看護とケアのジャーナル

Analysis of the Implementation and Systematization of a Nursing Office in a Specialized Lithotripsy and Endourology Unit Following the Lean Healthcare Methodology

Abstract

Gadea P and Budia Alba A

Objective: To evaluate the effectiveness and patient satisfaction of the implementation and systematization of a specialized nursery office in a Lithotripsy and Endourology Unit following the Lean Healthcare methodology.

Material and Methods: A total quality project management (TQPM) was developed in 2012 and applied in a Lithotripsy and Endourology Unit from a tertiary public Spanish hospital. The initial phase of the BPM was to evaluate the outcomes of our clinical practice and to identify improvement opportunities. The office process is the initial contact of the patient with the Unit in which is made a treatment decision. One of the main steps in the office process was the implementation and systematization of a specialized nursing office. To evaluate the implementation and systematization several indicators were designed and used. A specific satisfaction survey was designed and used for calculating the satisfaction index.

Results: A total of 5510 office processes were included and analyzed from 2014 to 2019. The initial organization and implementation of the nursing office into office process showed an improvement of the perception of information care quality. The posterior systematization of the tasks showed an improvement in the analysis of the office time. The percentage of patients that took more than 60 minutes for office visit was reduced significantly over the years until a value of 9% in 2018. The detailed analysis of the times by stages into the office process showed a reduction of the nursing office assessment time in more than 2 minutes (from an average of 14.56 in 2016 to 12.03 minutes in 2019). It allowed increasing the number of total nursing office visits in the last year (a total of 346 visits more). There was a global satisfaction increase from 90% to 98% in these years after achieving the improvement of the times.

Conclusion: The implementation and systematization of a specialized nursery office in a lithotripsy and Endo- Urology unit increases assistance quality and patient satisfaction. Lean methodology can effectively be applied to improve efficiency.