第三篇——A Lean Transformation
本帖最后由 小编H 于 2011-2-18 16:15 编辑
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Wisconsin hospital improves processes, changes culture
一家威斯康星州医院业务流程的改善与管理文化的变革
by Nicole Adrian, contributing editor 由妮可阿德里安，特约编辑
来源：3w.qualityprocess.com ruoshuiwei 翻译（注：初稿，需校准）
In 50 Words Or Less
• To reduce waste and improve patient satisfaction, a Wisconsin hospital turned to Six Sigma and lean.
• Hospital leaders embarked on Six Sigma Green Belt and lean training, and implemented projects to decrease costs and wait times.
• The efforts resulted in financial savings and an organizational culture change.
50字以内:
•为了减少浪费，提高患者满意度，该医院致力于六西格玛和精益。
•医院领导着手绿带培养和精益培训，并实施旨在降低成本和减少患者等待时间的项目。
•获得财务收益的增加和医院文化的变革
Sacred Heart Hospital CEO Steve Ronstrom first learned about lean while working on supply boats that sailed to Eskimo villages in Alaska. There, they didn’t waste a thing; they wouldn’t even throw away a piece of rope. When he later returned home and worked in a hospital, he observed tremendous amounts of waste. "The general attitude in healthcare toward waste and resources really surprised me," he said.
圣心医院的首席执行官史蒂夫•罗恩斯特龙早年曾在为阿拉斯加的爱斯基摩人村庄运送补给的船上工作，也就是在那个时候他第一次学会了精益。在船上他们没有浪费的事情，他们甚至不会扔掉一小段绳子。当他后来回到家乡在一家医院工作时，他亲眼目睹了医院巨大的浪费。他说“对医疗资源的浪费和这种普遍的态度真的让我吃惊，”
Later, when he joined the staff of Sacred Heart Hospital in Eau Claire, WI, lean concepts and tools were introduced to employees via connections at Honeywell and a local trade school. Ronstrom said a big part of bringing lean to Sacred Heart was getting people to be conscious of waste and process improvement, and to believe the employees needed to be part of the solution.
后来，当他加入了位于威斯康星州欧克莱尔市的圣心医院时，通过霍尼韦尔和当地职业学校把精益的概念和工具介绍给了医院的雇员们。罗恩斯特龙说精益给圣心医院所带来的益处主要是让雇员们关注浪费和如何进行流程改善，并且相信大家需要整体解决方案。
Sacred Heart Hospital is one of 13 hospitals in the Hospital Sisters Health System, scattered throughout Wisconsin and Illinois. The hospital has been on its Six Sigma and lean journey since 2002, when leadership started looking at ways to reduce waste. Since then, numerous projects and programs have been undertaken. And—maybe most importantly—a culture change has taken place.
圣心医院是分散在威斯康星州和伊利诺斯州卫生系统的13个姐妹医院之一。在2002年该医院的领导层开始寻找减少浪费的方法，六西格玛和精益也随之推行。从那时起，许多项目和方案着手进行。而且，也许最重要的是，一种文化的变革发生了。
"As at many hospitals, error reduction was one of the key areas of interest," said Dawn Garcia, division director for medical staff/quality for the Western Wisconsin Division of Hospital Sisters Health System. And as Sacred Heart was pursuing error reduction, national interest was growing in creating greater value for patients.
“由于在许多医院，减少失误是关注点之一，” 西威斯康星卫生系统姐妹医院部医务人员/质量总监道恩•加西亚说。并且在圣心医院不断追求减少失误期间，在为患者创造更大价值方面的国民利益正在不断增加。
Seeing how lean is applied successfully in other industries is important for bringing it into healthcare, Ronstrom said. "Hospitals with community boards have seen lean applied in manufacturing and in different industries," he said. "They’ve really encouraged and responded well to the way you can apply lean in healthcare."
弄清精益如何成功应用于其他行业对医疗保健领域引进她是重要的，罗恩斯特龙说。 “医院联合委员会弄清精益在制造业以及其它工业领域的应用，”他说。“真的很受鼓舞，并彻底回应了精益这种方式可以用在医疗保健领域。”
Bringing methods used by outside organizations—such as Honeywell and local schools—into the hospital is key, Ronstrom said. "Healthcare is insular, to a degree, and it’s good to look at what works in other industries and find people who have the programs and partner with them."
