運用精實方法改善檢驗作業流程之實證研究

An evidence-based study applying lean methodology to improve processes in a hospital laboratory

目的：為消除醫院檢驗作業流程的浪費，將國外精實生產系統改造醫院的經驗，運用到個案醫院的檢驗作業流程。方法：運用精實生產系統之「確認價值、確認價值溪流、暢流、後拉式及完善」五大原理，導入自動化系統及自動驗證，改善緊急與常規之血液、尿液、生化檢驗三大作業流程。結果：個案醫院檢驗部門在導入精實生產系統的方法後，檢驗空間減少63.4 平方公尺，生化檢體的傳送距離減少13.3 公尺。血液檢驗流程，緊急與常規檢體的平均週轉時間（Turnaround Time, TAT）在改善後分別下降27% 與66.4%；尿液檢驗流程，緊急與常規檢體的平均週轉時間在改善後分別下降31% 與58.9%；生化檢驗流程，緊急與常規檢體的平均週轉時間在改善後分別下降11.4% 與36.4%。結論：個案醫院導入精實系統可消除浪費，改善血液、尿液、生化檢驗作業流程。另外，運用精實生產系統「暢流」觀念，將常規檢體改由單件流方式進行檢驗，可明顯消除檢驗流程的浪費。本研究藉由導入精實系統，改善檢驗流程的浪費，可減少工作人員的負擔，增進檢驗服務效能，進而提升對病人高品質的醫療服務。

Objective: In order to efficiently eliminate waste in hospital laboratory processes, this case study implemented the Lean System in a hospital laboratory as had been done successfully in many foreign hospitals. Method: Lean methodology was implemented on the basis of five principles: Valuation, Value-Stream, One Piece Flow, Pull System and Perfection. Automation and auto-verification were also introduced to improve the Stat and Routine processes in hematology, urinalysis and chemistry. Results: After the Lean System was introduced, 63.4 m2 of laboratory space were freed up. In addition, the travel distance of specimens for chemistry tests was reduced to 13.3 meters. The average Turnaround Times for Stat and Routine of hematology procedures dropped 27% and 66.4%, respectively . The average Turnaround Times for Stat and Routine urinalysis procedures dropped 31% and 58.9% respectively；the average Turnaround Times for Stat and Routine chemistry procedures dropped 11.4% and 36.4% respectively. Waste in the routine transportation of specimens decreased by replacing Batch Flow with One Piece Flow. Conclusions: By applying Lean Methodology, the hospital laboratory can effi ciently decrease waste and improve the processes in hematology, urinalysis and chemistry. Improving these processes reduced staff workload and promoted effi cient service. As a result, hospitals can offer higher quality medical services to their patients.