整合HFMEA與VSM於醫療流程之改善

Integrating HFMEA and VSM for Healthcare Process Improvement

方振宇

指導教授 ： 蘇朝墩

國立清華大學/工學院/工業工程與工程管理學系/碩士(2008年)

摘要

醫療照護失效模式與效應分析為近年來醫療界普遍使用之預應式風險分析方法；價值流分析則為精實六標準差流程效率改善方法之一，整合二者之目的為，希望能同時改善醫療流程之風險性與時效性，以達到醫病雙贏之局面。本研究期望能整合醫療照護失效模式與效應分析及價值流分析於一體，而發展出簡單應用之架構。跨部門小組使用流程圖、危害分數矩陣和醫療照護失效模式與效應分析決策樹，去辨識及評估流程中潛在之失效點，並判斷針對這些失效點，須提出改善建議與否；適時搭配價值流分析手法，經由價值流程圖之繪製、運用流程週期效率及流程週期效率損失數據等指標，以判斷流程之改善優先順序，最後同時考慮醫療失效模式與效應分析及價值流分析之結果，以決定整體之改善優先順序及改善建議行動。
本研究以北部某醫院為個案對象，短期而言，不良事件之產生有減少之趨勢，而流程週期效率方面，經由精實概念之運用，其值由原本之4.05%上升至7.62%。就方法使用之方便性與有效性而言，院內人員皆有不錯之反應。

關鍵字

失效模式與效應分析 ； 醫療照護失效模式與效應分析 ； 精實六標準差 ； 精實概念 ； 價值流分析 ； 流程週期效率 ； 流程週期效率損失

並列摘要

Healthcare Failure mode and effects analysis (HFMEA) is a proactive risk analysis methodology and widely employ in healthcare field. On the other hand, Value Stream Mapping (VSM) is one of the process efficiency improvement approaches in Lean Six Sigma (LSS). The purpose of this study is developed a framework to conduct the integrated HFMEA and VSM methodologies into hospitals. This integrated approach attempts to increase the satisfaction of patents and the efficiency of healthcare institutions simultaneously. The crossfunction team uses some tools to identify, evaluate and priority the potential failures. Additionally, the value stream map will analyze the process flow and calculate the process cycle efficiency (PCE) and process cycle efficiency destruction (PCED) for determining the improvement priority. Finally, the integrated approach will decide the overall priority of the process.
The implementation of the proposed approach was carried out in a hospital in Taipei and the results illustrated the practicability of the proposed approach. In short- term, the number of harmful events is toward to decrease certainly. Moreover, through the concept of lean manufacturing, the PCE of process increases from 4.05% to 7.62%. The improved results illustrated the effectiveness of the proposed approach and the participants felt this improvement is helpful to handle their daily work.

並列關鍵字

FMEA ； HFMEA ； Lean six sigma ； Lean ； VSM ； PCE ； PCED

參考文獻

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