把外部组织（如霍尼韦尔和本地学校）所使用的方法引进医院是一个途径，罗恩斯特龙说。 “从某种程度讲医疗业是封闭的，看一看在其它行业所进行的一切是有益的，找到推行这些方案的同仁以及他们的伙伴是有帮助的。”
Lean, in particular, is essential to address costs, empower a workforce and meet patients’ needs, according to Ronstrom. It’s also important, he added, to partner with the hospital’s physicians and implement lean in a scientific and teachable way.
根据罗恩斯特龙说的，对于住址成本、赋以权利的工作人口和满足病人的需求，精益尤其必要。他补充说，与该院医生合作的伙伴、以科学的可以讲授的方法实施精益也同样重要。
"It’s imperative to have a culture of excellence," Ronstrom said, "so we can have the resilience to move to accountable care and have everyone in the building constantly looking at improvement."
“拥有一种优秀的文化是极其重要的” 罗恩斯特龙说，“因此我们能适应转而去做负责办理的事情并且使医院中的每个人不断地接受改进。”
Green Belt training 绿带培训
In 2004, Sacred Heart partnered with a local community college and trained about 15 hospital leaders as Six Sigma Green Belts (GBs). During the next few years, those who had been trained participated in numerous improvement projects designed to focus on patient satisfaction, and to save time and money.
2004年，圣心医院与当地的一所社区大学合作并培训了约15名医院领导作为六西格玛绿带（GBS）。在接下来的几年里，这些人承担了许多专注于病人满意度、节省等待时间和节约钱的项目。
One of these projects focused on finding ways to reduce meal-tray waste. The goal was to decrease by 60% the amount of waste created by late requests to change either a patient’s tray locations or diet. The results were excellent—95% of the project goal was met (the actual decrease was 57.6%), and the hospital saved $11,800 annually.
其中一个项目专注于发现减少餐具浪费的方法。其目标是减少60％的浪费，这通过制定改变患者餐具位置或患者日常饮食的新要求来实现。效果很不错，实现了目标值的95%（即实际下降57.6％），而医院每年节省$ 11,800。
Sacred Heart leaders continued to train Six Sigma Green Belts through early 2007. Then, the hospital’s focus turned to using lean to improve hospital processes. Garcia explained that leaders prioritize processes, and then choose tools and tactics based on those priorities.
圣心医院领导者继续培训六西格玛绿带一直到2007年初。接着，医院的重点转向使用精益改善医院流程。加西亚解释说，领导者把流程区分优先次序，然后基于优先考虑的事情选择工具和手段。
But that wasn’t enough, according to Garcia. To really dig deep into lean, hospital leaders considered a new ASQ training program. "We were looking for an avenue to get a core group of leaders to demonstrate lean’s impact," Garcia said.
但是按照加西亚所说的这还不够。为了真正深入地挖掘精益的价值，医院领导考虑了一个由美国质量协会举办的新培训项目。 “我们正在寻找一个途径以培养一支展示精益作用的领导者核心团队”加西亚说。
Sacred Heart found that avenue through ASQ’s Leading Lean Teams course. Garcia and Sue Peiffer, Sacred Heart’s performance improvement coordinator, worked with ASQ program developers to determine the training’s curriculum and design.
圣心医院找到了这个途径，那就是通过美国质量协会的精益团队精品课程培训。圣心医院的执行改善协调员加西亚和苏佩弗，与ASQ的项目开发者合作，共同确定了培训的课程设置和布局。
Later, the hospital had the opportunity to pilot the new ASQ training. "We accepted, knowing it would be a direct line to success," Garcia said. In total, 96% of Sacred Heart leadership—about 100 individuals—were trained through Leading Lean Teams.
后来，该医院拥有了试行新的ASQ培训机会。 “我们接受了，知道这将是一个可以直接通向成功的道路，”加西亚说。圣心医院96%的领导，总计约100人，通过精益团队训练。
The 11-week course includes four hours of virtual training and three days of activity-based classroom training. Additionally, students are assigned to read Thomas Zidel’s A Lean Guide to Transforming Healthcare1 and use ongoing personalized coaching from experienced healthcare quality experts. Lastly, those who take the training are given time to implement actual kaizen events at their organizations.
这11周的课程包括四个小时的模拟培训和三天的课堂培训活动。此外，安排学员们读托马斯赛德尔的《医疗机构变革精益指南》和让有经验的医疗质量专家对他们持续进行针对性辅导。最后，安排学员在他们的组织内进行现场改善演练。
From the group of Sacred Heart leaders who took the training, 15 teams were established. Each team had a specific project to tackle. Teams members were selected so each team would include a mix of skills, strengths and personalities, Peiffer said. Some teams had GBs, and the individuals varied in their experience with lean and quality.
