精實管理在護理照護及管理上的應用

精實管理被廣泛應用於醫療產業來提升優質照護品質。護理主要任務為照顧病人，以病人安全為首要照護目標。全台多家醫院近期在手術室運營及護理交班時間太長的問題透過應用精實管理皆有顯著改善。高雄市立小港醫院在改善手術室醫材管理及計價流程中將入帳作業時間減少77%，叫貨作業減少了64%。嘉義基督教醫院把護理人員首次交班30分鐘交班時間完成率，從改善前34%到改善後76%，提升42%；護理人員準時下班比率由64%提升至78%。恩主公醫院平均每位護理師給藥作業時間從大於30分鐘降為15.6分鐘。直接照護病人護理時數從2.43小時提昇為2.69小時。臺安醫院開刀房第一台刀劃刀延遲率由改善前32.1%降至7.6%，護理人員加班時數減少8.4%，減少護理人員不必要的加班，增加手術團隊的工作效率。整體而言藉著醫院投入系統性的精實管理訓練及專案規劃，加上高階主管的支持，可以從看到單點零星的改善轉為系統性改變。

關鍵字

精實；日常管理；護理交班改善；開刀房運作改善

並列摘要

Lean management is widely implemented in the healthcare industry to improve quality of care. The main task of nursing is safe direct patient care. Many hospitals in Taiwan instigated lean management and demonstrated improvement in the operating room and nursing shift handover. Kaohsiung Municipal Xiaogang Hospital improved operating room medical materials management and billing process. Chiayi Christian Hospital increased the rate completing nursing shift handover within 30-minutes from 34% to 76%. In Eunuchong Hospital, the time spent on medication administration decreased from more than 30 minutes to 15.6 minutes. The direct care time for patients increased from 2.43 hours to 2.69 hours. In Taiwan Adventist Hospital operating room, the delay rate for first procedure of the day was reduced from 32.1% to 7.6%. The nursing staff overtime hours were reduced by 8.4%, reduced unnecessary overtime of nursing staff and increasing the efficiency of the surgical team. In conclusion, by investing in systematic Lean management training and project planning, coupled with the support of high-level leaders, we can shift from sporadic improvements to systemic changes.

並列關鍵字

lean daily management ； nursing handover ； OR improvement

參考文獻

尤琇慧、張麗銀、彭素貞（2018）．精實思想管理以傷口照護流程為例．領導護理，19（1），13-21。http://dx.doi. org/10.29494/LN.201803_19(1).0001

Cerfolio, R. J., Ferrari-Light, D., Ren-Fielding, C., Fielding, G., Perry, N., Rabinovich, A., Sarace-ni, M., Fitzpatrick, M., Jain, S., & Pachter, H. L. (2019). Improving operating room turnover time in a New York City Academic Hospital via Lean. The Annals of Thoracic Surgery, 107(4), 1011-1016. https://doi.org/10.1016/j.athoracsur.2018.11.071

Coffey Jr, C., Cho, E. S., Wei, E., Luu, A., Ho, M., Amaya, R., Pecson, M., Dalton, F. V., Kahaku, D., Spellberg, B., & Sener, S. F. (2018). Lean methods to improve operating room elective first case on-time starts in a large, urban, safety net medical center. American Journal of Sur-gery, 216(2), 194-201. https://doi.org/10.1016/j.amjsurg.2018. 05.002

Donnelly, L. F., Cherian, S. S., Chua, K. B., Thank-achan, S., Millecker, L. A., Koroll, A. G., & Bisset, G. S. (2017). The daily readiness hud-dle: A process to rapidly identify issues and foster improvement through problem-solving accountability. Pediatric Radiology, 47(1), 22-30. https://doi.org/10.1007/s00247-016-3712-x

Isfahani, H. M., Tourani, S., & Seyedin, H. (2019). Lean management approach in hospitals: A sys-tematic review. International Journal of Lean Six Sigma, 10(1), 161-188. https://doi.org/10.1108/ IJLSS-05-2017-0051

被引用紀錄

蕭佳齡、徐紫蘭、張玉婷（2023）。提升手術室護理人員醫療衛材計價正確率之專案。領導護理，24(4)，155-170。https://doi.org/10.29494/LN.202312_24(4).0012

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精實管理在護理照護及管理上的應用

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