Sales Coll Marc, De Castro Rodolfo, Ochoa de Echagüen Anna, Martínez Ibáñez Vicenç
Essentia Health Management, 08021 Barcelona, Spain.
Department of Organization, Business Management and Product Design, University of Girona, 17003 Girona, Spain.
Healthcare (Basel). 2024 Feb 21;12(5):512. doi: 10.3390/healthcare12050512.
The objective of this study was to analyse and detail surgical process improvement activities that achieve the highest economic impact.
Over 4 years, a team of technicians and healthcare professionals implemented a set of Lean surgical process improvement projects at Vall d'Hebron University Hospital (VHUH), Barcelona, Spain. Methods employed in the study are common in manufacturing environments and include reducing waiting and changeover time (SMED), reducing first time through, pull, and continuous flow. Projects based on these methods now form part of the daily routine in the surgical process. The economic impact on the hospital's surgical activity budget was analysed.
Process improvements have led to annual operational savings of over EUR 8.5 million. These improvements include better patient flow, better management of information between healthcare professionals, and improved logistic circuits.
The current cultural shift towards process management in large hospitals implies shifting towards results-based healthcare, patient-perceived value (VBHC), and value-added payment. A Lean project implementation process requires long-term stability. The reason a considerable number of projects fail to complete process improvement projects is the difficulty involved in establishing the project and improving management routines. Few studies in the literature have investigated the economic impact of implementing Lean management a posteriori, and even fewer have examined actual cases. In this real case study, changes to surgical block management were initiated from stage zero. After being carefully thought through and designed, changes were carried out and subsequently analysed.
本研究的目的是分析并详细阐述能产生最大经济影响的手术流程改进活动。
在4年多的时间里，一个由技术人员和医疗专业人员组成的团队在西班牙巴塞罗那的比埃斯港大学医院（VHUH）实施了一系列精益手术流程改进项目。研究中采用的方法在制造环境中很常见，包括减少等待和换模时间（快速换模法）、减少首次通过率、拉动式生产和连续流。基于这些方法的项目现已成为手术流程日常工作的一部分。分析了对医院手术活动预算的经济影响。
流程改进已带来每年超过850万欧元的运营节省。这些改进包括更好的患者流程、医疗专业人员之间更好的信息管理以及改进的物流环节。
目前大型医院向流程管理的文化转变意味着向基于结果的医疗、患者感知价值（以患者为中心的医疗）和增值支付转变。精益项目实施过程需要长期稳定。相当数量的项目未能完成流程改进项目的原因是建立项目和改进管理流程存在困难。文献中很少有研究调查事后实施精益管理的经济影响，更少有人研究实际案例。在这个实际案例研究中，手术区域管理的变革从零阶段开始。经过仔细思考和设计后进行变革，并随后进行分析。