从圣心医院接受培训的团队中，建立了15个小组。每组有一个待解决的具体项目。小组成员经过挑选以使每个小组都是技能、长处和个性的组合，佩弗说。有些小组拥有绿带、在精益和质量方面有各式各样经验的成员。
Narrowing it down缩小范围
Before implementing the projects, the teams had to identify potential project focus areas and make sure they met the organization’s priorities, Garcia said. The teams also had to identify potential cost savings, patient value, and the likely benefit to quality metrics and outcomes. At the end of the training, facilitators had each team report its findings.
在实施项目之前，各小组必须识别潜在的项目重点领域，并确保它们符合组织的优先次序，加西亚说。各小组还必须识别潜在的成本节约、患者价值、质量度量和质量结果的预期收益。在培训结束时，精益推进者要求每个小组报告其调查结果。
"We had the attendees and members of the leadership teams identify which projects were most beneficial to the organization," Garcia said. The trained leaders had five minutes to showcase their project ideas for the other teams through graphics and videos. The audience—the other teams—rated the projects on scorecards.
“我们有精益领导团队成员和相关人员来确定哪些项目是最对组织有利的，”加西亚说。受训的小组组长有五分钟时间通过图表和视频向其他小组展示他们的项目思路。其他小组作为观众在记分卡上评分。
The scores and projects were put on a matrix (Figure 1) and from there, senior leaders selected which ones would move forward with implementation, Peiffer said.
把这些项目和其对应的分数放在一个矩阵图里（图1），高层领导根据此图选择哪些项目将推进执行，佩弗说。
The executive leaders’ team reviewed and endorsed three projects, and approved them for implementation:
• Outpatient registration: To increase accuracy of demographic data entry.
• Emergency department (ED) throughput: To decrease ED patient total bed time.
• Digital mammography: To reduce the reporting time, moving from 90% in 35 hours to 90% in fewer than 12 hours. This project has been completed, and the results as of January 2010 indicated 92% in fewer than 12 hours.
行政领导小组审查并签署其中的三个项目，核准实施：
•门诊挂号：为了提高入院人员统计的准确性。
•急诊（ED）吞吐量：为了减少ED患者的总待床时间。
•数字化乳腺摄影：为了减少出报告的时间，即从在35小时内出报告占90%减少到少于12小时出报告占90%。该项目已完成， 在2010年1月的结果显示：不到12小时出报告占92％。
After those three projects were implemented, another of the 15 original projects, a hotel menu project, began. When the project is completed, the organization will move from a generic menu to one that is more like a restaurant menu—customized and with options. The process goal was to improve first-run tray pass accuracy from 70% to 90%. The project was successful as a pilot, and was later expanded to include the whole hospital. The project is expected to be completed early this year.
在这三个项目实施后，15个项目中的另一个，医院旅馆菜单项目开始实施。当该项目完成后，该组织将把菜单从一个普通形式转变成更像似餐馆菜单（客人定制和可选择）。这一流程的改善目标是餐具首次传递精度从70％提高到90％。该项目取得试点成功，后来推广到整个医院。该项目预计于今年年初完成。
Just because the lean training ended didn’t mean lean improvement ideas and projects ended. Despite having only undertaken four of the 15 projects, the others are still being considered.
精益培训的结束并不意味着精益改进的观念和项目改进的结束。尽管只执行了15个项目中的四个，其他的项目仍然在考虑之中。
Peiffer said, "Leaders hold quarterly sessions in which the teams report on their project progress."
佩弗说：“各项目小组在领导层举行的季度会议上要报告其项目的进展情况。“
When leaders are identified as project stakeholders or champions, they have a one-year commitment to the project to make sure everything is in place, Garcia added. Peiffer keeps track of champions and their projects, and provides weekly reports to Garcia. "I have a list that I keep checking, asking ‘Where are you now?’" Peiffer said.
当领导者被确定为项目干系人或倡导者时，他们对项目有一个为期一年的承诺，以确保各司其职、各安其位。加西亚补充说。佩弗负责对倡导者和其项目的跟踪并向加西亚提供每周报告。 “我有跟踪检查一览表，在表中我询问‘你们的项目现在进展到哪一个位置？’”佩弗说。
Additionally, there is a centralized data repository in which individuals submit key metrics and results from their teams. Peiffer and senior leaders can look at the data at any time to make sure projects are on schedule. If not, Peiffer will ask for one-on-one updates.
