, Hanoi, Vietnam.
Faculty of Business Administration & Management, Dai Nam University, Hanoi, Vietnam.
Int J Health Plann Manage. 2022 Jan;37(1):156-170. doi: 10.1002/hpm.3310. Epub 2021 Sep 6.
Emergency departments (EDs) at public hospitals in Vietnam typically face problems with overcrowding, as well as being populated by a wide variety of illnesses, resulting in increasing dissatisfaction from patients. To alleviate these problems, we used the increasingly popular value-stream mapping (VSM) and lean strategy approaches to (1) evaluate the current patient flow in EDs; (2) identify and eliminate the non-valued-added components; and (3) modify the existing process in order to improve waiting times.
Data from a total of 742 patients who presented at the ED of 108 Military Central Hospital in Hanoi, Vietnam, were collected. A VSM was developed where improvement possibilities were identified and attempts to eliminate non-value-added activities were made. A range of issues that were considered as a resource waste were highlighted, which led to a re-design process focusing on prioritizing blood tests and ultrasound procedures. On the administrative side, various measures were considered, including streamlining communication with medical departments, using QR codes for healthcare insurance payments, and efficient management of X-ray and CT scan online results.
By implementing a lean approach, the following reductions in delay and waiting time were incurred: (1) pre-operative test results (for patients requiring medical procedures/operations) by 33.3% (from 134.4 to 89.4 min); (2) vascular interventions by 10.4% (from 54.6 to 48.9 min); and (3) admission to other hospital departments by 49.5% (from 118.3 to 59.8 min). Additionally, prior to the implementation of the lean strategy approach, only 22.9% of patients or their proxies (family members or friends), who responded to the survey, expressed satisfaction with the ED services. This percentage increased to 76.5% following the curtailment of non-value-added activities. Through statistical inferential test analyses, it can be confidently concluded that applying lean strategy and tools can improve patient flow in public/general hospital EDs and achieve better staff coordination within the various clinical and administrative hospital departments. To the authors' knowledge, such analysis in a Vietnamese hospital's ED context has not been previously undertaken.
越南公立医院的急诊科通常面临着拥挤的问题，同时也有各种各样的疾病，这导致患者的不满情绪不断增加。为了解决这些问题，我们使用越来越流行的价值流图（VSM）和精益策略方法来（1）评估急诊科当前的患者流程；（2）识别和消除非增值部分；（3）修改现有流程，以缩短等待时间。
共收集了 742 名在越南河内 108 军中央医院急诊科就诊的患者的数据。我们开发了一个 VSM，其中确定了改进的可能性，并尝试消除非增值活动。突出了一系列被认为是资源浪费的问题，这导致了一个重新设计的过程，重点是优先进行血液检查和超声检查。在行政方面，考虑了各种措施，包括简化与医疗部门的沟通、使用二维码支付医疗保险、以及在线管理 X 光和 CT 扫描结果的效率。
通过实施精益方法，以下延迟和等待时间得到了减少：（1）术前检查结果（需要手术/操作的患者）减少 33.3%（从 134.4 分钟减少至 89.4 分钟）；（2）血管介入减少 10.4%（从 54.6 分钟减少至 48.9 分钟）；（3）转至其他医院科室减少 49.5%（从 118.3 分钟减少至 59.8 分钟）。此外，在实施精益策略方法之前，只有 22.9%的患者或其代理人（家属或朋友）对急诊科服务表示满意。在消除非增值活动后，这一比例增加到 76.5%。通过统计推断测试分析，可以有信心地得出结论，即应用精益策略和工具可以改善公立医院急诊科的患者流程，并在各临床和行政医院科室中实现更好的员工协调。据作者所知，以前在越南医院的急诊科环境中没有进行过这样的分析。
