[翻译]第四篇——Addressing the Issues at Doctors Hospital of Augusta

本帖最后由 qxh622 于 2011-2-19 18:21 编辑

****第四篇已经翻译好了， 发在这里，请大家校正。
对医疗术语不是很熟悉，可能有些地方翻译的不够准确，欢迎大家及时指正！


译文和原文如下：
**Addressing the Issues at Doctors Hospital of Augusta
解决奥古斯塔的达可塔斯医院的问题**

Implementing Six Sigma has allowed Doctors Hospital of Augusta to begin winning the battles with the familiar healthcare issues related to quality, resource constraints and ensuring optimal, accessible services for the community.

By Sondra Smith
实施六西格玛已经使奥古斯塔的达可塔斯医院开始逐渐赢取与那些他们熟悉的医疗保健相关的质量问题、资源短缺和如何实现最优化配置，及如何为社区提供更易获取的医疗服务等问题之间的斗争。
——桑德拉．史密斯

Like most healthcare providers, Doctors Hospital in Augusta, Georgia, USA, has struggled with familiar issues related to quality, resource constraints and ensuring optimal, accessible services for the community. Implementing Six Sigma has allowed the hospital to begin winning the battles with these issues.
如同其他大部分医疗服务提供者一样，在美国乔治亚州奥古斯塔的达可塔斯医院，长期以来一直被那些他们熟悉的各种质量问题困扰着，包括资源短缺和如何实现最优化配置，及如何为社区提供更易获取的医疗服务等。导入六西格玛后使得医院开始逐渐解决这些问题。

In 2004, the hospital's leadership team decided to launch a new initiative aimed at improving performance throughout the organization. This effort included project-based education in Six Sigma and change management.
2004年，医院的领导团队决定推出一项新措施，目的在于提升整个的表现。这些努力包括推行六西格玛的基础教育项目和变革管理方式。

The first wave of Green Belt training began in May 2004, with 16 people selected from the hospital's staff. Initial projects targeted outpatient CT scan cycle time, wound center turnaround time, emergency department cycle time from the patient's experience, wound center accounts receivable billing, operating room turnaround time and MRI cycle time.
绿带培训的第一个浪潮始于2004年5月，从医院的工作人员挑选16个人。最初的项目目标包括：门诊病人CT扫描周转时间，创伤中心的周转时间，病人体验到的急诊科周转时间，创伤中心的应收账款的账单，手术室的周转时间和核磁共振（MRI）的循环时间。

To a certain degree, the improvement initiative at Doctors Hospital was a test case for Hospital Corporation of America, the hospital's parent organization. So far, the hospital's leadership team has been pleased with the progress and achievements.
在一定程度上，在达可塔斯医院中推行的这种主动改善行动，为美国医疗机构和其它医院的相关组织提供了一个测试案列。到目前位置，医院的领导团队对获得的进步和取得的成功都感到非常满意。