此外，还有一个中央数据库，在里面有每个倡导者提交的项目度量点和项目结果。佩弗和高层领导在任何时候都可以查看数据，以确保项目如期进行。如果没有，佩弗会要求一对一的更新项目进度。
Cultural change 文化变革
Implementing lean has led to a changed and improved organizational culture. "We were already directed to support the patients and provide quality in care," Garcia said. Observing and seeing things through the patients’ eyes helped reveal bottlenecks and opportunities to improve, she explained.
实施精益带来了组织文化的变革和进步。“我们已经把精力用在向患者提供护理质量上，“加西亚说。透过患者的眼睛所观察并看到的帮助我们揭示事物的瓶颈和改进的机会，她解释说。
Before undertaking lean and improving processes, Garcia said staff members had been sympathetic to waiting patients but didn’t necessarily recognize the waste that resulted from those delays. Having that patient background and understanding has really helped colleagues think and act, Garcia added.
在从事精益和改善流程之前，加西亚说，工作人员对等待的患者已表示同情，但并不一定认识到是那些浪费造成了这样的延误。只有掌握并理解了患者的背景资料才真的可以帮助同事们思考和行动，加西亚补充说。
Sacred Heart’s lean journey has gone so well that leaders—including Garcia and Peiffer—have created a video to share the details and best practices of their journey with the sister hospitals within their health system.
圣心医院的精益之旅进展得非常好，因此医院领导（包括加西亚和佩弗）创建了一个视频与他们卫生系统内的姐妹医院分享他们旅程的细节和最佳案例。
"Many of our sister facilities are not as far along ," Garcia said. "We’ve been asked a number of questions and thought the video would be a good strategy."
“我们姐妹医院的许多设施都没达到‘精益之旅’的要求，”加西亚说。“一直问我们好多的相关问题，通过这个视频分享将是一个很好的策略。”
Lean implementation has certainly been successful at Sacred Heart: the bottom line improved significantly, an employee engagement survey is under way, and significant cost reductions occurred, Ronstrom said.
在圣心医院实施精益无疑是成功的：盈亏结算线明显改善，员工雇用期调查正在进行之中，成本显著降低，罗恩斯特龙说。
Additionally, the organization has begun showcasing lean in community outreach programs. Some managers, for example, are helping places, such as free clinics, apply lean principles and tools.
此外，该医院已经开始在社区外展服务中展现精益。例如有些管理人员正在运用精益原则和工具帮助社区建免费诊所等。
Lean is now considered part of the hospitals’ process improvement, and it’s hardwired into employees, Garcia said. Peiffer said that she is receiving more phone calls from employees with ideas for lean projects. People are identifying that there are a lot more issues, and employees are excited to see a difference and make a difference with projects.
精益目前被认为是该医院流程改善的一部分，它已成为员工的硬件，加西亚说。佩弗说，她接收到雇员越来越多的有关于精益项目的想法的电话。大家正在发现更多的问题，当看到一种差异并有助于项目时他们很兴奋。
Looking to the future 展望未来
Although the majority of leaders have been trained in lean and some projects have been implemented, the journey is far from over.
虽然大多数领导者接受了精益培训并且有些项目已经实施，但精益旅程还远未结束。
"My priority is to get more members of the organization well versed in performance improvement tools," Garcia said. "The focus was on leaders. Now, leaders have to get tools and techniques to the teams. We want colleagues to be driving process improvement within their departments or through teams."
“我的首要任务就是让医院中拥有更多精通绩效改善工具的成员，”加西亚说。 “重点是领导者层面。现在，领导者必须掌握精益团队的工具和技术。我们希望同事们在他们的部门或团队内不断推进流程改善。”
Ronstrom said it’s important to train the next generation and have lean and quality completely embedded as part of governance and management structure. "At the management level, we have to make sure people have tools and knowledge, and that we are keeping current as lean process training improves," he said.
罗恩斯特龙说，重要的是要培养下一代，使精益质量完全融入到治理结构之中。“在管理水平上，我们必须确保大家熟悉精益工具和知识，并且与现行的精益流程培训始终保持同步，”他说。
"There’s no way we can operate without lean in healthcare today," Ronstrom said. "It’s fundamental to our operations management. Lean is here to stay."
