2019 № 4 The experience and results of lean manufacturing introduction in health care
The World Health Organization gives notice an increasing demand for medical service on the one hand and a tendency toward deterioration of financial conditions in the healthcare system on the other that is the cause of the main concern in modern medical management. The article is considerate feasibility of using principles and methods of lean production for the purposes of organizing practical healthcare. Analyzed the results of lean production implementation of over the past few decades, the main early successes achieved using the tools and methods of lean production, as well as the basic limitations of the application are evaluated. Special attention is given to potential roles of the leader of healthcare institutions in lean production adaptation as well as evaluating the success of a strategy. A deep analysis of modern economic indicators of lean production successful implemen- tation in medical clinics abroad is presented, the key points of the effective introduction of lean production are being updated. In additional to economic indicators, the impact of lean production implementation in medical organizations on reducing mortality rates, transmission of nosocomial infections, mortality from hospital infections, reducing waiting times for medical services (especially in the admission department) is estimated. The current task facing the health care system in the Russian Federation is updated. The main conclusion is made about a huge amount of positive results after introducing lean production, including the positive economic effect and the increase in the quality of medical care after the introduction of the principles and methods of lean production, and also the entity of lean production as a separate method of organizing processes.
2018 № 7 Process approach in the organization of medicinal support
The purpose of this article is to define and detail the basic principles of the process-oriented approach and the regulation of the organization’s activities – as the most effective management mechanisms, and the application of the process approach in the organization of continuous targeted drug provision of the treatment and diagnostic process in a federal multidisciplinary institution on the example of the “National Pirogov Medical Surgical Center” of the Ministry of Healthcare of the Russian Federation (hereinafter Pirogov Center).
2019 № 6 Reduction of time of providing medical service due to approach realization of “10 seconds”
The 10 seconds model which cornerstone creation of a multilevel cascade system of interaction with the patient in the medical organization is is offered. The main organizational documents on the basis of which realization of the specified approach is possible are listed. Introduction advantages are allocated and proved. Process realization on the example of activity of reception and diagnostic office in MSCh KFU is opened.
2017 № 4 Operational parameters and characteristics of MRI workflow in outpatient clinics of Moscow
We present continuous data of outpatient MRI units in Moscow, 2016. Unit uniformity, identical working conditions, compensation schemes, study justification, process monitoring and result analysis as well as first-time adoption of newest information technologies in Moscow allowed for process characterization and advanced result analysis of 28 outpatient MRI units. Presented data encompasses operational parameters of 64326 MRI examinations with results being evaluated on-line. Yearly median number of examinations for one MRI unit was 2076, with first and third quartile being 1830 and 2836. Reasons of low workload were analyzed. For instance, average number of work shifts in a month varied from 24 (95% CI 18-30) to 49 (95% CI 43-52). Workload during the day also varied. In first four hours of work shift up to 40% of all examinations were performed (95%; CI 40.5-41.2). In last four hours of work shift only 20% of all examinations were performed (95% CI 19.7-20.2). Additionally, the interval between sequential studies was 38 minutes, with first quartile being 29 minutes, and third quartile being 55 minutes. The delay was observed in 50.7 cases (95% CI 50.3-51.4). Every fifth delay was longer than 60 minutes, and in 7.4% of cases - longer than 90 minutes (95% CI 7.2-7.6). In best outpatient clinics, the prevalence of these intervals was only 4.8%. Average waiting interval in outpatient clinics was 7.8 days (95% CI 7.7-7.9). In 44.9% of cases, it was shorter than 6 days (95% CI 39.6-47.5) and in 8.2% of cases examination was performed on the day of study reservation. In several clinics waiting interval did not exceed one day without any detrimental effect on overall workload. The results highlight the need to improve operational processes and overall quality of diagnostic services.