毕业论文（设计）精益六西格玛在医院药品供配流程改进中的应用研究.pdf

硕士研究生论文精益六西格玛在医院药品供配流程 改进中的应用研究：摘要精益是一种服务理念，它通过消除一切在服务过程中出现的浪费，使流程 中的所有活动都能够为客户创造价值，达到在最短时间内、最大程度满足客户 需求的目标。六西格玛管理是通过减少波动、不断创新、质量缺陷达到或逼近 百万分之三点四的质量水平，以实现顾客满意和最大收益的系统科学。不改善 质量就不能把速度提高到最快，不提高速度也不能最大限度的改善质量。精益 六西格玛结合了促使公司成功的关键工具一一精益生产和六西格玛，这两种方 法论相互作用、相互补充，既有精益生产关注的过程速度，又有六西格玛一贯 提倡的过程质量，同时运用精益和六西格玛，能更快地获得更多的投资回报率，同时运用精益的工具去除非增值步骤和六西格玛优化过程的工具，可以创造一 个最佳的企业文化来保证精益六西格玛的实施。精益六西格玛管理作为一种先 进的质量管理方法，几乎涉及到医院管理的各个领域。医院作为特殊的服务机构，其直接作用对象是人的生命健康，故对质量的 要求远远超过其它行业。因此，医院管理者要转变观念，引入优秀的企业管理 方法以提高医院的综合竞争力，提高医院竞争水平。本研究项目将先进的精益六西格玛管理理念应用到医院管理当中，培训医 院行政管理和药房药库人员，并通过他们持续推进医院流程优化，从而降低医I中文摘要院运营成本、提高服务质量。此项变革打破了传统工作习惯，创造了全新的做 事方法和思维方式，再造了药品供应流程，为提高医院竞争水平和创建务实的 医院文化打下一个坚实的基础。本研究分二部分内容：第一部分项目评估目的确定医院药房药库进行精益六西格玛改善的必要性，组建精益六西 格玛改进团队，进行相关培训。方法 观察医院药房药库药工作环境、药品布 局现状，初步跟踪药品供配流程，绘制大致流程图，按照精益项目界定方法，寻找各个环节存在的基本问题。结果 药房药库存在的问题主要有：（1）药品 放置无序，不定点、定位，分类模糊，缺乏可视化管理；（2）硬件设备布局不 合理，工作环境零乱；（3）药品供配流程复杂，重复环节过多，造成不必要的 浪费。结论药房药库管理和药品的供配流程中存在诸多的问题，有必要采用 精益六西格玛管理方法进行改进，以提高工作效率，减少浪费。第二部分项目研究项目一运用精益六西格玛理念实现药房的5s管理目的 运用精益六西格玛管理中的5s等管理工具，对药房实施5s改进，创造良好的工作场所和空间环境，并最终提升人员素质，造就一个高素质的优 秀群体。方法组织团队人员参观门诊药房工作环境，客观掌握药房现状，根据 5S管理原则，采用头脑风暴和群策群力方法，收集现有问题，进行归纳，制定 改进方案。根据改进方案，组织团队人员分工负责，进行现场改进，并制定后 续改进计划。结果 药房存在的主要问题有：（1工作环境布局不合理；（2）药品分类不明确，缺乏可视化管理；（3）工作环境零乱。改进的主要措施有：（1）清除不用文件；（2）分类整理药品；（3）改善作业环境。结论 通过对我院药 房实施5s管理改进，创造出了一个干净、整洁、舒适、科学合理的工作场所和 空间环境，提高了工作效率，减少了场所浪费，为医院其它工作环境的改进提 供了模板。项目二运用精益六西格玛理念实现药库的可视化管理目的利用精益六西格玛管理中的相关工具，对药库实施可视化管理，使 药库的药品在库房内的存放处于柜、面、层、区、码目的区分状态，达到药品 的摆放定点、定位、定量，并和计算机联网，实现药品存放的可视化状态。方 法根据可视化管理原则，组织团队人员对药库进行现场诊断，收集问题，制 定改进方案利用可视化管理的基本工具，包括剪刀、纸条、胶带和白板笔等,根据拟定改进方案，进行现场改进。结果用定点、定容和定量的手段，充分硕士研究生论文利用现场空间，对药品进行标示和定位，药库工作环境变得规范、整洁、有序。各种药品均按类别划分，集中放置，按规定的位置和顺序摆放，并被清楚地标 示出来，初步实现可视化管理，工作人员能够迅速找到所需药品。结论 药库 是可视化管理典型的改进环境。通过改进，初步实现了药库的可视化管理状态，在后续的改进中仍需要不断发现问题，做到持续改善。项目三运用精益六西格玛理念改善医院药品供配流程目的运用精益六西格玛工具，在我院的药品供配流程改进中减少浪费和 过程中的非增值因素，再造药品供配流程，以达到流程的优化，降低运营成本 的目的。方法 组织人员分工跟踪药品供配流程的环节，绘制详细的流程图，采用头脑风暴法，分析流程中的增值和非增值步骤，绘制价值流图，计算过程 周期效率，识别过程中的浪费环节，进行改进模拟。结果 根据流程中的浪费 分析，主要包括以下几个方面：（1）电子信息化建设问题；（2）药房药库布局 和可视化管理问题；（3）药库位置选择和运输工具问题；（4）整个药品供应的 简单流程和药品分布问题。改进模拟的措施主要包括：加强信息化建设，药房 药库的可视化管理（已在5s管理项目中完成），更改供配流程，减少药库库存，：药库的重新选址，运输和储藏工具的改善。结论通过流程分析和改进，再造 了药品供配流程，减少流程中的浪费环节和行为，提高了流程效率。项目四运用精益西格玛管理方法缩短患者取药等候时间目的 运用精益六西格玛工具，分析门诊取药流程中延长患者等候时间的 缺陷，对流程进行优化改进，以缩短患者等候时间，提高患者满意度。方法 组 织人员分工跟踪门诊药房取药环节，绘制详细的流程图，分析流程中的增值和 非增值步骤，绘制价值流图。通过价值流图分析，影响患者取药等候时间长的 主要原因电脑信息的遗漏和传送带传输缓慢。识别过程中的浪费环节，进行改 进，绘制改进后的价值流图，评估分析改进后的结果。结果 改进后的流程主 要采用人工操作，消除了原有流程中主要影响患者等候时间的电脑信息遗漏和 传送带传输缓慢问题以及操作人员的重复操作浪费环节，患者等候时间由原来 的18min减少到8.5min,明显得到了提高。结论 通过门诊取药流程的改进，整个流程变得更为简捷、高效，患者等候时间得以减少，并提高了工作效率和 患者的满意度。关键词：药品供配流程精益六西格玛5S可视化管理ill硕士学位论文A study of management improving of pharmacy,drugstore and Process of Medicine Supply and Distribution in the Hospital by Applying the Concept of Lean Six Sigma ABSTRACTLean theory is a concept of service,which achieves the goal to satisfy customer demands to the largest extent within the shortest time by eliminating all the waste in the process of service in order to create values for customers in every activity.Six