“今天在医疗保健业如果没有精益，那将无法运转，”罗恩斯特龙说。 “这是我们经营管理的根本。精益在这里永存。”
组员们对第三篇文章翻译有什么意见或者建议，请跟帖回复讨论，以便对文章翻译进行最后的确认。
Wisconsin hospital improves processes, changes culture
一家威斯康星州医院业务流程的改善与管理文化的变革
by Nicole Adrian, contributing editor 由妮可阿德里安，特约编辑
来源：3w.qualityprocess.com ruoshuiwei 翻译（注：初稿，需校准）
In 50 Words Or Less
• To reduce waste and improve patient satisfaction, a Wisconsin hospital turned to Six Sigma and lean.
• Hospital leaders embarked on Six Sigma Green Belt and lean training, and implemented projects to decrease costs and wait times.
• The efforts resulted in financial savings and an organizational culture change.
50字以内:
•为了减少浪费，提高患者满意度，该医院致力于六西格玛和精益。
•医院领导着手绿带培养和精益培训，并实施旨在降低成本和减少患者等待时间的项目。
•获得财务收益的增加和医院文化的变革
Sacred Heart Hospital CEO Steve Ronstrom first learned about lean while working on supply boats that sailed to Eskimo villages in Alaska. There, they didn’t waste a thing; they wouldn’t even throw away a piece of rope. When he later returned home and worked in a hospital, he observed tremendous amounts of waste. "The general attitude in healthcare toward waste and resources really surprised me," he said.
圣心医院的首席执行官史蒂夫•罗恩斯特龙早年曾在为阿拉斯加的爱斯基摩人村庄运送补给的船上工作，也就是在那个时候他第一次学会了精益。在船上他们没有浪费的事情，他们甚至不会扔掉一小段绳子。当他后来回到家乡在一家医院工作时，他亲眼目睹了医院巨大的浪费。他说“对医疗资源的浪费和这种普遍的态度真的让我吃惊，”
Later, when he joined the staff of Sacred Heart Hospital in Eau Claire, WI, lean concepts and tools were introduced to employees via connections at Honeywell and a local trade school. Ronstrom said a big part of bringing lean to Sacred Heart was getting people to be conscious of waste and process improvement, and to believe the employees needed to be part of the solution.
后来，当他加入了位于威斯康星州欧克莱尔市的圣心医院时，通过霍尼韦尔和当地职业学校把精益的概念和工具介绍给了医院的雇员们。罗恩斯特龙说精益给圣心医院所带来的益处主要是让雇员们关注浪费和如何进行流程改善，并且相信大家需要整体解决方案。
Sacred Heart Hospital is one of 13 hospitals in the Hospital Sisters Health System, scattered throughout Wisconsin and Illinois. The hospital has been on its Six Sigma and lean journey since 2002, when leadership started looking at ways to reduce waste. Since then, numerous projects and programs have been undertaken. And—maybe most importantly—a culture change has taken place.
圣心医院是分散在威斯康星州和伊利诺斯州卫生系统的13个姐妹医院之一。在2002年该医院的领导层开始寻找减少浪费的方法，六西格玛和精益也随之推行。从那时起，许多项目和方案着手进行。而且，也许最重要的是，一种文化的变革发生了。
"As at many hospitals, error reduction was one of the key areas of interest," said Dawn Garcia, division director for medical staff/quality for the Western Wisconsin Division of Hospital Sisters Health System. And as Sacred Heart was pursuing error reduction, national interest was growing in creating greater value for patients.
“由于在许多医院，减少失误是关注点之一，” 西威斯康星卫生系统姐妹医院部医务人员/质量总监道恩•加西亚说。并且在圣心医院不断追求减少失误期间，在为患者创造更大价值方面的国民利益正在不断增加。
Seeing how lean is applied successfully in other industries is important for bringing it into healthcare, Ronstrom said. "Hospitals with community boards have seen lean applied in manufacturing and in different industries," he said. "They’ve really encouraged and responded well to the way you can apply lean in healthcare."
弄清精益如何成功应用于其他行业对医疗保健领域引进她是重要的，罗恩斯特龙说。 “医院联合委员会弄清精益在制造业以及其它工业领域的应用，”他说。“真的很受鼓舞，并彻底回应了精益这种方式可以用在医疗保健领域。”
Bringing methods used by outside organizations—such as Honeywell and local schools—into the hospital is key, Ronstrom said. "Healthcare is insular, to a degree, and it’s good to look at what works in other industries and find people who have the programs and partner with them."
