Lean Six Sigma-based Critical Value Management In Hospitals

BackgroundWith the deepening of China’s medical reform and the increasingly fierce competition between the medical industry,the state has also issued relevant policies requiring hospitals to improve medical quality and safety,so that hospitals from extensive to refined management,improve management level and operation efficiency.Hospital critical value reporting system,as one of the eighteen core systems of medical quality and safety,is directly related to the life safety of patients.Lean Six Sig management aims to reduce waste,improve efficiency and quality,reduce cost and improve customer satisfaction.Applying this method to critical value management is of great significance for further improving the level of medical service and quality and safety.ObjectiveThe general objective of this study is to apply lean six Sigma to improve the critical value management level of a tertiary hospital in Shandong Province.The specific purpose is to specifically understand and analyze the problems existing in the critical value management process by determining the key measurement indicators of critical value management,propose and implement improvement measures according to the problems,evaluate and analyze the improvement effects,and promote continuous optimization.MethodIn this study,data were collected by HIS to obtain critical value report data,interview medical staff,questionnaire survey medical staff’s evaluation of improvement measures,and other methods to analyze the status quo and problems of critical value management.Fishbone diagram was used to analyze the reasons affecting critical value management,and improvement measures were formulated and implemented.The change of critical value management index before and after the implementation of improvement measures was compared to evaluate the improvement effect.The KANO model was used to classify the attributes of the application value evaluation of the improvement measures of critical value management.SPSS20.0 and Nvivo12.0 software were used to process and analyze quantitative data and qualitative interview data respectively.Results(1)Current situation of critical value management before improvement:Before improvement,the processing rates of critical value information system for outpatient,emergency and inpatient patients in C hospital were low,which were 44.5%and 56.7%respectively;Treatment rates ≤30min were 45.1%and 33.8%,respectively.The average processing time was 15.52h and 23.61 h,respectively.The 6-hour course record rate of hospitalized patients was 28.6%;In addition to the entrance,emergency and hospitalization numbers,the qualified rate is 60%,and the rest are below 30%.The overall qualified rate is low.(2)Analysis of the problems and causes of critical value management:medical technology departments reported more "false" critical value,delayed the delivery of critical value report results,and the medical and technical staff were not active in their work attitude;In clinical departments,the receiving time of critical value report results was delayed,critical value processing was not timely,critical value registration was not qualified,medical staff were not familiar with the process of critical value system,and their working attitude was not positive.The main reasons include:Unqualified specimen collection and transportation,medical technology and clinical critical value items and threshold information is not smooth,critical value information system is not perfect,hospital critical value reporting items and threshold update cycle is long,medical technicians are not familiar with critical value system and reporting process,lack of quality control in the department,nurses work content is complicated and lack of human resources,and medical staff have poor sense of responsibility.(3)Formulate and implement measures to improve critical value management:①standardize collection and transportation of clinical specimens,②optimize critical value information system,③update critical value items,thresholds and registration,④carry out training and assessment,implement 6S management,⑤special personnel regularly supervise and feedback,and improve the management system.(4)Evaluation of the application value of improvement measures by medical care:Using KANO model,There were 4 improvement measures with basic attributes,including "nurse training,correction of critical value register,internal quality control in the department,setting up department quality control personnel",3 with expected attributes,namely "improve critical value information system,update critical value items and threshold,department 6S management",and 4 with charm attributes,namely"shift handover,special person management,performance assessment,publicity and feedback" There are two undifferentiated attributes,namely "doctor training and medical communication".(5)Optimization effect of critical value management:After improvement,the processing rates of critical value information system for door,emergency and inpatient patients were increased to 99.3%and 99.8%,respectively;≤30min treatment rates reached 94.5%and 95.5%respectively;The average treatment time was 0.35h and 0.32h,respectively.The 6-hour course of inpatients was 94.1%.The index of critical value recorded in the journal was more than 90 percent.After improvement,we interviewed again,and the results showed that the hospital actively improved the quality control measures of critical value management,the awareness rate of medical staff to the critical value reporting process and system had significantly improved,the critical value information system was continuously optimized,and the failure rate was reduced.ConclusionsThrough the evaluation of the current situation of critical value management in a Grade-A hospital in Shandong Province,problems were found,cause analysis was carried out,improvement measures were implemented,and effect evaluation was carried out.The following conclusions were drawn:(1)The measure index of critical value management level should be comprehensive and scientific;(2)Lean Six Sigma improved critical value management is a continuous and dynamic adjustment process;(3)Critical value management needs not only the improvement of hardware facilities,but also the improvement of soft power;(4)The number of critical value reports was unevenly distributed across different dates and departments.Based on the above findings,the following recommendations are made:(1)Pay attention to process management and dynamically adjust hospital critical value management measures;(2)Carry out diversified training to improve the management quality of medical and nursing critical value;(3)Pay attention to the participation of all staff,and constantly optimize the critical value information management system;(4)Strengthen communication and learning,and constantly improve the critical value management ability of the team.