نوع مقاله : مقاله پژوهشی
نویسندگان
1 دکتری تخصصی، مدیریت خدمات بهداشتی درمانی، گروه مدیریت خدمات بهداشتی درمانی، واحد تهران جنوب، دانشگاه آزاد اسلامی، تهران، ایران
2 کارشناس ارشد، مدیریت صنعتی، باشگاه پژوهشگران جوان و نخبگان، واحد رشت، دانشگاه آزاد اسلامی، رشت، ایران
3 کارشناس ارشد، آمار، بیمارستان چشم‌پزشکی فارابی، دانشگاه علوم پزشکی تهران، تهران، ایران
چکیده
مقدمه: لغو اعمال جراحی، از جمله مهم‌ترین علل عدم کارایی و اتلاف منابع بیمارستانی به شمار می‌رود. پژوهش حاضر با هدف شناسایی عوامل مؤثر بر لغو اعمال جراحی و ارایه راهکارهای مؤثر در کاهش آن با روش مدیریتی بهبود انجام شد.روش بررسی: این مطالعه از نوع توصیفی بود. عوامل تأثیرگذار در جلوگیری از لغو اعمال جراحی در بیمارستان فارابی تهران به روش میانگین هندسی و نرم‌افزار Excel غربالگری شدند. برای وزن‌دهی عوامل از روش FANP (Fuzzy Analytic Network Process) و Fuzzy DEMATEL (Decision Fuzzy Making Trial and Evaluation Laboratory) استفاده گردید. سپس مدل پژوهش برای کاهش لغو اعمال جراحی با استفاده از روش طوفان فکری توسط خبرگان و روش VIKOR ترسیم شد و به روش مدیریتی FOCUS-PDCA، اصلاحات در بیمارستان انجام گرفت.یافته‌ها: عدم مراجعه بیمار، تب و سرماخوردگی و سایر عوامل به ترتیب بیشترین درصد لغو اعمال جراحی گزارش شد و طبق رتبه‌بندی انجام شده، راهکارهای «هماهنگی بین بخشی»، «بهبود روند مشاوره‌های قبل از عمل»، «آموزش کارکنان»، «برنامه‌ریزی تهیه ملزومات و تجهیزات» و «آموزش بیمار» رتبه‌های اول تا پنجم را جهت کاهش لغو اعمال جراحی به خود اختصاص دادند. با اجرای روش FOCUS-PDCA، آمار لغو اعمال جراحی طی شش ماهه اول سال ١٣٩7 به نسبت همین زمان در سال 1396 کاهش داشت.نتیجه‌گیری: اجرای شیوه مدیریتی FOCUS-PDCA تأثیر مثبتی بر کاهش لغو اعمال جراحی بیمارستان فارابی داشته است. تنظیم برنامه اتاق عمل متناسب با نوع عمل و توان تیم جراحی، مدت زمان موجود و نظارت بر ساعات حضور پزشک جراح و بیهوشی و همچنین، مدیریت و نظارت دقیق بر فرایند آماده‌سازی بیمار قبل از عمل جراحی می‌تواند جهت ارتقای کیفیت و بهبود مدیریت اتاق عمل اثربخش مورد استفاده قرار گیرد.
کلیدواژه‌ها
عنوان مقاله [English]
Identifying Effective Factors on Surgery Cancellation and Providing Effective Solutions Using Improved Management Strategies in a Selected Hospital: A Case Study
نویسندگان [English]
- Zahra Hashemi-Dehaghi 1
- Hamed Karimi-Shirazi 2
- Masoomeh Nikbakht 3
1 PhD, Health Services Management, Department of Health Services Management, South Tehran Branch, Islamic Azad University, Tehran, Iran
2 MSc, Industrial Management, Young and Elite Researchers Club, Rasht Branch, Islamic Azad University, Rasht, Iran
3 MSc, Statistics, Farabi Hospital, Tehran University of Medical Sciences, Tehran, Iran
چکیده [English]
Introduction: Surgery cancellation is of the most important causes of hospital inefficiency as well as resource wastage. This study was conducted to determine effective factors and causes of surgery cancellation, and to identify areas to reduce it in a hospital using improved management method.Methods: In this descriptive study, effective factors on surgery cancellation and effective strategies for reducing it in Farabi hospital, Tehran, Iran, were extracted and were screened by using geometric mean and excel software. Fuzzy Analytic Network Process (FANP) and Fuzzy Decision Making Trial and Evaluation Laboratory (Fuzzy DMATEL) were used for weighing the factors. By using brainstorming and VIKOR methods, the model was designed and was applied using Find, Organize, Clarify, Understand, Select-Plan, Do, Check, Act (FOCUS-PDCA) method.Results: Missed appointments by patients, fever, colds, and other factors, respectively, had the highest percentages among the causes of cancellation. According to the ranking, "cross-sectoral coordination", "improvement of preoperative counseling", "personnel training", "programming to prepare supplies and equipment", and "patient education" ranked first to fifth to reduce surgery cancellation. By applying FOCUS-PDCA method, the number of surgery cancellations decreased in the first 6 months of 2018 compared to the same time in 2017.Conclusion: Carrying out FOCUS-PDCA methodology decreased surgery cancellation in Farabi hospital. Setting up program for operating room regarding the type of surgery and potency of surgical management, and precise monitoring on the process of preparing the patient before surgery were suggested to improve the quality and management of the operating room.
کلیدواژه‌ها [English]
- Surgery
- Quality Improvement
- Fuzzy Logic
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