把外部组织（如霍尼韦尔和本地学校）所使用的方法引进医院是一个途径，罗恩斯特龙说。 “从某种程度讲医疗业是封闭的，看一看在其它行业所进行的一切是有益的，找到推行这些方案的同仁以及他们的伙伴是有帮助的。”
Lean, in particular, is essential to address costs, empower a workforce and meet patients’ needs, according to Ronstrom. It’s also important, he added, to partner with the hospital’s physicians and implement lean in a scientific and teachable way.
根据罗恩斯特龙说的，对于住址成本、赋以权利的工作人口和满足病人的需求，精益尤其必要。他补充说，与该院医生合作的伙伴、以科学的可以讲授的方法实施精益也同样重要。
"It’s imperative to have a culture of excellence," Ronstrom said, "so we can have the resilience to move to accountable care and have everyone in the building constantly looking at improvement."
“拥有一种优秀的文化是极其重要的” 罗恩斯特龙说，“因此我们能适应转而去做负责办理的事情并且使医院中的每个人不断地接受改进。”
Green Belt training 绿带培训
In 2004, Sacred Heart partnered with a local community college and trained about 15 hospital leaders as Six Sigma Green Belts (GBs). During the next few years, those who had been trained participated in numerous improvement projects designed to focus on patient satisfaction, and to save time and money.
2004年，圣心医院与当地的一所社区大学合作并培训了约15名医院领导作为六西格玛绿带（GBS）。在接下来的几年里，这些人承担了许多专注于病人满意度、节省等待时间和节约钱的项目。
One of these projects focused on finding ways to reduce meal-tray waste. The goal was to decrease by 60% the amount of waste created by late requests to change either a patient’s tray locations or diet. The results were excellent—95% of the project goal was met (the actual decrease was 57.6%), and the hospital saved $11,800 annually.
其中一个项目专注于发现减少餐具浪费的方法。其目标是减少60％的浪费，这通过制定改变患者餐具位置或患者日常饮食的新要求来实现。效果很不错，实现了目标值的95%（即实际下降57.6％），而医院每年节省$ 11,800。
Sacred Heart leaders continued to train Six Sigma Green Belts through early 2007. Then, the hospital’s focus turned to using lean to improve hospital processes. Garcia explained that leaders prioritize processes, and then choose tools and tactics based on those priorities.
圣心医院领导者继续培训六西格玛绿带一直到2007年初。接着，医院的重点转向使用精益改善医院流程。加西亚解释说，领导者把流程区分优先次序，然后基于优先考虑的事情选择工具和手段。
But that wasn’t enough, according to Garcia. To really dig deep into lean, hospital leaders considered a new ASQ training program. "We were looking for an avenue to get a core group of leaders to demonstrate lean’s impact," Garcia said.
但是按照加西亚所说的这还不够。为了真正深入地挖掘精益的价值，医院领导考虑了一个由美国质量协会举办的新培训项目。 “我们正在寻找一个途径以培养一支展示精益作用的领导者核心团队”加西亚说。
Sacred Heart found that avenue through ASQ’s Leading Lean Teams course. Garcia and Sue Peiffer, Sacred Heart’s performance improvement coordinator, worked with ASQ program developers to determine the training’s curriculum and design.
圣心医院找到了这个途径，那就是通过美国质量协会的精益团队精品课程培训。圣心医院的执行改善协调员加西亚和苏佩弗，与ASQ的项目开发者合作，共同确定了培训的课程设置和布局。
Later, the hospital had the opportunity to pilot the new ASQ training. "We accepted, knowing it would be a direct line to success," Garcia said. In total, 96% of Sacred Heart leadership—about 100 individuals—were trained through Leading Lean Teams.
后来，该医院拥有了试行新的ASQ培训机会。 “我们接受了，知道这将是一个可以直接通向成功的道路，”加西亚说。圣心医院96%的领导，总计约100人，通过精益团队训练。
The 11-week course includes four hours of virtual training and three days of activity-based classroom training. Additionally, students are assigned to read Thomas Zidel’s A Lean Guide to Transforming Healthcare1 and use ongoing personalized coaching from experienced healthcare quality experts. Lastly, those who take the training are given time to implement actual kaizen events at their organizations.
这11周的课程包括四个小时的模拟培训和三天的课堂培训活动。此外，安排学员们读托马斯赛德尔的《医疗机构变革精益指南》和让有经验的医疗质量专家对他们持续进行针对性辅导。最后，安排学员在他们的组织内进行现场改善演练。
From the group of Sacred Heart leaders who took the training, 15 teams were established. Each team had a specific project to tackle. Teams members were selected so each team would include a mix of skills, strengths and personalities, Peiffer said. Some teams had GBs, and the individuals varied in their experience with lean and quality.
