|摘要: ||手術病理檢體的收集送檢是手術室關鍵的醫療作業，手術病理檢體可提供醫師診斷與治療之參考依據，而手術病理檢體之取得為侵入性行為，病人須承受出血、感染甚至死亡等風險。尤其手術病理檢體送檢的完整性攸關病人的安全，如在任何環節有所疏失，將影響病人的診斷、治療。若遺失檢體重複執行檢查，更讓病人面臨再度承受侵入性檢查之風險，當病理檢體送檢不完整也會增加人力處理之浪費。由此可見在醫療照護上，必須嚴加規範，制定與執行正確採集手術病理檢體、保存及運送標準，確保流程之無誤，減少檢體退件率，降低醫療之風險，實為醫療照護上重要課題之一。而現況之手術室作業流程有相當多的風險、浪費和無效率動作，因此需要一套經過驗證的方法論改善目前問題，透過應用在製造業以消除流程浪費、不安全的方法－精實思想（Lean Thinking）導入醫療領域，進而改善當前流程浪費與不安全之問題是刻不容緩之任務。因此本研究之目的是以精實變革之觀點，探討醫院應用智慧科技成功落實手術病理檢體送檢之精實醫療。
The collection and inspection of surgical pathology specimens is a key medical task in the operating room (OR). Such specimens provide physicians with a referential basis for diagnosis and treatment. The collection of surgical pathology specimens is an invasive procedure, during which patients are at risk of bleeding, infection, and even death. The integrity of surgical pathology specimen inspection is crucial to patients’ safety, and any missing links may affect their diagnosis and treatment. Furthermore, reexamination of missing specimens puts patients at greater risks related to invasive examination. The incomplete inspection of pathology specimens increases human resource usage. Thus, medical care requires the introduction of stricter norms; establishment and practice of correct collection, storage, and transportation of surgical pathology specimens; elimination of mistakes in the process; reduction of specimen rejection rates; and reduction of treatment risks. Current OR processes are characterized by multiple risks, a high level of wastage, and ineffective actions. Therefore, a proven method must be used to address existing problems. It is thus necessary for lean thinking—normally used in the manufacturing industry—to be implemented in medical care to address methods that are risky and cause process waste. Accordingly, this study explored the use of lean healthcare in surgical pathology specimen inspection implemented through smart technologies.
The research objective was the use of lean healthcare by a medical center for surgical pathology specimen inspection. In-depth interviews, field observations, and relevant secondary data collection methods were used to explore informatization and the application of surgical pathology specimen inspection from the perspective of lean healthcare, as well as benefits and obstacles in systematic development. Data were analyzed and discussed using the content analysis method.
The data analysis results can be summarized according to five lean principles:
1.Specify value: The value of treatment activities related to surgical pathology specimens is patient safety, which must be ensured and protected in the process of relevant inspection. The correct actions and timing can reduce delay- and mistake-related risks.
2.Identify the value stream: The confirmation of the value stream, including the informatization of the surgical pathology specimen inspection process, can contribute to cooperation within surgical teams and reduce complications related to traditional manual processes, paper waste, and other waste and errors. Information management tasks include the informatization of all operations related to list compilation, pathology specimen collection, and inspection completion. On-the-job education and systematic testing can be provided to ensure the effective collection, delivery, and management of information in the overall process. This can reduce process-related waste and increase the safety of operational processes because of an absence of man-made mistakes, thereby transforming the current unfavorable situation into a more ideal value stream.
3.Flow: Three core steps exist in flow establishment. The first is to perform an overall examination of the design of surgical pathology specimen inspection from beginning to completion in order to determine problems influencing the flow. The second step is to solve current issues and conduct on-the-job education regarding the informatization of the inspection process. A quality management center performs problem analyses, proposes improvement methods and problems occurring in the intervention of information seeds, and determines specimens for 30-minute laboratory registration and inspection. The safety protection mechanism used in specimen inspection includes a careful examination of inspection operations, which transforms the service line into a continuous flow. The final step involves rethinking specific work methods and tools to exclude repetitive and canceled processes. Thus, necessary technologies, special pathology-related facilities, and operational process norms can be established according to relevant informatization needs to avoid process waste.
4.Custom pull: The matching processes to patient needs include the coordination of patients’ pathological reports from various departments and adjustment of the specimen stream. Processing of surgical pathology accounting must be adjusted according to emergency outpatient and inpatient needs to ensure the integrity of the specimen inspection accounting procedures.
5.Continuous improvement: Problems related to the informatization of pathology specimen inspection must be addressed and solved by individual units through continuous monitoring of surgical pathology specimen quality.
The practical application of lean principles in this study effectively reduced process-related waste. Smart technologies were effectively used to monitor patient safety. The use of lean thinking was explored to improve the quality of surgical pathology specimens without increasing the use of human resources as well as to avoid process waste. The results can provide a reference for organizations currently or prospectively engaged in developing lean healthcare.