Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.
Yasmin Infertility Clinic, Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
J Healthc Eng. 2022 Mar 16;2022:6229181. doi: 10.1155/2022/6229181. eCollection 2022.
Evaluation of patients' experiences and satisfaction is vital for assessing the quality of healthcare service, including in fertility clinics. One promising concept that has recently been widely used to increase efficiency and service quality in hospitals is the lean concept. Lean is a form of philosophy that focuses on reducing waste of a process and continuous improvement so that consumers receive greater value. This study aims to identify waste and improve efficiency using lean management methods in the controlled ovarian stimulation (COS) monitoring process during in vitro fertilization (IVF) treatment in a fertility clinic.
This study used an action research approach by observing the total service time of monitoring ovarian stimulation in IVF patients ( = 40). The identified waste and solutions were then compiled for use in a focus group discussion (FGD). From the FGD, a priority plan was obtained for the implementation of lean management. This study uses the PDCA cycle for improvement.
Three priority solutions were chosen, which are as follows: (1) evaluating ovarian stimulation via USG only; (2) allocating more time during doctor's counselling; and (3) increasing counselling time by nurses in the injection room. The total patient wait time was reduced to 6 hours 32 minutes over the three visits, 13 hours 35 minutes decrease from before the intervention. In addition, the value-added ratio (VAR) was increased from 9% to 22% after the intervention.
This research provides theoretical and practical contributions for the lean management principles in IVF treatment. The findings of this study will contribute to the pursuit of knowledge and dissemination of lean principles in the management of healthcare, including IVF clinics.
评估患者体验和满意度对于评估医疗保健服务质量至关重要，包括生育诊所。最近，一种有前途的概念——精益概念已被广泛用于提高医院的效率和服务质量。精益是一种专注于减少过程浪费和持续改进的理念，以使消费者获得更大的价值。本研究旨在通过在生育诊所的体外受精（IVF）治疗中使用精益管理方法来确定卵巢刺激（COS）监测过程中的浪费并提高效率。
本研究采用行动研究方法，观察了 IVF 患者的卵巢刺激监测总服务时间（=40）。然后，将确定的浪费和解决方案汇编用于焦点小组讨论（FGD）。从 FGD 中，获得了实施精益管理的优先计划。本研究使用 PDCA 循环进行改进。
选择了三个优先解决方案，如下所示：（1）仅通过 USG 评估卵巢刺激；（2）在医生咨询期间分配更多时间；（3）增加注射室护士的咨询时间。三次就诊后，患者总等待时间减少到 6 小时 32 分钟，比干预前减少了 13 小时 35 分钟。此外，干预后增值率（VAR）从 9%增加到 22%。
本研究为 IVF 治疗中的精益管理原则提供了理论和实践贡献。本研究的结果将有助于在医疗保健管理中追求知识和传播精益原则，包括 IVF 诊所。
