为了更好地保护患者、卫生保健需要更多的“精益思想”

Q168

【翻译不是很准确，邀请你共同参与英文翻译中文的校对】
To Better Protect Patients, Health Care Needs More ‘Lean Thinking’
为了更好地保护患者、卫生保健需要更多的“精益思想”
Processes that create the problems shouldn’t be used to fix them
产生问题的流程不应该被用来修复它们
As the Supreme Court debates the fate of “Obama Care,” we should recall the formal name of the law: the Patient Protection and Affordable Care Act (PPACA) . Most of the public debate has been about the cost of health care, losing sight of the urgent need to fix the ongoing crisis of quality and patient safety. More health care organizations need to adopt the lean management philosophy to “bend the cost curve” and save lives, as some innovators have proven during the last 10 years.
作为最高法院辩论的命运,“奥巴马保健”，我们应该回想到法律的正式名称：《患者保护与平价医疗法案》(PPACA)。大多数的公开辩论是关于医疗保健成本,而忽略了紧急需要解决目前的质量危机和病人安全。更多的卫生保健组织需要采用精益管理思想-如何“改变成本曲线”和拯救生命,正如一些创新者在过去的10年间已经证明。
The most highly touted aspects of the PPACA include attempts to protect patients by increasing their access to health insurance. A 2009 Harvard Medical School study estimated that 45,000 Americans die each year due to a lack of coverage. Even if patients can get appointments or get admitted to a hospital, there are dangers that are underappreciated by the public. The Department of Health and Human Services reported, in 2008, that 80,000 Medicare patients die each year due to preventable medical errors. Other studies estimate that 90,000 patients are killed annually by hospital-acquired infections. Ironically, we are granting easier access to a very dangerous system.
PPACA最高度吹捧的方面包括通过增加他们的享受医疗保险试图保护病人。2009年哈佛医学院的研究估计，每年有45000名美国人因缺少保险项目而死亡。即使患者可以得到医生预约或得到送入医院，这里面的危险被公众低估了。在2008年卫生与公众服务部门的报告中，每年预计有80000名医疗保险病人死于可预防的医疗差错。其他的研究估计每年由院内感染死亡90000例。具有讽刺意味的是,我们正在允许容易接近一个非常危险的系统。
The good news is that the system need not be dangerous, and some hospitals are demonstrating that patient safety and health care can be dramatically improved while simultaneously reducing costs. Health care organizations like the Cleveland Clinic and Florida Hospital have worked to learn and adapt lean process improvement and management systems based on the famed Toyota Production System.
好消息是,该系统不需要是危险的，一些医院显示病人安全及卫生保健可以显著提高，同时降低成本。卫生保健组织像克利夫兰诊所和佛罗里达医院，基于著名的丰田生产系统，一直致力于学习和采纳精益流程改进和管理系统。
Another such system, ThedaCare, in Wisconsin, has results that we should all hope to duplicate. For example, patients with chest pain are better protected by more timely treatment for their heart attacks (waiting just 45 minutes compared to 91 minutes in 2005) . As they say, “time is muscle,” and the faster care saves lives and reduces damage to patients’ hearts—which speeds recovery times and reduces treatment costs.
另一个这样的系统，西达，在威斯康辛州，我们应该都希望复制他们取得的成绩。例如，胸痛病人得到了更好的保护，通过更及时的治疗他们的心脏病发作(现在等待仅仅45分钟，相比于2005年91分钟的等待时间缩短了)。正如他们所说，“时间是力量”，更快的护理可以拯救生命,减少损害病人的心脏，速度争取了时间,降低了治疗成本。
To get these results, staff members study the way care is provided, and they are fully engaged in fixing processes. Improvements include weeklong “rapid improvement events” and a method called “continuous daily improvement.” ThedaCare has demonstrated gains in patient access, quality and safety, and cost in areas ranging from cardiac surgery care, outpatient orthopedics, inpatient, and primary care.