"Much of the excitement generated during our Six Sigma experience has actually come not only from the accomplishments of the teams, but also from the experience of getting together and attacking opportunities together," Shayne George, president and CEO at Doctors Hospital, said. "We have been able to gain a great deal of value during the journey, as well as the destination."
“在我们推行六西格玛的过程中，产生了很多让人激动的时刻，而大部分的这些激动不仅仅来源于小组取得的成绩，更来源于大家聚在一起和有机会一起进攻的这种体验。” 沙恩，乔治，达可塔斯医院的总裁和首席执行官这样说，“在这个过程中，除了能获得我们预定的目标外，我们还能获得更多的价值。”
Linking Six Sigma with Strategic Plans
Hospital creates a strategic plan every year, and for 2004, driving Six Sigma and achieving culture change were major themes within the plan. The hospital concentrated on establishing a clear communication plan to keep everyone informed, making sure people received training and instilling the process as the way they would work going forward.
将六西格玛和战略计划联系起来
达可塔斯医院从2004年开始为每年制定了一个战略计划，推行六西格玛和获得文化变革就是这个计划的重要主题。医院将重点建立一个清晰的沟通交流计划，来保证让每个人能获取更多信息，保证员工获得培训和按照他们想要的工作方式来推广这个过程。
Six Sigma has been viewed as supporting the organization's strategic plan in several ways:
六西格玛主要在以下几个方面支持着本组织的战略计划：
Human resources - The project-based training helped to drive a specific strategy listed under human resources retention and productivity.
人力资源——基于该项目的培训有利于推进在人力资料保有量和流动性上的具体战略的实现。
Efficiency and growth - At the division level, the hospital has an outpatient imaging and surgery taskforce focused on driving efficiency and strategic growth. One objective is to effectively compete against freestanding imaging centers by improving the customer's experience. Projects in CT and MRI specifically addressed cycle time, aimed at reducing lengthy waits, which are a major source of dissatisfaction for patients. Another objective was to increase capacity in the operating room by striving for turnaround times found in ambulatory surgery centers.
效率和增长——在部门水平上，医院的门诊成像和手术小组都致力于提高效率和战略增长，它们的一个目标就是通过提高消费者的消费体验来与独立的成像中心进行有力的竞争、而在CT和MRI部门的项目目标就明确在周转时间上，他们的目标是减少等待时间，这是一个让病人感到不满意的主要来源。另外一个目标是争取降低门诊手术中心的周转时间来增加手术室的容量。
Emergency department performance - Another strategy targeted the improvement of emergency room performance metrics, including throughput time.
急症部门的工作表现——另一个战略目标在于是改进急症室的工作指标，包括吞吐量时间。
Patient satisfaction - The hospital measures customer satisfaction each quarter using an independent survey company. In the outpatient test and treatment areas, one of the strongest drivers of satisfaction is wait time. The team knew that reducing cycle time with the CT, MRI and wound center projects would help improve satisfaction by shortening the wait time.
病人的满意度——医院每季度都通过独立的调查机构进行顾客满意度调查。在门诊测试和治疗区，最强的满意度驱动力之一就是等待时间。该团队发现，减少CT，MRI和创伤中心项目的周转时间会有效的减少等候时间，从而有助于提高顾客满意度。

Teamwork and Solutions
Beyond specific projects and measurable results in key areas, an important byproduct of this effort has been greater proficiency, collaboration and communication among the team. Challenges that face the staff on a daily basis are being addressed through a common set of tools, and the approach is resonating well within the organization.
团队合作与解决方案
除了具体的项目和在关键领域衡量的结果，这种努力的一个重要的副产品是让各团队之间更加高效、合作和沟通。员工每天面对的挑战都被一个普遍通用的工具进行评估，这种方法可在组织内部产生很好的共鸣。

Employees who went through Green Belt training said they felt as if they had received a "master's" level education. They appreciated the investment leadership had made in promoting the initiative, providing the training and recognizing their achievements.
那些通过绿带培训课程的员工说，他们感觉自己接收了一个“大师”水平的教育。他们非常赞赏医院领导在积极推进这项活动，提供培训课程上的投资，并承认他们取得的成绩。
All project teams, especially within perioperative services, received additional support as they went through each phase of their projects. Team members from various departments provided input and participated in Work-Out sessions. They contributed suggestions in areas that might be considered outside their usual scope of work.
所有的项目团队，特别是那些负责手术前后服务的团队，得到更多的支持，例如他们会通过他们项目的每一个阶段。来自不同部门的团队成员都大量的投入和参与工作会议，他们贡献建议的领域可能极大的超出了自己平常的工作范围。

