精實管理於精神科病房護理交接班之應用

The Utilization of Lean Management in Nursing Handover at a Psychiatric Acute Ward

10.6224/JN.202010_67(5).09

郭旭展(Hsu-Chan KUO)；魏品菁(Ping-Ching WEI)；張以智(Yi-Chih CHANG)；洪翠妹(Tsui-Mei HUNG)；鄒淑萍(Shu-Ping CHOU)

精實管理 ； 交接班 ； 精神科 ； lean management ； handover ； psychiatric

護理雜誌

67卷5期（2020 / 10 / 01）

65 - 73

繁體中文

背景：交接班乃確保照護品質及病人安全的重要工作，本精神科急性病房察覺在護理交接過程中存有低價值工作導致效能下降。目的：運用精實管理改善精神科病房護理交接流程。解決方案：為有效找出導因並解決問題，專案小組運用精實管理的價值流程圖分析，發現造成交接流程不順的原因為動作浪費、等待浪費及不良浪費。依循精實管理原則，在集思廣益及決策、成本效益矩陣輔助下，訂立改善方案包括視覺化點班、調整交接模式、更改交接地點及系統化交接班。結果：精實管理可有效將點班時間由5分鐘縮短為2分鐘，改善達60%；等待時間由114分鐘縮短為49.6分鐘，改善近56.5%；交接內容有效性則由66%提升至90%。結論：精實管理的應用有助於發現問題並減少浪費，進而提升效率而有效改善交接班，使護理工作在日益複雜的環境中發揮價值及效益。

Background & Problems: Efficient handover is essential to ensuring high levels of caring quality and patient safety. In our psychiatric acute ward, it was noticed that there were many valueless tasks being performed during the nursing handover process that negatively affected efficiency. Purpose: To apply lean management principles to improve the nursing handover process in the psychiatric acute ward. Resolution: In order to find the rightful solution, our task team analyzed the problem using the Value Chart of Lean Management and detected that the handover process was slowed down by motion, waiting, and defects. According to the rules of lean management, group discussion, decision making, and the cost-benefit matrix, we proposed improvement solutions including visual stocktaking, adjusting handover patterns, switching the handover location, and systematizing nursing handover procedures. Results: The time required for stocktaking was shortened from 5 to 2 minutes (60% improvement). The waiting time was shortened from 114 to 49.6 minutes (56.6% improvement). The efficiency of the handover process increased from 66% to 90%. Conclusions: Applying lean management principles helped detect critical problems and reduce waste, which enhanced efficiency, improved handover, and helped maximize nursing value and benefit in an increasingly complex environment.

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