Improving wait times to care for individuals with multimorbidities and complex conditions using value stream mapping
Improving wait times to care for individuals with multimorbidities and complex conditions using value stream mapping
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DOI：
10.15171/ijhpm.2015.76
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发表时间：
2015-07-01
影响因子：
3.5
通讯作者：
Blackmore, Gail
中科院分区：
文献类型：
--
作者：
Sampalli, Tara;Desy, Michel;Blackmore, Gail
背景：认识到复杂慢性病患者的护理等待时间的显著影响，我们应用了精益方法，即适应价值流图(VSM)，以满足多种慢性病患者的需求，并在不增加资源或资金的情况下改善等待时间。方法：在18个月的时间内，工作人员应用了以患者为中心的方法，包括VSM的精益方法，以改善护理的等待时间。我们的评估框架以等待接受治疗的患者和个人的需求和观点为基础。通过诸如慢性病护理患者评估(PACIC)和基于过程工程的问题等调查获得以患者为中心的观点。此外，还添加了VSM精益方法，以确定导致等待时间的非增值流程。结果：关怀团队在2014年成功地将等待时间减少到2个月，2015年没有预期的等待时间。提高患者参与度和满意度也是这一创新计划的结果。此外，成功的转型和实施在不增加成本的情况下提高了资源效率。在综合慢性护理服务(ICCS)干预后，患者的功能健康状况有了显著改善。该方法将应用于首都卫生和该省的其他慢性病管理领域。结论：在多发性疾病和其他复杂疾病的管理中等待护理的时间不仅会增加受影响的个人的负担，而且会增加医疗保健系统的负担。在这项研究中，一种新的和改进的精益方法被应用于在护理提供过程中嵌入患者的声音，并在复杂的慢性病的管理中减少护理的等待时间。
Background: Recognizing the significant impact of wait times for care for individuals with complex chronic conditions, we applied a LEAN methodology, namely - an adaptation of Value Stream Mapping (VSM) to meet the needs of people with multiple chronic conditions and to improve wait times without additional resources or funding.Methods: Over an 18-month time period, staff applied a patient-centric approach that included LEAN methodology of VSM to improve wait times to care. Our framework of evaluation was grounded in the needs and perspectives of patients and individuals waiting to receive care. Patient centric views were obtained through surveys such as Patient Assessment of Chronic Illness Care (PACIC) and process engineering based questions. In addition, LEAN methodology, VSM was added to identify non-value added processes contributing to wait times.Results: The care team successfully reduced wait times to 2 months in 2014 with no wait times for care anticipated in 2015. Increased patient engagement and satisfaction are also outcomes of this innovative initiative. In addition, successful transformations and implementation have resulted in resource efficiencies without increase in costs. Patients have shown significant improvements in functional health following Integrated Chronic Care Service (ICCS) intervention. The methodology will be applied to other chronic disease management areas in Capital Health and the province.Conclusion: Wait times to care in the management of multimoribidities and other complex conditions can add a significant burden not only on the affected individuals but also on the healthcare system. In this study, a novel and modified LEAN methodology has been applied to embed the voice of the patient in care delivery processes and to reduce wait times to care in the management of complex chronic conditions.