Sigma Management is a systematic science that fulfllls customer expectations and maximizes their profits via lessening fluctuation,constantly innovating,as well as controlling quality defect up to 0.00034%.It is impossible to maximize the pace without improving the quality.Likewise,it is impossible to improve the quality to the largest extent without quickening the pace.With both the processing speed that Lean production is concerned about and the processing quality that Six Sigma has always been promoting,Lean Six Sigma combines the two crucial means to the success of the company,namely,Sean production and Six Sigma Management.These two means interact with and complement each other.By applying both Lean and Six Sigma at the same time,more investment returns are able to be gained at a faster pace.The simultaneous application of both Lean means to eliminate non-value-added steps and Six sigma means to optimize the process enables the creation of the optimum organizational culture to ensure the implementation of Lean Six Sigma.Lean Six Sigma management is an advanced method for quality management,which reaches nearly every field of hospital management.Hospital being a special service institution,its direct target is peoples health,ABSTRACTthus,its quality requirements far surpass those in other professions.Consequently,managers in hospitals have to change their conception and introduce excellent business management methods so as to enhance hospitals comprehensive competitiveness.Therefore,applying the advanced management concept of Lean Six Sigma to hospital management will extremely increase hospitals competitiveness.This research project trains managers in our hospital and staff in the dispensaries and the pharmaceutical storerooms with the concept of Lean Six Sigma,and constantly optimizes the process of hospital service in order to reduce hospital operation costs and improve service.This change breaks free from the conventional working customs,innovates a brand-new way of doing and thinking,renews the process of medicine supply,and establishes a pragmatic hospital culture in the course of continuous improvement.This research consists of the following four parts:Part I Project EvaluationObjectives This part determines the necessity of improving the service in the dispensaries and the pharmaceutical storerooms with Lean Six Sigma,and forms a Lean Six Sigma improvement team with related training.MethodsThis part observes the working environment in the dispensaries and the pharmaceutical storerooms,as well as the current medicine distribution,tracks the process of medicine supply and distribution at the preliminary stage in order to draw a rough flowchart,and finds out the fundamental problems existing in every sector on the basis of the defining methods in the Lean project.ResultsThe main problems existing in the dispensaries and the pharmaceutical storerooms are as follows:(1)The disorderly placement without fixed position of the medicine goes against