運用精實管理提升護理人員準時下班達成率之專案

A Projects of Use Lean Management to Improve the AverageRate of Nursing Staff Off Duty on Time

10.6692/KJN.202304_40(1).0003

戴瑞芬(Jui-Fen Tai)；劉瓔宜(Ying-Yi Liu)；林麗英(Li-Ying Lin)

精實管理 ； 價值溪流圖 ； 即時傳呼系統 ； 準時下班 ； Lean Management ； Value Stream Mapping ； Instant Call Help System ； Off Duty On Time

高雄護理雜誌

40卷1期（2023 / 04 / 01）

26 - 40

繁體中文;英文

護理人員因工作流程繁瑣，容易延遲下班，也讓工作效能及滿意度降低，影響身心健康。調查2016年8-11月4個護理單位，發現準時下班達成率平均只73.6％，工作效能滿意度平均只2.9分（1－5分評量），故成立專案小組，並設定目標值為準時下班達成率由73.6％上升至93.5％。運用精實概念中八大浪費與價值溪流圖實證發現，造成延遲下班原因為：書寫護理過程紀錄耗時、困難注射、聯繫醫師藥物到期及聯繫醫師填寫自費同意書及簽章。經確立問題，擬定解決策略包括：運用精實管理手法：價值流圖、目視化、自働化等創新手法，精簡護理紀錄模式、自動帶入會診紀錄、成立神射手及研發「即時傳呼系統」、運用資訊完成醫師簽章與提示系統，並標準化。經改善後，準時下班達成率由73.6％提升至96.3％、工作效能滿意度由2.9分提升至3.8分。2018年效果維持，達成率更達98.8％。經由跨單位合作以精實管理概念與手法，刪除工作流程中不必要的浪費流程，有效提升護理人員準時下班達成率，創造出精實的價值。

Owing to heavy workload and cumbersome workflow, it is easy for clinical nursing staff to confront delays in work, leading to reduced satisfaction of work effectiveness, thereby affecting physical and mental health. In a survey of four care units from August to November 2016, we found the average rate of nursing staff being off-duty on time was only 73.6%, but the average satisfaction rate of work efficiency was only 2.9 points (via the five-point method). Using the empirical results of the eight wastes and value stream map in Lean Management, the following reasons for the delays in getting off work were found: writing up the record of the nursing process, difficult injections, and contacting the physician for the expiration of drugs and requiring his/her signature for the self-paying consent form. The average rate of nursing staff off-duty on time increased from 73.6% to 96.3% by using the methods in Lean Management as follow: standardization, value stream maps, visualization, signal boards and automation, etc. By streamlining the nursing recording mode and automatically bringing in consultation records, setting up a team for smooth injection flow and developing a real-time contact system, the use of information systems to complete the physical signature and a reminder system was enhanced. Then, we standardized these methods. Finally, the average rate of nursing staff off-duty on time increased from 73.6% to 96.3%, and the average satisfaction rate of work efficiency increased from 2.9 points to 3.8 points. This effect continued from January to August 2018, where the average rate of nursing staff off-duty on time increased to 98.8%. Through cross-unit cooperation with Lean Management and removing unnecessary waste progress in the workflow effectively improved the rate of nursing staff off-duty on time.

1. 尤琇慧、張麗銀、彭素貞(2018)．精實思想管理以傷口照護流程為例．領導護理，19(1)，13-21。https:// doi.org/10.29494/LN. 201803 19(1).0002
   連結：
2. 柯雅婷、王秀紅、許素珍(2016)．運用組織轉變改善護理人員延遲下班問題．領導護理，17(4)，58-70。https://doi.org/10.29494/LN.201612
   連結：
3. 黃麗玲、黃薇瑄、葉德豐、鍾燕宜、林川雄、黃建財(2015)．護理人員超時工作與疲勞之相關性分析．休閒運動保健學報，(8) ，10-25。 https:// doi.org/10.6204/JRSHP.2015.08.02
   連結：
4. 張彩秀、張淑萍、陳妮婉(2013)．護理人員工作時數與工作滿意度之關係探討．弘光學報，69，12-25。
   連結：
5. 張麗銀、張瑛瑛、彭素貞、尤琇慧(2017)．護理品質監測系統之精實資訊流策略與成效．榮總護理，34(3)，289-298。 https://dx.doi.org/10.6142/VGHN.34.3.289
   連結：
6. 蘇麗卿、張世芬、蔡貴蘭、古秋雲、方玉瓊(2016)．提升肝膽腸胃內科病房護理師準時下班之專案．馬偕護理雜誌，10(2)，40-49。https:// doi.org/ 10.29415/JMKN.201607 10(2).0004
   連結：
7. Bae, S. H., & Fabry, D. (2014). Assessing the relationships between nurse work hours/overtime and nurse and patient outcomes: systematic literature review. Nursing outlook, 62 (2), 138-156. https:// doi.org/10.1016/ j.outlook.2013.10.009
   連結：
8. Bercaw, R. (2017). Lean leadership for healthcare: approaches to lean transformation. Productivity Press.
   連結：
9. Chang, T. H., Chang, S. P., & Chen, N. W. (2013). The relationships between nurses’ work hours and job satisfaction. Hungkuang Academic Review, (69), 12-25.https:// doi.org/10.6615/HAR.201303.69.02
   連結：
10. Kadarova, J., & Demecko, M. (2016). New approaches in lean management. Procedia Economics and Finance,39, 11-16. https:// doi.org/10.1016/ S2212-5671(16)30234-9
    連結：
11. Oshodi TO, Bruneau B, Crockett R, et al. The nursing work environment and quality of care: content analysis of comments made by registered nurses responding to the Essentials of Magnetism II scale. Nurs Open.2019;6:878–888.
    連結：
12. Tai, J.F., Yang,T.L., Juang,W.C., & and Lin,L.Y(2022).Effects of an Intranet-Based Call-for-Help System onTeamwork, Work Efficiency, Job Satisfaction, and Job Stress in Nurses. Journal of Patient Safety, 62(2),1004-1009.
    連結：
13. Zicko CJM, Schroeder LRA, Byers CWS, et al. Behavioral emergency response team: implementation improves patient safety, staff safety, and staff collaboration. Worldviews Evid Based Nurs. 2017;14:377–384.
    連結：
14. 陳起(2017，6月)．精實3P的改善應用･於臺灣醫療品質協會主辦之精實醫療研討會．台中：澄清醫院中港分院。
15. 莊孟蓉、蔣佳綺、陳琮琳、賴昭翰(2018)．探討加護病房護理人員工作負荷與逾時下班之關係-以南部某醫學中心為例．志為護理-慈濟護理雜誌，17(4)，63-75。
16. 勞動部(2023，01月05日)･工時制度及工作彈性化措施介紹･取自http://www.mol.gov.tw/topic/3067/14530/14533/
17. 鄭紹宇(2017)･精實醫院:提升醫療品質、病人安全與員工素質(初版)･合記。
18. Lingard L, Espin S, Evans C, et al. The rules of the game: interprofessional collaboration on the intensive care unit team. Crit Care. 2004;8:R403–R408.