背景與動機:目前台灣醫療因健保制度的實施,醫療院所面臨醫療成本增加與人力不足的困境,並配合相關評鑑業務造成醫護人員的工作負擔沈重,出現「血汗醫院」的情況,國外成功運用精實生產系統改造醫院的經驗,值得國內醫院效法。 方法:本研究是個案醫院運用精實方法,改善緊急與常規之血液、尿液、生化檢驗作業流程的實證研究。以精實生產系統之「確認價值(Value)、確認價值溪流(Value stream)、暢流(Flow)、後拉式(Pull)及完善(Perfection)」等五大觀念為基礎,導入改善措施藉此消除檢驗流程之七大浪費。 本研究是以精實觀點,找出檢驗流程中檢體傳送、人員走動及各檢驗步驟間等待的浪費,為消除檢驗流程不必要的浪費,將血液、尿液、生化檢驗作業流程分別導入自動化與自動驗證系統;並將常規檢體的檢驗作業流程由原本以批次流(Batch Flow)的作業模式改成以單件流(One Piece Flow)作業。 結果:個案醫院檢驗部門在導入精實生產系統後,其具體的改善成果如下,第一項在檢驗空間減少63.4平方公尺,第二項在生化檢體的傳送距離減少13.3公尺。另外第三項分析各項檢驗平均週轉時間(Turnaround Time,TAT),來探討檢驗流程改善成效。經比較分析發現,在改善後血液檢驗流程,緊急與常規檢體的平均TAT分別下降27%與66.4%;在改善後尿液檢驗流程,緊急與常規檢體的平均TAT分別下降31%與58.9%;在改善後生化檢驗流程,緊急與常規檢體的平均TAT分別下降11.4%與36.4%。 結論:個案醫院導入精實系統可消除浪費,改善血液、尿液、生化檢驗作業流程。另外運用精實生產系統「暢流」觀念,將常規檢體改由單件流方式進行檢驗,可明顯消除檢驗流程的浪費。本研究藉由導入精實系統,改善檢驗流程的浪費,可減少工作人員的負擔,增進檢驗服務效能,進而提升對病人高品質的醫療服務。
Background and Motivation:Since National Health Insurance was implemented in Taiwan implementing, now hospitals in Taiwan have been faced with the problems of the highly increasing costs and manpower shortage. Also, the medical staffs participated in many accreditations caused overworked situations, so that the phenomenon of “Sweat Hospitals” appeared and has existed in Taiwan. Based on the intention to improve this current issue, this study is going to investigate the Lean System applied by these foreign medical institution with successful outcomes. Method: This case study worked on Lean methodology with the purpose to improve the stat and routine processes of hematology, urinalysis and chemistry. There are a list of five principles involved in this study: Evaluation, Define Value Stream, Flow Model, Pull Model and Perfection to experiment the laboratory process how to decrease the seven wastes. With the application of Lean system, it found out the wastes of transported specimens, staff walking and waiting in laboratory processes. Automation and auto-verification system are used in the processes of hematology, urinalysis and chemistry to solve the unnecessary wastes in laboratory processes. And the routine specimen transportation are changed from Batch Flow to One Piece Flow. Results: The case in the hospital’s laboratory has concrete results after the application of Lean System. First of all, The laboratory layout freed up 63.4 m2 of space . Secondly, specimen traveled distances for chemistry tests was reduced to 13.3 meters. Thirdly, to analyze the improvement in the processes of Turnaround Time (TAT). According to comparative analysis we found, the average TAT of Stat and Routine, each dropped down to 27% and 66.4%, after improving the hematology procedure; 31%, 58.9% in urinalysis, and 11.4%, 36.4% in chemistry. Conclusion: The hospital laboratory with the application of Lean Methodology can efficiently decrease wastes and improve processes of hematology, urinalysis and chemistry. Besides, the routine specimen transportation was changed from Batch Flow model to One Piece Flow model and obviously decreased wastes. This study has applied this learn methodology to improve the processes of hospital laboratory, reduced staff workload and promoted service efficiency. Accodingly, the hospitals can offer the high quality medical service for their patients.
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