Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Cologne, Germany.
Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Cologne, Germany.
Eur J Oncol Nurs. 2021 Oct;54:102037. doi: 10.1016/j.ejon.2021.102037. Epub 2021 Sep 17.
In order to design a patient-centered discharge process, the entire process is visualized in Value Stream Mapping. The duration of the process steps and waiting times are measured and presented. As a team, health professionals discuss problems and agree on suitable solutions.
After applying Value Stream Mapping, we conducted eight interviews in 2018, four with physicians and four with breast care nurses. We used the Consolidated Framework for Implementation Research to develop the interview guide and to identify categories for content analysis. To identify the differences in attitude and experience between the occupational groups, we conducted a framework analysis.
Each team of health professionals developed action steps to optimize the discharge process. Obstacles became apparent in the implementation of these action steps. The lack of adequate staff and complex structures were identified as the main factors. These hierarchical structures also prevented a patient-centered discharge process independent of patient-centered care by health professionals. Self-efficacy varied more among breast care nurses than physicians. The group of physicians perceives standardization in the discharge process critically and therefore assumes limitations in transferring Value Stream Mapping to hospitals. The breast care nurses were open in their attitude. Financial incentives contribute to the acceptance of the method.
Value Stream Mapping is a simple way to uncover waste and develop applicable action steps. Since the implementation of the action steps was hindered by hierarchical problems and a lack of resources, management involvement and a hospital-wide approach could be beneficial.
为了设计以患者为中心的出院流程，我们在价值流图中直观呈现整个流程。我们测量并呈现了流程步骤的持续时间和等待时间。作为一个团队，卫生专业人员共同讨论问题，并就合适的解决方案达成一致。
在应用价值流图之后，我们于 2018 年进行了 8 次访谈，其中 4 次与医生进行，4 次与乳腺护理护士进行。我们使用实施研究综合框架来制定访谈指南，并确定内容分析的类别。为了确定不同职业群体的态度和经验差异，我们进行了框架分析。
每个卫生专业人员团队都制定了优化出院流程的行动步骤。在实施这些行动步骤时，出现了障碍。缺乏足够的员工和复杂的结构被确定为主要因素。这些层级结构也阻碍了卫生专业人员独立于以患者为中心的护理开展以患者为中心的出院流程。自我效能在乳腺护理护士中比医生之间的差异更大。医生群体对出院流程的标准化持批评态度，因此认为将价值流映射应用于医院存在限制。乳腺护理护士的态度比较开放。经济激励有助于该方法的接受。
价值流图是一种揭示浪费并制定可行行动步骤的简单方法。由于行动步骤的实施受到层级问题和资源短缺的阻碍，因此管理层的参与和全院范围的方法可能会有所帮助。