ergonomics.Furthermore,the classification is ambiguous,and the medicine lacks visualization management;(2)The hardware devices are inationally positioned,and the working environment is in a mess;(3)Unnecessary waste is caused by both the complex process of medicine supply and distribution and too many overlapping sectors.ConclusionsIt is necessary to form a Lean Six Sigma improvement team to improve the process of medicine supply and distribution in the dispensaries and the pharmaceutical storerooms so as to increase efficiency and reduce waste.Part II The Realization of the 5S Management in the Dispensaries by硕士学位论文Applying the Concept of Lean Six SigmaObjectivesThis part applies the 5S management means in the concept of Lean Six Sigma,to the dispensaries,creates a favorable workplace and environment,and ultimately,forms an excellent team with high quality by enhancing the quality of each team member.MethodsThis part organizes the team visit to the dispensaries in order to keep them objectively informed on the present working environment there,and works out an improvement program for the existing problems by the brainstorming of the whole team on the basis of the 5S management.Each team member is responsible for part of the improvement program,improving the present condition as well as working out the follow-up improvement plan.ResultsThe main problems existing in the dispensaries are as follows:(1)The irrational layout of the working environment;(2)The indefinite classification of the medicine and lack of visualization management;(3)The messy working environment.The major improving measures are:(1)Clearing away those files of no use;(2)Systemizing the medicine with clear classification;(3)Improving the working environment.ConclusionsBy applying the 5S management to our dispensaries,a neat,tidy,comfortable,and scientifically rational workplace and environment are created,providing an improvement model for the other working environments in the hospital by enhancing work efficiency and reducing waste.Part III The Realization of the Visualization Management in the Pharmaceutical Storerooms by Applying the Concept of Lean Six SigmaObjectivesThis part applies the visualization management in the concept of Lean Six Sigma to the pharmaceutical storerooms,stores medicine in accordance with different grades of cupboards,levels,layers,districts,and codes,and realizes the visualization management of medicine storage by both computer network and storing fixed quantity of medicine in fixed positions.MethodsABSTRACTThis part organizes the team visit to the pharmaceutical storerooms in order to keep them objectively informed on the present condition there,and works out an improvement program for the existing problems by the brainstorming of the whole team on the basis of visualization management.Each team member is responsible for part of the improvement program,improving the present condition as well as working out the follow-up improvement plan.ResultsMedicine is marked