Lean Management in Obstetrics and Gynecology: Application in the Ambulatory Clinic Pre- and Post-Kaizen

OBJECTIVE: The ambulatory clinic was an important departmental problem. Providers hated working there and patients complained about the wait times there. It seemed there were equal numbers of patients and provider complaints. In the spirit of solving the problem, data was gathered, a LEAN intervention was planned, and data was collected. METHODS: We defined the service families in the clinic as registration, vital signs, provider or ultrasound visit, nursing visit, and registration for the return visit. We walked the Gemba engaging all the staff in the process. Many observations pointed to long waits between and among the five stations. In order to study the current state, time data was collected by attaching a sheet of paper to a folder that the patient would carry themselves to all the clinical steps. On the sheet of paper each station logged the time that patient appeared and the time the patient left their sight. Data was gathered each day and every day from October 2016 to the summer of 2017. The data was analyzed. Leadership met and identified value and waste in the process. A Kaizen event was scheduled after the first set of measurements engaging all the staff. After the data was thoroughly analyzed and digested, brainstorming occurred. Together we determined our future state. We created a vision and strategic goals to reach our future state. RESULTS: The data pre-Kaizen event showed that the process of arrival to leaving took 124 minutes. We discovered that not every patient passed through each station. We learned the patients were on time or early for their visit most of the time. The providers were late most of the time by 1 - 1.5 hours. We learned how long each station took from the patient’s point of view. There were no statistically significant differences between ultrasound and provider visits;there were no statistically significant differences between midwife and physician visits. Each day of the week was similar. The arrival rate was higher in the morning because of the template. After the event, the total time in clinic did not change however the variability in time between and among each station decreased in variance. We informed the staff of these findings so that they could take responsibility for their part in the process. The atmosphere in clinic changed dramatically and the complaints from both providers and patients stopped. CONCLUSION: LEAN management was used to improve the clinic. It yielded important results, got the staff engaged in the process, and provided a way for the patients to see the efforts made by staff to improve.

基于B/S模式的孕妇儿童体检系统的设计与实现

为了改善孕妇、儿童体检流程的繁重手工管理,提高保健质量和体检效率,同时实现系统在妇幼保健等医疗单位更好地共享。参照《国家基本公共卫生服务规范(2011年)》提出基于B/S模式的孕妇儿童体检系统。介绍系统的总体结构,开发环境、数据库及功能模块设计,并以医生平台为例详细说明儿童体检模块的具体实现过程。系统基本上实现了妇幼保健机构孕妇儿童体检信息及工作考核等的无纸化、规范化和高效化管理,具有较好的实用价值。

北京协和医院面向全科医师的女性健康管理MOOCs建设

为响应国家政策的号召及基层全科医师培养的需求,北京协和医院(PUMCH)将线上课程(MOOCs)教学模式引入全科医师女性健康管理,进行了一次大胆的尝试。通过对项目的背景、过程、优势、展望等的分析,以期由一次小规模尝试的成功来使这种教学模式得以逐步推广,并最终使基层全科医生女性健康管理水平得以逐步提升。

Health Promotion Model: An Integrative Literature Review

Background: The Health Promotion Model (HPM) indicates that each person is a biopsychosocial creature that is partially shaped by the environment, but also seeks to create an environment in which inherent and acquired human potential can be fully expressed. The HPM is proposed as a holistic predictive model of health-promoting behavior for use in research and practice. Purpose: The purpose of this review is to examine how the HPM has been applied in various research studies. Methods: An integrative review was used to find studies that were guided by the HPM. Data search was between 2008 to 2018 using Google Scholar, Scopus, Web of Science, Science Direct, PubMed, Medline, CINAHL, EBSCO, Cochrane, ERIC, Joanna Briggs Institute and EBSCO host. The keywords used were Pender’s and Health Promotion Model. Results: Seventeen studies were reviewed;most of them were quantitative studies. These studies discussed variables from the HPM. Most of the study variables were measured using instruments derived from the HPM. The results of the reviewed studies revealed that the HPM had predictive value in estimating health-promoting behaviors. Conclusion: The HPM was widely established in the nursing community and was implemented in nursing practice, education, and research. In addition, the HPM constructs were used to hypothesize conceptual frameworks in many studies to predict health-promoting behaviors in many chronic diseases.

