缩短门诊病人超声检查出报告时间

缩短门诊病人超声检查出报告时间浙江省台州医院---林仙方项目陈述：2005年上半年，病人抱怨台州医院门诊超声检查后出报告时间太长，平均约40分钟，有的超过1小时，常引发患者不满，甚至投诉，影响医院形象。业务案例：•提高病人满意度，增加医院形象。•改进工作流程，提高工作效率，增加医院年门诊量。项目范围：•2005年8月至2006年2月台州医院门诊超声检查患者团队成员赞助人：陈海啸组长：林仙方成员：韩文胜，伍霞芳，陈晓星黑带大师：梁丁Define项目时间表Define步骤05.8.2005.8.2805.10.105.11.2105.12.26D定义M测量A分析I改善C控制超声检查结束后出报告框架流程图程序转入下一病人检查报告打印结束打印以前未完成报告Define4号室取报告回各诊室签字各诊室超声检查结束拿至服务台病人拿报告检查者报告打印者候诊人员Y1Y2Y3开始当前病人报告打印5秒3秒不等不等10秒不定时统一拿即刻注：报告打印即报告文字录入项目Y定义Y=门诊病人超声检查出报告时间起点：门诊病人超声检查结束，止点：病人拿到报告单。缺陷定义：门诊病人出报告时间大于15分钟。数据来源随机收集周一至周五门诊病人超声检查出报告时间。时间记录包括超声检查结束时间，开始打印报告时间，报告打印结束时间，病人拿到报告时间。并记录检查医师、报告打印者、检查项目、诊室、报告模版是否齐全。DefineYX1X2X3X4X5病人检查结束时间报告打印开始时间报告打印结束时间病人拿到报告单时间检查医师报告打印者何种检查项目检查诊室模版是否齐全数据采集表格MeasureY1Y2Y3原始数据诊室医生打印者检查项目模版有无检查结束时间开始打印时间打印结束时间出报告时间Y1Y2Y3Y42635110:30:2511:13:1311:17:2011:22:16256824729631112632110:42:1011:14:3011:15:1311:22:1619404342324062631110:45:5011:15:5011:18:3511:33:00180016586528302635110:51:2011:19:0211:21:0711:33:00166212571325002631110:56:0411:20:1811:22:2011:33:00145412264022162631110:59:3011:22:4911:24:3411:33:00139910550620102631111:02:1011:24:4011:26:1511:33:0013509540518502632111:04:0511:25:5811:27:1011:33:0013137235017352631111:06:3411:27:2011:30:3211:33:00124619214815862634114:21:1014:29:5014:32:5014:48:1052018092016202634114:28:4014:32:1014:34:1014:48:1021012084011702635114:37:2015:02:4715:05:1015:30:231527143151331832635114:48:5015:09:2015:11:3015:30:231230130113324932635114:55:2315:14:0615:16:3415:30:23112314882921002634114:59:1015:15:5015:17:1015:30:231000807931873…..…..…..…..….…..…..….…..…..….…..…..Measure鱼骨图病人方法医生机器材料环境--医生业务水平--报告书写速度诊室内环境--服务意识----医生在岗人数---打印机故障--机器数量--仪器性能老化---预约方法---申请单规范-----软件实用性--病人量是否合作----报告模版---病情轻重----检查项目----Define门诊病人超声出报告时间电脑死机--正正正现在水平分析P0.05，数据是正态的，均值29分10秒，标准偏差11分零4秒。Z值为-1.51，改进的余地很大。Analyze350030002500200015001000500MedianMean180017001600Anderson-DarlingNormalityTestVariance440749.0Skewness0.528608Kurtosis0.183119N127Minimum499.0A-Squared1stQuartile1235.0Median1712.03rdQuartile2181.0Maximum3655.095%ConfidenceIntervalforMean1633.40.471866.6P-Value0.241Mean1750.0StDev663.9350030002500200015001000500USL12011010090807060504030201011000000100000100001000100101e:erSpec:inal:ortunity:ortedby:ject:artment:cess:racteristic:ts:erSpec:90095%ConfidenceIntervalsSummaryforY4Actual(LT)ProcessPerformanceProcessDemographicsActual(LT)Potential(ST)Sigma(Z.Bench)DPMO-1.28899341.40.22412082.2ProcessBenchmarksReport1:ExecutiveSummaryActual(LT)Potential(ST)40003000200010000ProcessPerformanceUSLActual(LT)Potential(ST)1000000100