and positioned by the means of fixed position,fixed capacity,and fixed quantity,and a standardized,neat,and orderly working environment is created by making full use of the present space.All sorts of medicine is classified with clear marks and orderly placed in fixed positions.The visualization management is realized at the preliminary stage that staff is able to pick out the wanted medicine promptly.ConclusionsThe pharmaceutical storeroom is a representative environment to be improved by the visualization management.The improvement realizes the visualization management at the initial stage,but the continuous follow-up improvement is required by the coming problems.Part IV The Improvement of the Process of Medicine Supply and Distribution in the Hospital by Applying the Concept of Lean Six SigmaObjectivesThis part applies the means in the concept of Lean Six Sigma in order to reduce waste and non-value-added factors in the process of medicine supply and distribution in our hospital,and renews the process to optimize it and reduce operation costs.MethodsEach team member is responsible to track part of the detailed process of medicine supply and distribution in order to draw a detailed flowchart.This part brainstorms the value-added and non-value-added steps in the process in order to draw the value flowchart,and calculates the periodic efficiency of the process in order to find out the waste steps fbr simulated improvement.ResultsThe waste is analyzed to exist in the following steps:(1)The construction of electronic informationalization;(2)The layout in the dispensaries and the pharmaceutical storerooms,as well as the visualization management;(3)The selection of the location of the pharmaceutical storerooms and the transportation;(4)Medicine distribution and its simple process.硕士学位论文The major simulated improving measures constitute the strengthening of the construction of informationalization,the visualization management in the dispensaries and the pharmaceutical storerooms,which has already been accomplished in the 5S management project,the alteration of the offering process,the reduction of the number of dispensaries and pharmaceutical storerooms,the relocation of the pharmaceutical storerooms,and the improvement in transportation and storage.ConclusionsThe process of medicine supply and distribution is renewed through its analysis and improvement,reducing waste and increasing efficiency and patients,satisfactions.Part V The Shortening of the Patients9 Waiting Time for Medicine by Applying the Concept of Lean Six SigmaObjectivesThis part applies the means in the concept of Lean Six Sigma in order to analyze and improve the defects in the process of fetching medicine from the clinic.MethodsEach team member is responsible to track part of the process of fetching medicine from the clinic in order to draw a detailed flowchart.This part brainstorms the value-added and non-value-added steps in the process in order to draw the value flowchart,and analyzes