Study On Optimization Of Patient Admission Based On Lean Thinking

ObjectiveTo improve patients' medical experience and improve their satisfaction,this study investigate the current status and problems of the hospital admission process in the case hospital.Based on lean thinking and tools,analyze the causes through value stream mapping to effectively resolve patients'problem that the long queue time and processing time in the admission process and poor handling experience.Methods1.SWOT analysis:Confirmation of improvement needs through SWOT analysis of case hospitals.2.Lean value stream analysis method:Based on lean thinking and process reengineering theories and tools,using value stream analysis method,combined with on-site observation,questionnaire survey,semi-structured interviews methods to collect the time data of the admission process and draw the value flow chart.Understand patient satisfaction and needs,and confirm the problems and causes of patient admission and discharge service center and make a lean process optimization plan.3.Statistical analysis method:Using the non-parametric test to analyze different process time with degree of satisfaction on the admission process.Using multivariate ordinal logistic regression method to analyze patient satisfaction with different types of expense in which provide the basis for finding improvement measures.Using descriptive analysis and non-parametric test methods to evaluate the effect of the optimization.Results1.Through the redesigning and implementation of comprehensive improvement measures,including:handling process by classification windows,increasing the number of service windows,changing the division of labor and scheduling time,optimizing the layout of facilities and equipment,increasing self-service equipment,and establishing a consensus on the coordination of beds between departments,so that the patient admission improved efficiency in case hospital.The queuing time and coordination bed time were significantly improved;the processing time was shortened from 308 seconds before improvement to 295 seconds,and the total processing time was shortened from 1030 seconds before improvement to 299 seconds,and the difference was statistically significant(P<0.05),The queuing time and the waiting for nurse coordination bed time of the admission business process were significantly improved;the processing time was shortened from 308 seconds before improvement to 295 seconds,and the total processing time was shortened from 1030 seconds before improvement to 299 seconds.At the test level of P<0.05,the non-parametric test difference is significant.2.The proportion of patients with queuing time over 30 minutes in the admission and discharge service center(all service types)decreased from 23%to 14.3%.3.The satisfaction of inpatients admission and discharge process rate increased from 84.7%to 86.1%.4.The proportion of coordinated beds decreased from 7.76%before improvement to 1%.Conclusion1.Applying lean thinking and business process reengineering theory to optimize patient admission is an effective way to boost process efficiency.2.It is recomended that set 5 minutes as the goal of optimizing the queuing time.3.The influencing factors of self-paid patients and the urban medical insurance patients' satisfaction of admission process are different.The influencing factors at the self-paying patients are the window processing time and waiting for the nurse to allocate a bed time;the influencing factors of urban medical insurance patient include the queuing time,window processing time,waiting nurse's bed allocation time and patient expectation of process time.The window processing time and the waiting time for the nurse to allocate a bed time are the common influencing factors of the self-paid patients and the urban medical insurance patients.It should be given priority to improvement.5 Put forward four key points for the implementation of medical process optimization:Continuing attention from hospital leaders is the key to lean optimization.Going to the scene to grasp the status quo is the first and crucial step in implementing process optimization.Use structured table tools.Measure the effectiveness of improvement measures in time,and solve problems in time.The establishment of reward and punishment mechanism is the driving force for process optimization.Strengthen the sense of communication of leadership to employee to increase employee engagement.