以妇女儿童为主体 发挥妇联网络优势开展HIV/AIDS预防教育与关怀活动

以妇女儿童为主体,发挥妇联网络优势,与联合国儿基会合作通过层层培训及大众传媒,深入开展了艾滋病预防知识宣传培训的社会动员工作,包括培养骨干,将宣传材料翻译成11种少数民族文字,利用各种途径传播相关知识,开展针对辍学女童等不同人群为目标人群的HIV/AIDS预防教育培训。通过以上措施,提高了广大妇女儿童有关预防和控制HIV/AIDS知识。

Comparing Lifestyle Convenience of Multiple Daily Injection and Continuous Subcutaneous Insulin Infusion

Aim: This study investigated the lifestyle convenience of Insulin therapy for adult women patients with type 1 diabetes. Methods: Participants were type 1 diabetes adult women patients who switched from multiple daily injection (MDI) therapy to Continuous Subcutaneous Insulin Infusion (CSII) therapy. We conducted semi-structured interviews with participants. To analyze, we referenced the classification table of Hamada’s study comparing the usefulness of both the NovoPen? and CSII. Semi-structured interviews were conducted with the research subjects. The questions focused mainly on diabetes management, instrument operation, everyday life, and social, psychological and lifestyle convenience aspects during MDI and CSII. Results: Research subjects were 4 women patients with type 1 diabetes. The average age was 35.3 ± 6.24 (SE) years old. Participants were undergoing MDI therapy;however, in the middle, they switched to CSII therapy. CSII therapy is convenient in terms of diabetes management, social and psychological. MDI therapy is convenient in terms of instrument operation and daily life. Compared to MDI therapy, CSII therapy is less convenient in terms of instrument operation and everyday life. However, since CSII therapy has more stable HbA1c and blood glucose levels compared to MDI therapy, it is more convenient in terms of social and psychological aspects and reduces those burdens. About economy CSII therapy, patients paid about 5000 yen more per month compared to MDI therapy. Conclusion: It is believed that patients prioritize therapeutic effects, and choose CSII, which is stable in psychological and social aspects, even though it is inconvenient with life.

Women and Children's Health in Tibet

AS a doctor in the management of maternity and children’s hygiene in the Tibet Autonomous Region for nearly 20 years, I would like to present a brief introduction of the situation of Tibetan women and children’s health, as well as the related services. Prior the Liberation in Tibet, this region coveting over 1.2 million square kilometers, had few health care facilities for women and children. Such activities were carried out by three Tibetan medical institutions, a small number of folk doctors of Tibetan medicine, and a few private clinics. Under the feudal serf system in Tibet, women who gave birth were discriminated against because it was considered an obscene act. Women could not give birth in their tent homes, but were instead forced to seek shelter in cow stalls or sheepfolds no matter how severe the weather. Women and children at the time had no rights to health care. Countless women and children died of birthing complications

Women and Children's Health Care in the Yimeng Mountain Area

The Yimeng Mountain area in the central and southern part of Shandong Province, is very poor.

最低工资标准提升对女性育儿时间的影响研究

当前我国经济面临着较为复杂的外部发展环境和内部多重挑战,这使我国低收入家庭尤其女性家庭成员存在较大的收入不确定性,这些变化将会对女性的工作(有酬劳动)和育儿(照料子女)的选择产生深刻影响。尽管已有研究广泛探讨了女性所面临的工作-育儿冲突问题,但现实生活中我国女性在二者之间究竟会作何选择并可能引致何种后果则少有文献涉及。文章借助最低工资政策的实施,构建理论模型刻画女性在面临增收机会情境下育儿时间的选择机制,以期加深理解低收入女性在工作和育儿之间的权衡难题。文章还利用子女的未来健康状况变化进一步考察女性育儿时间决策的后果,为上述问题的分析提供补充证据。在此基础上,采用2004—2015年中国健康与营养调查数据和同期各区县的最低工资标准进行系统的实证检验。结果显示最低工资标准提升对低收入女性育儿时间具有显著负向影响,该结论在经过一系列内生性分析和稳健性检验后依然成立。机制分析表明最低工资标准提升主要通过提高女性参与劳动的概率和工作时间产生作用,这一结论为低收入女性用工作替代育儿的事实提供了直接证据。异质性分析表明:处于生育平稳期、子女年龄为4~6岁或父辈健康状况较好的女性因具有更高的育儿弹性,育儿时间受到的负向影响更强,同时技能水平更低或工作搜寻难度更小的女性育儿时间同样也更容易受到最低工资政策的不利影响。进一步研究发现最低工资标准提升对短期内子女的身心健康具有显著负向影响,且均可归因于女性育儿时间的减少,这也为文章中的核心结论提供了补充性证据。据此建议政府部门推动建立父亲育儿假制度,加强对托儿机构的普遍监管和支持,鼓励企业为女性群体提供灵活的工作时间和工作模式,聚焦低技能、低学历女性群体的职业技能培训和教育提升,增强其就业竞争力,同时加强最低工资政策的执行力度,确保小时工资标准得到遵守,防止企业延长工作时间。这些措施有助于弥补女性育儿时间减少导致的不利后果,构建合理的生育支持政策体系。