the major causes for the patientsJ long time waiting period for medicine,such as the missing of computer information,the slow movement of the conveyer belt,and the double signature problem in the process of medicine distribution.Improvement can be made by finding out the waste steps,and the improved value flowchart can be drawn to evaluate the improved outcome.ResultsThe improved process is manually operated,which eliminates the waste steps of the major causes for the patients long time waiting period for medicine in the original process,such as the missing of computer information,the slow movement of the conveyer belt,and the repeated operation.Consequently,the waiting time has been greatly shortened from 18 minutes to 8.5 minutes.ConclusionsThe improvement of the process of fetching medicine from the clinic simplifies and quickens the whole process,and the analysis of the highly effective process reduces waste,and increases the efficiency and the patients,satisfaction.KEYWORDS:Medicine;Offering Process;Lean Six Sigma;5S;Visualization Management硕士学位论文刖 B随着我国经济的快速发展，服务行业的竞争日趋激烈。在服务业里顾客眼 中的非增值成本要远高于制造业。服务速度的提高和服务质量的改进对收入的 增长有相当大的潜力，同时这样的改进成果能给组织带来强大的竞争优势，以 在竞争日趋激烈的市场中占有一席之地。医院作为特殊的服务机构，其直接作用对象是人的生命健康，故对质量的 要求远远超过其它行业。我国入世之后，医疗市场逐步开放，已由相对封闭的 状态随着外资、私有资本的加入而被打被，医院为争取更多的病人，就必须不 断提高服务的质价比。医疗服务也在向始于患者需要，终于患者满意模式转化，而质量管理是形成这些工作的核心，也是决定医院利润和发展的决定性因素。随着医学科学技术的不断发展，三级分科越来越细，各种检查技术也越来越多，加上人们生活节奏的加快及日门诊量的增加，提高医疗护理工作的增值服务质 量、提高患者满意度、大幅度减少人、物和设备的闲置时间、工作切换时间、库存、工作中的非增值行为和流程，降低医院运营成本，已是医院管理工作的 当务之急。因此，医院管理者要转变观念，引入优秀的企业管理方法以提高医 院的综合竞争力。有鉴于此，我们将先进的精益六西格玛管理理念应用到医院管理当中，培 训医院管理人员和药房、药库人员，并通过他们持续推进医院流程优化，从而 降低医院运营成本、提高服务质量。此项变革打破了传统工作习惯，创造了全 新的做事方法和思维方式，再造了药品供应流程，并在不断的改善过程中为创 建务实的医院文化打下了坚实的基础。硕士学位论文第一部分项目启动1项目评估通过现场调查、流程跟踪和业务咨询，了解我院药房药库管理和药品供配 流程基本状况，发现存在的主要问题。L1药库1.1.1 基本情况(1)面积5501n2,其中冷库40m位于一栋4层楼房的顶层。(2)库存：1,800万人民币价值的药品，药品有效期一般为18至24个月。(3)库存种类：主要是针剂和片剂，不包括大输液，按药理分为30余种，药品种类约16501700种，其中基础用药20余种。(4)每批采购的药品从入库到全部出库周期一般在一个月左右。(5)药库每周向各药房送药一次，药房作计划提单到收到药的周期为一周。(6)药库现共有六个工作人员：2个库管，1个物价，1个记账，1个采购，1 个会计。(7)药品供应商约65个。1.1.2 主要存在问题药品放置无序，不定点、定位，分类模糊，缺乏可视化管理。1.2门诊药房1.2.1 基本情况(1)位于门诊大楼一层，在同楼地下一层另有一个门诊附属药库。(2)普通药房有8个发药窗口，一般开4个左右，周一和其它高峰时间根据 情况增开窗口。(3)普通药房开放时间为每日早上8:30至下午5:30,包括周末，每天晚上关 闭。(4)急诊药房在门诊药房侧面，与普通药房连通。(5)急诊药房24小时开放，常备药约280种，在医院转到地方之前曾作为白 天急诊和军人内部优先的发药窗口，但现有领药优先机制不明确。1.2.2 曾经的辉煌门诊药房建于90年代初，设计曾经充分发挥精益思想。普通药房配药和发 药之间有一到屏风，通过一条传送带连接，充分发挥了运营学中的“游泳池效 应(pooling)传送带是由药学部陈主任在80年代末受日本机场的行李传送带 3项目启动启发，由医院在90年代初自发设计OEM并建造。传送带转一周为3分6秒，而一般配药时间为1分半钟到两分钟左右，传送带速度与配药速度配合无间。门诊药房的货架设计也曾经使用精益思想，在80年代末90年代初，药品多为 散装，配药时分装在纸袋，因此药柜由大量不锈钢抽屉组成，不锈钢抽屉有大 和小两个型号，每种抽屉放一种药品。两组药柜组成一个配药操作空间，在90 年代初，一个操作空间的药柜可以放下同一种类的全部药品，每一个配药人员 在两组药柜中间工作，不需要多余的走动。1.2.3 主要问题硬件设备、布局不合理；药品摆放分类不明确；药品未按照使用频率摆放,使工作人员增加了很多多余的动作如：弯腰、爬高、来回走动等；药架侧面有 药品目录，但正面无药品名称标识；没有急诊用药目录：门诊药房内生活区域、配药区和办公区域没有明显界限，人员进出通道上摆放药品，缺乏监管机制。1.3药品配送流程基本情况13.1药品配送流程（图1-1）1.3.2主要问题流程复杂，重复环节过多。针对目前药房、药库管理和药品配送流程中存在的主要问题，根据三M原 则（有意义的、有价值的、可执行的），本课题在研究中将精益六西格玛管理理 4硕士学位论文念应用到了药房、药库的管理中，确定了四个改善项目，分别是药房的5s管理、药库的可视化管理、运用精益西格玛理念缩短患者取药等候时间和药品供配流 程的优化。2高层承诺和团队组建精益六西格玛项目