Day surgery is one of the key tasks of the national medical reform. It is still in the stage of rapid developing in the country. It is the responsibility of the large general hospitals to explore the effective management mode of the day surgery center to meet the clinical quality and safety. During the establishment and management of day surgery center in general hospital, it is needed to build a strong specialized day surgery team through professional training, and to establish a coordination and incentive mechanism for the cooperation between the day ward and the specialized subjects by introducing lean thinking strategy. According to the characteristics of day surgery, the clinical pathway management and the whole course rehabilitation and the health education system of day surgery are established. The formulate norms for medical records of day surgery will be built. The monitoring system for the efficiency and safety of day surgery is established to improve the medical quality and safety of day surgery. As a result, the model of day surgery that conforms to the medical characteristics of China will be established.
Objective To explore the effect of lean management on patients’ safety, medical quality, and satisfaction in day surgery ward. Methods The patients underwent day surgery between May 4th, 2017 and April 30th, 2018 were selected as the subjects (the lean management of day surgery ward implemented on November 1st, 2017). The patients underwent day surgery between May 4th and October 31st, 2017 were taken as the control group (n=2 864), and the ones between November 1st, 2017 to April 30th, 2018 were taken as the observation group (n=2 705). The following data between the two groups were compared: the cancellation rate of day surgery, the 24-hour delayed discharge rate, the rate of 12-hour median or severe pain after surgery, the rate of 12-hour postoperative nausea and vomiting, the awareness rate of health education, the patients’ satisfaction, and the incidence of adverse events.Results Compared with those in the control group, the cancellation rate of surgery (4.81% vs. 6.25%), the 24-hour delayed discharge rate (2.76% vs. 4.28%), the 12-hour median or severe pain after surgery (5.55% vs. 8.31%), the rate of 12-hour postoperative nausea and vomiting (5.86% vs. 7.71%) decreased in the observation group, and the differences were statistically significant (P<0.05). The awareness rate of health education increased from 92.18% to 98.02% after the implementation of lean management, the patients’ satisfaction increased from 92.48±2.58 to 96.53±1.64 after the implementation of lean management, and the differences were statistically significant (P<0.05). The incidences of adverse events in the two groups were not statistically different (0.16% vs. 0.41%, P>0.05). Conclusion The implementation of lean management model can insure the medical safety and quality of day surgery, and improve overall work efficiency and the patients’ medical service experience in day surgery ward.
ObjectiveTo analyze the application status of Kanban management in medical service management at home and abroad and to provide a reference for lean medical management practice in China.MethodsUsing the bibliometric method, in China National Knowledge Infrastructure, Wanfang Database, CQVIP Journal Database, Springer Link, Embase and PubMed, we used “Kanban” and “Kanban management” as Chinese search terms, “Kanban system” and “two-bin system” as English search terms to search for literature published from 2009 to 2019. The number of articles published, institutions, authors, citation frequencies, key words, Kanban usage, and improved areas where Kanban was applied in were statistically described and analyzed.ResultsA total of 219 articles were retrieved. Of the 14 articles included in the study, 12 articles were published from 2015 to 2019, 8 articles were published by hospitals, and 9 articles were cited more than or equal to 3 times. The key words were basically the combinations of Kanban and related topics in the field of medical service management, such as quality control and improvement, ward service, high-quality care and process evaluation; 11 articles used Kanban alone. Kanban was used in medicine supply chain management, ward bed management, and material inventory management abroad; and was used in medicine management, emergency room patient management, medical staff performance management, operating room equipment management, and high-quality medical service management in China.ConclusionsKanban as a lean management method was introduced into the domestic medical field late, and the current research development is not balanced. Asa visual management tool, Kanban needs to be extended in the medical field. As a lean improvement tool, Kanban has positive significance in improving medical quality and patient satisfaction. It is suggested that researchers should not be limited to the existing applied research, and can study the application of Kanban in different medical service fields in combination with different lean management tools according to the actual situation of the hospital.
ObjectiveTo analyze the application status and existing problems of value stream mapping (VSM) in improving medical services at home and abroad, so as to provide decision evidence for hospitals to apply VSM to improve medical services.MethodsUsing “value stream mapping” and “value stream” as search terms, we searched PubMed, Embase, China National Knowledge Infrastructure, CQVIP Journal Database and Wanfang Database (2009-2019), and collected relevant literature on the application of VSM to improve medical services at home and abroad. We conducted bibliometric analysis after confirming the literature according to the inclusion criteria. The standardization of application of VSM was also evaluated.ResultsOf the 299 articles retrieved, 13 studies fulfilled the inclusion criteria. The publication time of the literature was distributed between 2013 and 2019. Of the 8 foreign articles included, the regions to which the first author belonged were 4 in the United States, 1 in Ireland, Norway, Lebanon and Indonesia respectively. Of the 5 included domestic articles, the regions to which the first author belonged were 2 in Zhejiang and Shanghai respectively, and 1 in Guangdong. Of the foreign literature, 5 articles did not clearly state the sample size observed when drawing VSM, 5 articles incomplete drawing elements of VSM, and 3 articles did not show VSM. Of the domestic literature, 2 articles did not clearly state the sample size observed when drawing VSM, 3 articles had incomplete drawing elements of VSM, and 1 article did not show VSM.ConclusionsVSM is relatively more used in high-income and upper-middle income countries. The medical service improvement issues for which VSM is applied are relatively single. The standardization of the application of VSM in domestic and foreign literature needs to be improved overall.
ObjectiveTo analyze the application of visual management in foreign medical service management, and to provide a reference for lean medical management practice in China.MethodsUsing “visual management” and “visual tool” as the search terms, we searched PubMed, Web of Science, Springer Link, ScienceDirect, to retrieve relevant literature on the application of visual management tools to improve medical services in foreign countries. The number of published articles, journals, improvement objectives, measures and effects were analyzed descriptively.ResultsA total of 534 articles were retrieved. According to the inclusion and exclusion criteria, 7 articles were finally included, all of which were published in SCI journals, of which the number of articles in the United States was the highest (5 articles). Among the 7 included articles, 3 articles used face cards, 2 articles used whiteboards, 1 article used electronic Kanban, and 1 article used discharge “traffic lights”. Five articles studied the improvement of doctor-patient communication, and two studied the improvement of bed turnover rate. In the included articles, the contents of visualization mainly include the nursing goals of the inpatient, inspection plan, turnover, discharge plan, and the names and roles of medical staff.ConclusionsVisual management tools have a significant effect on promoting doctor-patient communication and improving hospital bed turnover. The application of foreign visual management tools in wards is relatively mature, and used more in promoting doctor-patient communication. Visual management tools are constantly updated, and electronic tools may gradually become a trend in the future.