江苏省妇幼保健机构感染管理工作现况调查

目的:了解分析妇幼保健机构感染管理部门配置及工作开展情况现状,并针对存在问题提出改进措施。方法:从江苏省内苏南、苏中、苏北地区妇幼保健机构分层抽样,对感染管理部门配置及工作开展情况进行问卷调查。结果:共纳入17份问卷,所有医疗机构均已成立院感委员会;76.5%的医疗机构院感委员会每年召开4次例会;94.1%的医疗机构医院感染管理部门独立设置。感染管理部门专职人员数量配置充足,院感专职人员以护理人员为主,占64.2%,学历以本科学历为主占75.5%,从事院感工作不满3年的占41.5%,高级职称人员占47.1%。93.3%的医院开展院感病例监测;57.1%的医院开展了手术部位感染目标性监测;设置新生儿监护室的医院100%开展了新生儿监护室医院感染目标性监测;设置重症监护室的医院71.4%开展了重症监护室(非新生儿)医院感染目标性监测;64.7%的医疗机构内检验科可自行开展微生物检测,其中81.8%的医院开展了多重耐药菌感染目标性监测;91.4%的医院开展了手卫生监测;80%的医院配备了信息化院感监测系统;94.1%的医院复用诊疗器械清洗、消毒和灭菌方式为消毒供应中心集中管理。结论:妇幼保健机构仍需完善医院感染管理三级组织,进一步优化专职人员专业结构,提升医院感染管理工作水平,促进妇幼保健机构医院感染管理高质量发展,确保医疗质量和医疗安全。

宫颈长度对早产的预测意义及其相对于孕期的预测效果

目的：探讨宫颈长度测量对早产的预测效果,并分析其与孕期之间关系,提高诊断的科学性.方法：对2011 年5-7 月的首诊孕妇进行普查追踪,采用SAS 9.2 对资料进行描述性统计分析.结果：早产组的宫颈长度明显短于非早产组（Z=8.3293,P=0.001）,宫颈长度随着孕周的退后而逐渐缩短（ 字2=163.1823,P=0.001）,孕后期（P5～6） 的宫颈长度均数18.86 mm.以宫颈长度〈25 mm 作为预测早产的阳性指标,其特异度随着孕期的退后而下降,孕后期（P5～6） 的特异度均为0.5000.多因素分析显示了孕期和宫颈长度都对预测早产有明显的影响.结论：宫颈长度测量具备预测早产的普遍意义,然而随着孕期推后的子宫正常生理,判别点需要进行调整以降低误诊可能.宫颈长度的基于定量的定性判别可能更适合于孕中期,孕后期则要考虑到更多因素的综合指示意义.

2011-2015年我国妇幼保健机构医用设备配备状况分析

目的了解2011-2015年妇幼保健机构医用设备的配备情况,为进一步合理配置医院设备提供基础数据。方法利用2011-2015年度全国妇幼保健机构监测数据,对全国妇幼保健机构万元以上医用设备配备现状进行描述性分析。结果5年间,我国妇幼保健机构万元以上医用设备呈现逐年增长的趋势,总体增幅为74.97%,1万元~、10万元~和50万元~3组设备总数增幅分别为70.93%、87.57%和103.50%;县区级妇幼保健机构各年医用设备拥有量最大,均占53%以上;1万元~组设备占总数的80%左右。从设备均数上看,省级、地市级、县区级妇幼保健机构平均设备拥有量比例为16.5∶5.7∶1,增幅分别为58.22%、69.25%和75.43%。结论我国妇幼保健机构医用设备呈现增长的趋势,与妇幼保健机构整体的业务发展相适应。从"十三五"开始,我国妇幼保健机构医用设备配置和管理将面临新的发展机遇和挑战。

妇幼健康教育现代管理模式的探讨

采用网站、语音、短信、视频等现代化管理手段,以国家妇幼保健中心为核心,联盟全国各妇幼保健机构,统一规划、建设各级妇幼保健机构门户网站和信息服务平台,为各级妇幼保健机构提供一套现代化的妇幼健康与健康管理现代服务模式及服务支撑系统,促进妇幼保健机构的现代服务水平和综合实力的提高。