从圣心医院接受培训的团队中，建立了15个小组。每组有一个待解决的具体项目。小组成员经过挑选以使每个小组都是技能、长处和个性的组合，佩弗说。有些小组拥有绿带、在精益和质量方面有各式各样经验的成员。
Narrowing it down缩小范围
Before implementing the projects, the teams had to identify potential project focus areas and make sure they met the organization’s priorities, Garcia said. The teams also had to identify potential cost savings, patient value, and the likely benefit to quality metrics and outcomes. At the end of the training, facilitators had each team report its findings.
在实施项目之前，各小组必须识别潜在的项目重点领域，并确保它们符合组织的优先次序，加西亚说。各小组还必须识别潜在的成本节约、患者价值、质量度量和质量结果的预期收益。在培训结束时，精益推进者要求每个小组报告其调查结果。
"We had the attendees and members of the leadership teams identify which projects were most beneficial to the organization," Garcia said. The trained leaders had five minutes to showcase their project ideas for the other teams through graphics and videos. The audience—the other teams—rated the projects on scorecards.
“我们有精益领导团队成员和相关人员来确定哪些项目是最对组织有利的，”加西亚说。受训的小组组长有五分钟时间通过图表和视频向其他小组展示他们的项目思路。其他小组作为观众在记分卡上评分。
The scores and projects were put on a matrix (Figure 1) and from there, senior leaders selected which ones would move forward with implementation, Peiffer said.
把这些项目和其对应的分数放在一个矩阵图里（图1），高层领导根据此图选择哪些项目将推进执行，佩弗说。
The executive leaders’ team reviewed and endorsed three projects, and approved them for implementation:
• Outpatient registration: To increase accuracy of demographic data entry.
• Emergency department (ED) throughput: To decrease ED patient total bed time.
• Digital mammography: To reduce the reporting time, moving from 90% in 35 hours to 90% in fewer than 12 hours. This project has been completed, and the results as of January 2010 indicated 92% in fewer than 12 hours.
行政领导小组审查并签署其中的三个项目，核准实施：
•门诊挂号：为了提高入院人员统计的准确性。
•急诊（ED）吞吐量：为了减少ED患者的总待床时间。
•数字化乳腺摄影：为了减少出报告的时间，即从在35小时内出报告占90%减少到少于12小时出报告占90%。该项目已完成， 在2010年1月的结果显示：不到12小时出报告占92％。
After those three projects were implemented, another of the 15 original projects, a hotel menu project, began. When the project is completed, the organization will move from a generic menu to one that is more like a restaurant menu—customized and with options. The process goal was to improve first-run tray pass accuracy from 70% to 90%. The project was successful as a pilot, and was later expanded to include the whole hospital. The project is expected to be completed early this year.
在这三个项目实施后，15个项目中的另一个，医院旅馆菜单项目开始实施。当该项目完成后，该组织将把菜单从一个普通形式转变成更像似餐馆菜单（客人定制和可选择）。这一流程的改善目标是餐具首次传递精度从70％提高到90％。该项目取得试点成功，后来推广到整个医院。该项目预计于今年年初完成。
Just because the lean training ended didn’t mean lean improvement ideas and projects ended. Despite having only undertaken four of the 15 projects, the others are still being considered.
精益培训的结束并不意味着精益改进的观念和项目改进的结束。尽管只执行了15个项目中的四个，其他的项目仍然在考虑之中。
Peiffer said, "Leaders hold quarterly sessions in which the teams report on their project progress."
佩弗说：“各项目小组在领导层举行的季度会议上要报告其项目的进展情况。“
When leaders are identified as project stakeholders or champions, they have a one-year commitment to the project to make sure everything is in place, Garcia added. Peiffer keeps track of champions and their projects, and provides weekly reports to Garcia. "I have a list that I keep checking, asking ‘Where are you now?’" Peiffer said.
当领导者被确定为项目干系人或倡导者时，他们对项目有一个为期一年的承诺，以确保各司其职、各安其位。加西亚补充说。佩弗负责对倡导者和其项目的跟踪并向加西亚提供每周报告。 “我有跟踪检查一览表，在表中我询问‘你们的项目现在进展到哪一个位置？’”佩弗说。
Additionally, there is a centralized data repository in which individuals submit key metrics and results from their teams. Peiffer and senior leaders can look at the data at any time to make sure projects are on schedule. If not, Peiffer will ask for one-on-one updates.