Work-Out sessions, with their clear structure and focus on grassroots problem-solving, have changed the employee reactions to meetings at Doctors Hospital. A common employee complaint had been the seemingly endless meetings that did not create consensus or resolve the issues under discussion. People are beginning to use Work-Out tools in other meetings to make the meetings more focused and productive. In one session, a team was able to scope the vision, develop a toolkit and create a who-what-when plan with specific assignments - all accomplished within one hour. As more employees go through the training and gain experience applying the tools, this approach is becoming ingrained as a common framework for problem-solving. People now feel they are better equipped to solve problems and manage change.
工作会议中，他们具有清晰的组织，并专注在解决基层的问题上，这些都改变了员工们对达可塔斯医院会议的看法。一个普通员工抱怨道，过去医院的那些看上去无休止的会议并没有使大家产生共识或者也无法解决所讨论的问题。人们开始在其它会议中使用设计好的工具，从而使得会议更加具有针对性和效率。在一次会议上，某个团队扩展了人们的视野，他们开发了一套工具，并根据具体的任务创建一个是“谁-什么-何时”的计划，所有这些都在一小时内完成。随着越来越多的员工通过培训并获得应用这种工具的经验，这种方法就逐渐彻底的了大家解决问题的通用框架。现在人们觉得他们已经准备好去地解决问题和管理变革。

Making the program work also depends on determining the right level of involvement for clinicians, and making the exchange of information as efficient as possible. One of the physicians participating in the process commented that this was the first time he had been really excited about an improvement project because he could actually see data-driven progress. Six Sigma is an objective and scientific process with a natural appeal for physicians.
制作程序的工作也同样依赖于决定临床医师参与的正确水平，和做出尽可能高效的信息交流。据参与该过程的一个医师这样评论，这是他第一次真正的感受到改善项目的兴奋，因为他真能看到数据驱动的进步。六西格玛是一个客观和科学的过程，对医师们具有自然的吸引力。

Tangible and Intangible Results
Improving processes and operating as efficiently as possible in every facet of patient care is crucial for ensuring quality, managing the bottom line and raising patient and staff satisfaction. The data-driven approach also is helping the hospital to meet its compliance obligations.
With the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) survey process, healthcare providers have to be able to demonstrate that they are actually improving their performance and helping the patient. This type of rigorous, evidence-based approach is giving the organization the confidence to know it is doing the right things.
有形和无形的结果
改善流程和尽可能在病人护理的每个方面高效率地工作是确保质量的关键，同样管理底线和提高病人和员工的满意度也至关重要。数据驱动的方法正在帮助医院实现自己应该履行的义务。
随着医疗机构联合委员会（JCAHO）的评审调查过程要求，医疗机构必须能够证明，他们实际上是在改善其表现并帮助病人。这种严格的基于事实的方法给本组织提供了信心，使我们知道正在做正确的事。

All projects from the first wave are now in the Control phase. The leadership team is continuing to fine-tune processes and monitor progress, but its efforts have already paid off and delivered measurable benefits to the organization.
从第一波开始的所有的项目目前都正处于可控阶段。领导团队也在继续微调过程和监测进展，但其努力已见成效，并为组织带来了可衡量的利益。

Potential Increase in Departmental Earnings by Project
各项目在部门收入中的潜在增长
Project Process
Improvement Potential Increase
in Dept. Earnings
Operating Room:
Reducing Turnaround Time Capacity increased by 80 cases/month by reducing TAT from 39 minutes to 25 minutes. 8%
MRI:
Reducing Time from Patient to Patient Capacity increased by 22 cases/month by reducing time from 52 minutes to 45 minutes. No show reduction from 17% to 10%. 3%
Reducing Unscanned Supplies Increase in number of items scanned; improved charge capture, and decreased losses for materials used. .5%
OP CT:
Reducing Cycle Time Capacity increased by 100 cases/month by reducing cycle time from 59 minutes to 38 minutes. 8%
ER:
Reducing Cycle Time Capacity increased by 254 cases/month by reducing cycle time from 135 minutes to 120 minutes. Increase in downstream ICU and med/surg patients for increase in number of ED patients (6 cases/month in ICU and 16 cases/month med/surg). 10%
Unbilled:
Reducing Time from Patient to Coding Reduced time to code records from 13 days to 5 days. Total out-patient unbilled amount is lowest since 2003.
Wound Center:
Reducing Cycle Time Finishing implementation of improvements and remeasuring. Yet to Be Determined

