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基于精益六西格玛管理法的某院PIVAS运营成本-效益管理
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| 篇名： | 基于精益六西格玛管理法的某院PIVAS运营成本-效益管理 |
| TITLE： | Practice of PIVAS operation cost-benefit management in a hospital based on lean Six Sigma management |
| 摘要： | 目的 探讨精益六西格玛管理法在某三甲综合医院（以下简称“S医院”）静脉用药集中调配中心（PIVAS）运营成本-效益管理中的实践与应用效果，为医院PIVAS的运营管理提供借鉴。方法对S医院PIVAS运营成本-效益实施精益六西格玛管理的5个步骤（界定、测量、分析、改进、控制，即DMAIC），对其运营成本-效益管理要素（人力资源成本、医疗卫生材料成本、全合-肠外营养配制收益）实施精益管理，制定人员培训与绩效考核、耗材精细化管理制度、全合-肠外营养液医嘱套餐等在内的多项干预措施，最后以PIVAS总收益、总成本、净收益评价总体改善效果；以员工工作效率、工作质量、工作满意度、离职率、积休天数评价人力资源配置优化效果；以医疗卫生材料成本金额评价耗材成本管理效果；以全合-肠外营养液配制收益金额、配制数量、单瓶肠外营养液使用占比评价全合-肠外营养液配制收益改进效果。结果与S医院PIVAS运营成本-效益实施DMAIC前比较，实施DMAIC后，PIVAS总收益由（471366.50±9201.5）元/月上调至（479679.50±14320.14）元/月（P＞0.05），总成本由（305878.88±3201.75）元/月显著降低至（294610.59±5007.33）元/月（P＜0.05），PIVAS净收益较实施DMAIC前增加11.83%；员工工作效率、工作质量、工作满意度显著提高，员工积休天数显著降低，第三方员工离职率由15.0%降低至7.5%；医疗卫生材料成本由（67826.42±2812.76）元/月显著降低至（56384.33±4607.67）元/月（P＜0.05）；全合-肠外营养液配制数量由（1263.75±135.83）组/月显著增加至（2061.25±89.04）组/月（P＜0.05），单瓶肠外营养液使用人数占肠外营养液总使用人数的比例由93.25%降低至58.75%，全合-肠外营养液配制收益较实施DMAIC前上涨63.18%。结论基于DMAIC实施PIVAS运营成本-效益管理，有助于加强PIVAS的成本管控，促进PIVAS的健康发展。 |
| ABSTRACT： | OBJECTIVE To explore the practice and application effect of lean Six Sigma （LSS） management in the cost- benefit management of PIVAS operation in a tertiary comprehensive hospital （hereinafter referred to as “S Hospital”）， providing reference for the operation and management of PIVAS in hospitals. METHODS The five steps （define， measure， analyze， improve and control， i.e. DMAIC） of LSS management were implemented for PIVAS operation cost-benefit of S Hospital， and lean management was implemented for its cost-benefit management elements （human resource cost， medical and health material cost， and all-in-one parenteral nutrition preparation income）. Several intervention measures including personnel training and performance assessment， refined management system of consumables， and doctor’s advice package of full parenteral nutrition were developed. Finally， the overall improvement effect was evaluated by the total benefit， total cost and net benefit of PIVAS. The effects of human resource allocation optimization and improvement were evaluated by the work efficiency， work quality， job satisfaction， turnover rate and accumulated rest days. The effects of consumables cost management were evaluated by the amount of medical and health materials cost. The improvement effects of all-in-one parenteral nutrition preparation income were evaluated by the profit amount， quantity and the proportion of single bottle of parenteral nutrition. RESULTS After implementing DMAIC in S Hospital， the total benefit of PIVAS was increased from （471 366.50±9 201.5） yuan/month to （479 679.50±14 320.14） yuan/month （P＞ 0.05）， the total cost was decreased from （305 878.88±3 201.75） yuan/month to （294 610.59±5 007.33） yuan/month （P＜0.05）， and the net benefit of PIVAS was increased by 11.83% compared with that before the improvement. The work efficiency， work quality and job satisfaction of employees were significantly improved， the accumulated rest days were significantly reduced， and the turnover rate of third-party employees was reduced from 15.0% before the improvement to 7.5% after the improvement. The cost of medical and health materials significantly decreased from （67 826.42±2 812.76） yuan/month before improvement to （56 384.33±4 607.67） yuan/month after improvement （P＜0.05）. The quantity of all-in-one parenteral nutrition was significantly increased from （1 263.75±135.83） group/month before improvement to （2 061.25±89.04） group/month after improvement （P＜0.05）， and the proportion of users of single bottle of parenteral nutrition in total users decreased from 93.25% before improvement to 58.75% after improvement. The profit of all-in-one parenteral nutrition was 63.18% higher than that before implementing DMAIC. CONCLUSIONS The implementation of PIVAS operation cost-benefit management based on DMAIC is conducive to strengthening the cost control of PIVAS and promoting the healthy development of PIVAS. |
| 期刊： | 2025年第36卷第01期 |
| 作者： | 黄蕾；张慧；耿洲；施爱明；潘杰 |
| AUTHORS： | HUANG Lei，ZHANG Hui，GENG Zhou，SHI Aiming，PAN Jie |
| 关键字： | 静脉用药集中调配中心；成本-效益；精益六西格玛管理；全合-肠外营养液 |
| KEYWORDS： | PIVAS； cost-benefit； lean Six Sigma management； all-in-one parenteral nutrition |
| 阅读数： | 5 次 |
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