Amati Mirjam, Valnegri Alan, Bressan Alessandro, La Regina Davide, Tassone Claudio, Lo Piccolo Antonio, Mongelli Francesco, Saporito Andrea
Information and Process Management/Supportive Area, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
Hospital Direction, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland.
Front Med (Lausanne). 2022 Apr 27;9:822964. doi: 10.3389/fmed.2022.822964. eCollection 2022.
Maximizing the utilization of the operating room suite by safely and efficiently changing over patients is an opportunity to deliver more value to patients and be more efficient in the operating suite. Lean Thinking is a concept that focuses on the waste inadvertently generated during organization and development of an activity, which should maximize customer value while minimizing waste. It has been widely applied to increase process efficiency and foster continuous improvement in healthcare and in the operating room environment. The objective of this paper is to provide insight on how healthcare professionals can be engaged in continuous improvement by embracing Lean Thinking and ultimately reducing changeover time between surgeries.
Using an action research approach, Lean methodology such as Gemba walks, Process Mapping, Root-Cause-Analysis, and the Single Minute Exchange of Dies (SMED) system was applied to understand the causes of variability and wastes concerning changeovers and improve processes in the context of gynecological- and general surgery. Data were collected and analyzed through observations and video recordings. Problem and issue have been raised to management team attention and included in the annual balanced scorecard of the hospital. This initiative has been also made relevant to the team working in the operating suite and related processes before and after the entry of the patient in the operating suite.
Improved patient flow and inter-professional collaboration through standardized and safer work enabled effective parallel processing and allowed the hospital to reduce changeover time between operations by 25% on average, without changes in terms of infrastructure, technology or resources.
Lean thinking allowed the team to re-evaluate how the whole operating suite performs as a system, by starting from a sub-process as changeover. It is fundamental in order to improve further and obtain sustainable results over time, to act on a system level by defining a common goal between all stakeholders supported by a management and leading system such as visual/weekly management, optimizing planning, implementing standard-works to be followed by every associate and guaranteeing the role of the surgeon as process driver who pull performances.
通过安全、高效地更换患者来最大限度地利用手术室套件，是为患者提供更多价值并提高手术室效率的一个契机。精益思维是一种关注在活动的组织和开展过程中无意间产生的浪费的理念，它应在最大限度提高客户价值的同时尽量减少浪费。它已被广泛应用于提高医疗保健及手术室环境中的流程效率并促进持续改进。本文的目的是深入探讨医疗保健专业人员如何通过接受精益思维来参与持续改进，并最终减少手术之间的更换时间。
采用行动研究方法，应用诸如现场观察、流程映射、根本原因分析和单分钟换模（SMED）系统等精益方法，以了解与更换相关的变异性和浪费的原因，并在妇科和普通外科的背景下改进流程。通过观察和视频记录收集并分析数据。问题已提交给管理团队关注，并纳入医院的年度平衡计分卡。该举措还与患者进入手术室之前和之后在手术室及相关流程中工作的团队相关。
通过标准化和更安全的工作改善了患者流程和跨专业协作，实现了有效的并行处理，使医院平均将手术之间的更换时间减少了25%，而无需在基础设施、技术或资源方面进行改变。
精益思维使团队能够从更换这一子流程入手，重新评估整个手术室作为一个系统的运行方式。为了随着时间的推移进一步改进并获得可持续的成果，在系统层面采取行动至关重要，即通过定义一个由视觉/每周管理等管理和领导系统支持的所有利益相关者之间的共同目标，优化规划，实施每个员工都应遵循的标准作业，并确保外科医生作为拉动绩效的流程驱动者的角色。