各项目在部门收入中的潜在增长
项目 流程改善 在部门收入中潜在增长
手术室:
缩短周转时间 通过将TAT时间由39分钟减少为25分钟后，手术室容量增加了80例/月。 8%
MRI:
缩短病人之间周转时间 将检查时间由52分钟缩短至45分钟，使得检查容量增加了22例/月。空闲时间从17%降至10%。 3%
减少未扫描供应 增加扫描项目数量； improved charge capture, 并降低对废旧物资损失。 .5%
OP CT:
缩短循环时间 将循环时间由59分钟缩短至38分钟，容量增加了100例/月 8%
ER:
缩短循环时间 将循环时间由135分钟缩短至120分钟，容量增加了254例/月。在下游加护病房和中/外科学的ED患者的增加数量（6例/月，加护病房；16例/月，中/外科）。 10%
未入账：
缩短病人到编码的时间 将病人代码记录时间从13天减少到5天。使得所有门诊未入账的金额是降至2003年以来的最低水平。
创伤中心:
缩短循环时间 整理实施改进和重新计量。 尚未确定

In the wound center, the hospital was able to reduce turnaround time for patient visit to coding of the medical record from 13 days to just five. The improvements in cycle time for outpatient CT scans provided the capacity for an additional 100 scans each month. A Black Belt team working in MRI reduced cycle time from 52 to 45 minutes, freeing capacity for 22 additional patients per month. With reduced cycle time in the emergency department, capacity was increased by approximately 250 more patients per month. Although the project team met its goal in this area, the hospital would like to see the numbers improve even more.
在创伤中心，医院将病人周转访问医学病例编码的时间由13天减少到仅需要5天。这项在周转时间上的改进，为门诊CT扫描每月额外增加了100次检查能力。黑带团队的工作是将MRI检查周期时间从52分钟缩短至45分钟，这样每月可多检查22名患者。随着急诊部门周期时间的缩短，急诊部的接待容量每月增加了约250人。尽管各项目组已经达到了各自领域的目标，但医院更希望看到这些数字可以提高得更多。

A problem in the hospital's operating room that had lingered for a long time was room turnaround time. By applying the right tools and getting the right people into a one-day Work-Out session, the team was able to create consensus and develop a viable solution. Room turnaround time was reduced from 39 to 25 minutes, adding capacity to perform 80 additional surgeries each month.
很长时间以来医院的手术室都存在一个问题，即手术室周转时间。通过应用正确的工具和挑选正确的人进行了为期一天的工作会议，使得团队之间产生了共识并获得可行的解决办法。手术室的周转时间由39分钟缩短至25分钟，使得手术室每月额外增加了80例手术的容量。

Keeping the Momentum Growing
With the results that have been achieved so far, momentum has begun to build. Ideas for new projects are constantly rolling in. Four of the initial Green Belt liaisons are coordinating all projects during the second phase of the initiative. The hospital has integrated the entire process into the performance improvement committee. All projects - including Work-Out sessions and larger Green Belt projects - now report to this committee. The group's members comprise a major portion of the organization's JCAHO survey process. The level of information the hospital is tracking and the results it is able to demonstrate assist in reporting progress to the board of trustees and medical committees.
保持增长势头
到目前为止取得的成果，已经建立起增长势头，各种新项目的想法正在滚滚而来。在第二阶段，最初的四个绿带联络员正在协调这项倡议的所有项目。医院已经将整个流程集中到性能改善委员会。所有的项目，包括工作会议和更大的绿带项目，现在都要向委员会汇报。该小组的成员大部分是主要是由该组织的JCAHO调查过程的成员构成。医院追踪信息的水平和结果，有助于他们向董事会及医疗委员会报告取得的进步。

