2019 № 3 Historical background the scientific organization of labour in health care: the experience of the early twentieth century
The active introduction of lean production technologies in the activities of medical organizations, conducted in recent years, was the occasion to study the history of the origin and formation of management science in Russia, as well as the study and rethinking of the Russian and Soviet experience of health care organization. Analysis of documents and literature related to 20–30 years of the last century, a period when the rapid pace of construction and development of the national economy of the USSR makes rethink the place and role of the Soviet experience of production management, which was at one time called “scientific organization of labor and production”, and later – “rationalization”. The universality of technologies and methods of scientific organization of labor (SOL) allows to use them both in production and non-production spheres, including health care. Note that the Soviet experience, as a rule, is not reflected in Western textbooks on management, or only mentioned, although the achievements of Soviet scientists 20-ies of the last century anticipated many areas of modern management and remain relevant even after almost a hundred years.
2019 № 9 Application of lean management in medical examination of children in Tomsk region
The object of the study is the process of preventive medical examination of children of the first year of life, which can be improved on the basis of the principles of lean production. As part of a joint project of the Ministry of health of Russia and Rosatom state Corporation “Lean clinic”, which is designed to improve the efficiency of medical organizations and the availability of their assistance by introducing elements of lean production in public health institutions on a systematic basis, in the Tomsk region on the basis of a pilot medical organization – children’s clinic – a project was implemented to introduce lean technologies in the process of preventive examination of children of the first year of life, in order to minimize the loss of time when receiving medical services by the patient. The main directions of optimization: improving the productivity of the process using the mapping method; increasing the productivity of a single workplace using the 5C technique; increasing the productivity of the movement of medical staff using the Spaghetti diagram. During the project, the logistics scheme of patients and staff movement was significantly improved, and a route map was developed, which was issued to the parents of patients in the registry of the medical organization. In addition, in order to assess the effectiveness of the developed measures before the project and after its implementation, a sociological survey was conducted among the parents of children undergoing pre¬ventive medical examination, which allowed to assess the level of their satisfaction with the assistance provided. As a result of the implementation of the project on the introduction of lean technologies, it was possible to achieve the goals, in particular, to reduce by almost 3.5 times the time spent by patients on the passage of a full cycle of preventive examination, to reduce to 2 number of visits to the clinic, as well as to increase comfort of staying in the institution of patients and their parents.
2021 № 1 Applying lean manufacturing technologies to optimize ambulance operations amid the spread of COVID‑19
The pandemic of new coronavirus infection COVID‑19 has become a serious challenge for the national health
systems, including Russia, setting ambitious goals aimed at preventing the spread of infection and maintaining the availability of medical care in environment of increasing pressure. The aim of the study was to develop, based on the principles of lean production, a set of measures to increase the availability of emergency medical services for patients diagnosed with or suspected of a new coronavirus infection COVID‑19 in the Tomsk Region. Standard tools of lean manufacturing are applied to the work process of the admission department of the respiratory center in RSBHI «Medical sanitary station № 2». As a result of implementation of target state map, which provides for the optimization of process of transferring a patient diagnosed or suspected of a new coronavirus infection COVID‑19 to admission department, a positive dynamics of local (5.4 times increase in the proportion of calls completed within 15 minutes after the patient was delivered to the admission department) and system (an increase of 1.3 times in the proportion of calls with the time the ambulance team reaches the patient within 20 minutes) indicators of the ambulance service was achieved. The study confirms the effectiveness of lean manufacturing tools for optimizing the work of ambulance and allows us to recommend them for use in a pandemic and other risks of emergency.
2022 № 5 Review of lean practices in clinical laboratories
The main role of clinical laboratory diagnostics is to obtain reliable, reproducible and timely results that help to make the right clinical decisions. As the literature review shows, there are a number of common problems for many clinical laboratories, such as: long turnaround times, high laboratory costs for consumables, insufficient level of satisfaction with quality of services received by patients and high number of complaints. The use of lean manufacturing can be one way of solving these problems.
Purpose of the study is to summarize and analyze the literature regarding the application of lean manufacturing in clinical laboratories.
Materials and methods. A literature review was performed using the following abstract databases: Web of Science, Scopus, PubMed, ScienceDirect, Mendeley, and NCBI. The depth of the search according to the time parameter had no limitations. The following keywords were used as search markers: “lean management”, “lean thinking”, “lean six sigma”, “lean tools”, “healthcare”, “health services”, “clinical laboratory”. More than 100 publications were analyzed, from which 28 most representative studies were selected.
Results. The implementation of lean production methods provides a reduction in turnaround time, costs and errors in the clinical laboratory, reduces the contamination of biological material at the preanalytical stage and reduces waiting time for services and, as a consequence, reduces the number of patient complaints.
Conclusion. The above results indicate that lean production methods can be used in laboratories to solve frequently occurring problems and demonstrate the effectiveness of their application in clinical laboratories.
2020 № 1 New model of ambulatory healthcare operation as a form of sustainable development of healthcare organization
The article presents a review of the literature and the data of our own research on the problem of introduction of certain elements of the lean production model in the work of the ambulatory healthcare and assessment of its impact on the sustainable development of the healthcare organization as a whole. It was revealed that the new model of the am¬bulatory healthcares increases the efficiency of activities in the following areas: the achievement of long-term development strategy by 6.8 times, the introduction of organizational improvements and training of personnel by 5 times, synchronizes processes and optimizes resource provision 3 times more often than the initial level of work of the healthcare organization. In this regard, the sustainability potential of the healthcare organization providing primary health care to the population has increased by 3.47 times, which indicates an increase in the efficiency of the organization.
2018 № 3 The design of an automatical inventory management system of irreducible reserves of the pharmacy on the example of a multifield hospital
The article describes the design of an automatical inventory management system of irreducible reserves of the pharmacy in a multifield hospital in order to follow the principles of lean production. The authors proposes a flexible model of the summary standards formation of medicines reserves of pharmacy using XYZ-, VEN-, ABC-analysis and additional expert evaluation. Conclusions were drawn about the need to automate the inventory management system of irreducible reserves of the pharmacy in a multifield hospital in order to optimize the logistics of movement, accounting and consumption control of medicines and to construct an automatical system of planning and monitoring of purchases of medicines