为了取得这些成果，管理人员学习提供保健的方式，他们充分参与过程完善。改进包括为期一周的“快速改进事件”和一个被称为““持续日常改进”的方法。西达保健表明收益在病人访问、质量和安全，及从心脏手术的护理、门诊矫形手术、住院病人到初级保健范围内的费用。
Dr. Richard Shannon, of the University of Pennsylvania, has led efforts to reduce certain types of deadly hospital infections by 90 percent. Beyond the benefit to patients, the hospital saves millions each year. The hospital stay for patients who would have previously gotten infections has also been reduced, freeing up beds for other patients. Reducing infections is a far more affordable way to create bed space compared to the construction of a new hospital tower.
宾夕法尼亚大学的理查德香农博士，领导努力减少某些类型的致命的90%医院感染。超出了对病人的好处，医院每年节省了数百万。以前得到感染的住院患者人数也被降低，为其他病人空出了床位。减少感染是一个更为可行的方法，提供了床位空间，相比建造了一个新医院楼。
Hospitals using the lean methodology have everybody working together to reduce waste that otherwise consumes the days of harried nurses and staff, such as running around searching for supplies, equipment, and information. While some might say the hospitals are understaffed, it’s often not realistic to increase costs by hiring more people (if you can even find them, given the shortages of key medical professionals) . The smarter approach is to free up staff time through process improvement, as Shannon frees up beds at the University of Pennsylvania. Lean hospitals have more time for patient care, so patient satisfaction and health outcomes improve.
医院使用精益方法论让大家共同努力减少浪费，否则是在忙碌的护士和工作人员，如四处寻找物资、设备和信息的日子中度过。虽然有些人可能会说，医院人手不足，雇用更多的人来增加成本，它常常是不现实的（考虑到关键的医疗专业人员短缺，如果你甚至可以找到他们）。更聪明的方法是通过过程改进空出来员工时间，正如在宾夕法尼亚大学香农博士腾出床位。精益医院有更多的时间去照顾病人，于是病人的满意度和健康效果改善了。
Hospital leaders must realize that, despite all the strengths and talents of their organizations, we can’t solve problems by using the same kind of thinking we used when we created them. It’s time to reach out to quality and safety leaders in other industries, including aviation and manufacturing. It’s easy to shun these proven methods by saying, “We are different.” Yes, health care is different. Lives are on the line, and families are shattered when a preventable medical error kills a patient. That’s all the more reason to adapt, spread, and share what works: a lean management system.
医院的领导必须意识到，尽管组织内拥有优势和人才，我们不能通过使用同样的思维方式（我们使用我们创造的思维方式）来解决问题。到了去接触在其他行业（包括航空和制造业）质量和安全的领导人时间了。通过说““我们是不同的行业”很容易避开这些证明方法。是的，卫生保健是不同的。生命处于危险中，当一个可预防的医疗差错害死一个病人，使家庭破碎。这就是所有的更多的理由去采纳、传播、分享精益管理系统作品。
ABOUT THE AUTHOR
关于作者
Mark Graban
Mark Graban is an author, consultant, and speaker in the field of lean health care, through his company, Constancy Inc. He is a faculty member the Lean Enterprise Institute (LEI) and the chief improvement officer at KaiNexus, where the management process required for continuous improvement is streamlined using web-based technology. He is founder of the Lean Blog and is author of the Shingo Prize-winning book Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement, Second Edition (Productivity Press, 2011) and, with Joseph E. Swartz, Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements (Productivity Press, 2012) .
马克*格雷班
马克*格雷班是精益卫生保健领域（通过他的顾问公司）的一个作家、顾问和发言人。他是精益企业研究所(LEI)的 一名教员和KaiNexus的首席改进官，需要持续改进的管理过程合理化运用了网络技术。他是精益博客的创始人，获新乡奖的书《精益医院》作者：提高质量、病人安全和员工敬业度，第二版(生产力出版社，2011)，和约瑟夫•史瓦兹合著的医疗保健改善：在可持续的持续改进中雇用一线员工(生产力出版社，2012)。

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