此外，还有一个中央数据库，在里面有每个倡导者提交的项目度量点和项目结果。佩弗和高层领导在任何时候都可以查看数据，以确保项目如期进行。如果没有，佩弗会要求一对一的更新项目进度。
Cultural change 文化变革
Implementing lean has led to a changed and improved organizational culture. "We were already directed to support the patients and provide quality in care," Garcia said. Observing and seeing things through the patients’ eyes helped reveal bottlenecks and opportunities to improve, she explained.
实施精益带来了组织文化的变革和进步。“我们已经把精力用在向患者提供护理质量上，“加西亚说。透过患者的眼睛所观察并看到的帮助我们揭示事物的瓶颈和改进的机会，她解释说。
Before undertaking lean and improving processes, Garcia said staff members had been sympathetic to waiting patients but didn’t necessarily recognize the waste that resulted from those delays. Having that patient background and understanding has really helped colleagues think and act, Garcia added.
在从事精益和改善流程之前，加西亚说，工作人员对等待的患者已表示同情，但并不一定认识到是那些浪费造成了这样的延误。只有掌握并理解了患者的背景资料才真的可以帮助同事们思考和行动，加西亚补充说。
Sacred Heart’s lean journey has gone so well that leaders—including Garcia and Peiffer—have created a video to share the details and best practices of their journey with the sister hospitals within their health system.
圣心医院的精益之旅进展得非常好，因此医院领导（包括加西亚和佩弗）创建了一个视频与他们卫生系统内的姐妹医院分享他们旅程的细节和最佳案例。
"Many of our sister facilities are not as far along ," Garcia said. "We’ve been asked a number of questions and thought the video would be a good strategy."
“我们姐妹医院的许多设施都没达到‘精益之旅’的要求，”加西亚说。“一直问我们好多的相关问题，通过这个视频分享将是一个很好的策略。”
Lean implementation has certainly been successful at Sacred Heart: the bottom line improved significantly, an employee engagement survey is under way, and significant cost reductions occurred, Ronstrom said.
在圣心医院实施精益无疑是成功的：盈亏结算线明显改善，员工雇用期调查正在进行之中，成本显著降低，罗恩斯特龙说。
Additionally, the organization has begun showcasing lean in community outreach programs. Some managers, for example, are helping places, such as free clinics, apply lean principles and tools.
此外，该医院已经开始在社区外展服务中展现精益。例如有些管理人员正在运用精益原则和工具帮助社区建免费诊所等。
Lean is now considered part of the hospitals’ process improvement, and it’s hardwired into employees, Garcia said. Peiffer said that she is receiving more phone calls from employees with ideas for lean projects. People are identifying that there are a lot more issues, and employees are excited to see a difference and make a difference with projects.
精益目前被认为是该医院流程改善的一部分，它已成为员工的硬件，加西亚说。佩弗说，她接收到雇员越来越多的有关于精益项目的想法的电话。大家正在发现更多的问题，当看到一种差异并有助于项目时他们很兴奋。
Looking to the future 展望未来
Although the majority of leaders have been trained in lean and some projects have been implemented, the journey is far from over.
虽然大多数领导者接受了精益培训并且有些项目已经实施，但精益旅程还远未结束。
"My priority is to get more members of the organization well versed in performance improvement tools," Garcia said. "The focus was on leaders. Now, leaders have to get tools and techniques to the teams. We want colleagues to be driving process improvement within their departments or through teams."
“我的首要任务就是让医院中拥有更多精通绩效改善工具的成员，”加西亚说。 “重点是领导者层面。现在，领导者必须掌握精益团队的工具和技术。我们希望同事们在他们的部门或团队内不断推进流程改善。”
Ronstrom said it’s important to train the next generation and have lean and quality completely embedded as part of governance and management structure. "At the management level, we have to make sure people have tools and knowledge, and that we are keeping current as lean process training improves," he said.
罗恩斯特龙说，重要的是要培养下一代，使精益质量完全融入到治理结构之中。“在管理水平上，我们必须确保大家熟悉精益工具和知识，并且与现行的精益流程培训始终保持同步，”他说。
"There’s no way we can operate without lean in healthcare today," Ronstrom said. "It’s fundamental to our operations management. Lean is here to stay."
“今天在医疗保健业如果没有精益，那将无法运转，”罗恩斯特龙说。 “这是我们经营管理的根本。精益在这里永存。”
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qys0418 (威望:0) (辽宁 大连) 机械制造 经理
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