As requests increase, the improvement committee will continually prioritize projects, with a particular focus on increasing patient safety, clinical quality and patient satisfaction. The leadership team is putting a process in place to streamline how people make improvement suggestions.
随着需要的增加，改进委员会将继续优先改善的重点项目是：增加病人安全感，医疗质量和病人满意度。领导团队正在建立一个流程，以简化人们如何提出改善建议。

To familiarize new employees with the purpose and basics of Six Sigma, a short elevator speech on the methodology has been created. "During orientation, new employees learn that Six Sigma is a highly structured process that we began using in 2004 to evaluate and improve the way we work," said John Doriot, a Green Belt who also teaches customer service training at the hospital. "An important part of our service excellence culture is to make decisions based on data rather than opinions. We need help from all employees to identify changes that need to be made, and to support and sustain change," Being able to clearly explain the purpose of the process helps to build acceptance and encourage participation.
为了让新员工全面了解六西格玛的目的和基础知识，他们创建了一个简短的关于方法论的电梯演说。 “在介绍中，新员工学到六西格玛是我们从2004年开始使用的一种高度结构化的流程，我们将其用来评价和改进我们的工作方式”，负责医院客户服务培训的绿带培训师，约翰. 多里奥说。 “我们的卓越服务文化的重要组成部分是我们是基于数据，而不是意见来做决定。我们需要所有员工共同帮助，来确定需要做出哪些变革，并且共同来支持和维持这些变革”。能够清楚解释这个流程的目有助于员工接纳和鼓励其参与。

For 2005, Doctor's Hospital focused on maintaining the momentum and using the training to impact other key areas in the organization. With a large influx of new physicians, the hospital is streamlining existing processes to accommodate extra procedures and volume. It also is continuing to use Six Sigma as a way to create greater efficiencies in perioperative services.
2005年，达可塔斯医院集中在保持增长势头，并使用培训来影响组织中的其他关键领域。随着大量新医生的涌入，医院正在精简现有程序，以容纳额外的程序和容量。它们也继续使用六西格玛的方法在术前服务中创造更高的效率。

Hard work and dedication from the entire team, along with ongoing leadership commitment, have been key factors in making this initiative a success. Beyond specific process improvements, one of the most important benefits of this initiative has been the ability to furnish people with proven new tools and techniques to solve everyday problems.
整个团队的辛勤工作和奉献精神，与目前领导层的承诺是促使这项倡议取得成功的关键因素。除了在具体流程中取得的进步，这一举措的最重要的好处之一是能够为人们提供那些证明有效的新工具和技术来帮助他们解决每天遇见的问题。

The approach is creating a common foundation for leading change within the organization. Instead of simply making assumptions about underlying issues, teams are gathering, analyzing and verifying data to make an educated decision. Then they put in place solutions that can be sustained.
这种方法为引导组织内的变革创造了一个共同的基础。他们不是以前那样简单地对潜在的问题做出假设，现在整个团队都在收集，分析和核实数据，来做出一个经过充分考虑的决定。然后他们再在那里提出一个可持续的解决方案。

About the Author: Sondra Smith is assistant vice president of service line development and sales for Doctors Hospital in Augusta. She oversees product line development of musculoskeletal services, neuroscience, oncology and cardiology. Prior to this role, she was director of physical medicine services at the hospital. Ms. Smith is a Six Sigma Green Belt, and her current projects include outpatient CT turnaround time and day surgery preoperative process cycle time. She can be reached at Sondra.Smith@HCAHealthcare.com This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
作者简介：桑德拉.史密斯是奥古斯塔的达可塔斯医院负责服务线发展和销售的助理副主席。她负责监督医院肌肉骨骼服务，神经科学，肿瘤学和心脏病学的产品线发展。在此之前，她是医院负责物理医学服务的主管。史密斯女士是六西格玛的带，她目前的项目包括门诊CT的周转时间和日间手术术前护理流程的循环时间。您可以通过Sondra.Smith@ HCAHealthcare.com与她联系，该E-mail地址受垃圾邮件保护程序Spambots保护，因此您需要启动JavaScript才能看到它。