School of Business, University of Wollongong, Wollongong, Australia.
College of Human and Health Sciences, Swansea University, Swansea, UK.
J Health Organ Manag. 2024 Jun 18;ahead-of-print(ahead-of-print). doi: 10.1108/JHOM-12-2022-0378.
This study investigates how a hospital can increase the flow of patients through its emergency department by using benchmarking and process improvement techniques borrowed from the manufacturing sector.
DESIGN/METHODOLOGY/APPROACH: An in-depth case study of an Australasian public hospital utilises rigorous, multi-method data collection procedures with systems thinking to benchmark an emergency department (ED) value stream and identify the performance inhibitors.
High levels of value stream uncertainty result from inefficient processes and weak controls. Reduced patient flow arises from senior management's commitment to simplistic government targets, clinical staff that lack basic operations management skills, and fragmented information systems. High junior/senior staff ratios aggravate the lack of inter-functional integration and poor use of time and material resources, increasing the risk of a critical patient incident.
RESEARCH LIMITATIONS/IMPLICATIONS: This research is limited to a single case; hence, further research should assess value stream maturity and associated performance enablers and inhibitors in other emergency departments experiencing patient flow delays.
This study illustrates how hospital managers can use systems thinking and a context-free performance benchmarking measure to identify needed interventions and transferable best practices for achieving seamless patient flow.
ORIGINALITY/VALUE: This study is the first to operationalise the theoretical concept of the seamless healthcare system to acute care as defined by Parnaby and Towill (2008). It is also the first to use the uncertainty circle model in an Australasian public healthcare setting to objectively benchmark an emergency department's value stream maturity.
本研究探讨了医院如何通过借鉴制造业的基准测试和流程改进技术来增加急诊部门的患者流量。
设计/方法/途径：对一家澳大拉西亚公立医院的深入案例研究利用了系统思维的严格、多方法数据收集程序来对急诊部门（ED）的价值流进行基准测试，并确定了性能障碍因素。
高价值流不确定性源于低效流程和薄弱控制。由于管理层对简单的政府目标的承诺、缺乏基本运营管理技能的临床人员以及分散的信息系统，导致患者流量减少。高初级/高级员工比例加剧了功能间集成不足和时间和物质资源利用不佳的问题，增加了关键患者事件的风险。
研究局限性/影响：本研究仅限于单个案例；因此，进一步的研究应该评估其他经历患者流量延迟的急诊部门的价值流成熟度和相关的绩效促成因素和障碍因素。
本研究说明了医院管理者如何使用系统思维和无上下文的绩效基准衡量标准来确定所需的干预措施和可转移的最佳实践，以实现无缝的患者流量。
原创性/价值：本研究首次将 Parnaby 和 Towill（2008）定义的无缝医疗系统的理论概念应用于急性护理。它也是第一个在澳大拉西亚公共医疗保健环境中使用不确定性循环模型客观基准测试急诊部门价值流成熟度的研究。