000100001000100101100500Potential(ST)Actual(LT)SigmaPPM(Z.Bench)ProcessBenchmarks934233-1.28899788-1.51ProcessDemographics900Opportunity:Nominal:LowerSpec:UpperSpec:Units:Characteristic:Process:Department:Project:Reportedby:Date:Report1:ExecutiveSummary05010001000200030004000IandMRChartObserv.Mean=1750UCL=3296LCL=204.30100020003000R=581.2UCL=1899LCL=090053.913446.11Potential(ST)CapabilityProcessToleranceSpecificationsIIIII900-247.783747.80Actual(LT)CapabilityProcessToleranceSpecificationsIIIIIPpkPpCpkCpPPMYieldP.TotalP.LSLP.USLZ.ShiftZ.BenchZ.LSLZ.USLStDevMeanSTLTCapabilityIndicesDataSource:TimeSpan:DataTrace:1750.01563.63-1.51-1.51-0.230.9342330.9342336.57667934233-0.501750.01663.89-1.28-1.28-0.230.8997880.89978810.0212899788-0.43Report2:ProcessCapabilityforY4P0.005,Y1呈偏态性分布,中位数为3分33秒,25%及75%位数分别为:1分25秒及10分33秒。数据离散性较大。Analyze24002000160012008004000MedianMean500450400350300250200Anderson-DarlingNormalityTestVariance258184.39Skewness1.68549Kurtosis2.53666N127Minimum1.00A-Squared1stQuartile85.00Median213.003rdQuartile633.00Maximum2568.0095%ConfidenceIntervalforMean343.2110.29521.6795%ConfidenceIntervalforMedian186.74267.5595%ConfidenceIntervalforStDev452.38579.65P-Value0.005Mean432.44StDev508.1295%ConfidenceIntervalsSummaryforY1AnalyzeP0.05,Y2呈正态分布,均数2分43秒，标准差1分15秒.36030024018012060MedianMean180170160150140Anderson-DarlingNormalityTestVariance5664.90Skewness0.490286Kurtosis-0.076721N127Minimum20.00A-Squared1stQuartile112.00Median152.003rdQuartile215.00Maximum384.0095%ConfidenceIntervalforMean149.420.67175.8595%ConfidenceIntervalforMedian140.96172.0495%ConfidenceIntervalforStDev67.0185.86P-Value0.078Mean162.64StDev75.2795%ConfidenceIntervalsSummaryforY2AnalyzeP0.05,Y3呈偏态性分布,中位数为16分52秒,25%及75%位数分别为:11分30秒及26分36秒。Y3所占时间长，数据离散性大，因此是改进的重点。3000240018001200600MedianMean1300120011001000900Anderson-DarlingNormalityTestVariance372305.7Skewness0.776419Kurtosis0.339086N127Minimum148.0A-Squared1stQuartile690.0Median1012.03rdQuartile1596.0Maximum3215.095%ConfidenceIntervalforMean1047.81.511262.195%ConfidenceIntervalforMedian920.01197.895%ConfidenceIntervalforStDev543.2696.1P-Value0.005Mean1154.9StDev610.295%ConfidenceIntervalsSummaryforY3Analyze25%9%66%123各时间段所占比例Y3所占比例最大，且此时报告单已可随时发放，因此，如何优化此环节的流程，是改进的重点；Y2最短，Y1较长，实际上Y1主要决定于前面余下的未打印的报告单数目，显然亦与打报告速度直接相关，Y1+Y2比例达34%，因此提高打报告单速度又是另一个需改进的重点。不同检查医生对于报告打印完毕后送出时间有明显差异，这与服务意识有关，在候诊人员取报告后还增加了自主取报告单次数。不同检查医生Y3分析AnalyzedoctorY36543213500300025002000150010005000676.51221.59301598.51285978BoxplotofY3vsdoctorOne-wayANOVA:Y3versusDOCTAnaly