广东省某三甲妇幼保健院医保住院患者就医满意度影响因素研究

目的 通过调查广东省某三甲妇幼保健院医保住院患者就医满意度,探讨影响医保患者就医满意度的相关因素,发现医保服务的不足之处,从而为提高医院医保管理水平提供参考依据。方法 采用问卷调查法了解2021年9月—12月住院期间医保患者就医服务满意度情况,采用描述性分析对数据的分布进行探索,并对影响就医的因素进行进行单因素方差分析及线性回归分析。结果 影响患者就医满意度的主要因素包括出入院手续办理、病房环境舒适度、医保政策宣传、便民服务、医保结算效率、医保报销清晰度等。结论 医疗水平、环境设施与医保服务对总体满意度的影响较大,医院应重点改善出入院手续办理、病房环境以及医保报销清晰度,进一步提高医保住院患者的就医满意度。

信息优化应用于儿童健康管理的效果研究

目的 通过信息优化应用于儿童健康管理的效果分析,为提高儿童保健服务质量提供依据。方法 对来源于“闵行区社区卫生信息工作平台”的数据和“0~3岁儿童健康管理问卷”的调查结果进行统计分析显示,2014年共调查480人,2015年共调查527人。结果 信息优化后,0~3岁流动儿童系统管理率、家长儿童健康知识知晓率、儿童健康管理行为及满意度均高于优化前,家长给孩子体检和看病的总花费低于优化前,以上差异均有统计学意义（P〈0.05）。结论 信息管理不断优化能提高儿童保健服务质量。

湖南省妇幼保健院妇幼公共卫生项目管理模式的探讨与实践

目的探讨湖南省妇幼保健院妇幼公共卫生项目的管理模式及效果。方法以"结构-过程-结果"分析方法,从组织结构、资源配置、规章制度、开展的项目系统活动、结果等方面对湖南省妇幼保健院妇幼公共卫生项目的管理策略进行总结分析。结果采用健全辖区质量管理三级组织、成立多学科项目小组、保障群体保健人员工作时间及待遇、规范公共卫生不良事件上报、每月推进项目进度、定期组织项目重点问题交流讨论会等综合性策略措施促进项目的良性运行。2017年妇幼公共卫生项目的培训督导覆盖面、频次、质量等均较上年同期有所增高,保健与临床的融合更加深入,项目相关的质量管理工作落实日趋规范。2015-2017年湖南省主要妇幼卫生指标逐步改善,孕产妇死亡率、5岁以下儿童死亡率、出生缺陷发生率等呈逐年下降趋势,妇幼重大公共卫生项目取得显著成效。结论湖南省妇幼保健院的妇幼公共卫生项目管理模式运行良好,有效提高了项目的实施质量与成效,通过不断改进,将为妇幼公共卫生项目更好地惠及全省妇女儿童提供强有力的保障。

山西省妇幼卫生信息化建设及信息人力资源现状分析

目的了解山西省妇幼卫生信息化建设及信息人力资源现状,为决策者制定全省妇幼卫生信息化建设方案提供依据。方法通过国家妇幼卫生综合信息平台的"全国妇幼保健机构信息化与信息管理工作现状调查直报系统"收集数据。运用SPSS15.0软件对数据进行分析。结果有门户网站或正在建设中的机构占25.3%,有医院信息管理计算机网络的机构占20.0%,有覆盖本辖区妇幼保健信息系统的机构占5.3%。信息人员平均年龄(中位数)为38岁,女性占83.4%,大专学历占45.2%,初级职称及以下占57.3%,相关专业人员占42.8%。结论妇幼保健机构信息网络化建设工作滞后,信息管理工作发展不平衡,信息人员素质偏低,特别是县级。进一步加强妇幼卫生信息化建设,大力培养信息人才,借鉴或应用中国疾病预防控制中心妇幼保健中心研究的有关妇幼卫生信息化建设的成果,逐步实现全省信息的高效统一、互联互通、安全共享。

基于妇幼人群健康管理全流程信息化的建设研究

本研究以南京市妇幼保健院妇幼保健信息化建设为例,介绍了医院借助信息技术,建立了以妇幼保健业务为核心的医院妇幼人群健康管理信息系统架构。通过对医院妇幼人群健康业务信息系统的流程再造,分析了流程重建下相关业务信息系统模块需要改造的关键环节,提出了改善妇幼人群就医体验的新模式,进一步加强了医院医疗质量安全,提升患者满意度,实现妇幼人群诊疗信息化闭环管理,以期为各省市妇幼保健院组织开展院内外各项妇幼人群健康管理工作提供参考。

以妇幼健康项目实施推进分级诊疗制度落实的实践

目的了解扬州市妇幼保健院探索以开展妇幼健康服务项目为抓手,扎实推进分级诊疗工作落实的运行模式。方法扬州市妇幼保健院借助妇幼联合体平台,对幼儿髋关节发育不良筛查、儿童孤独症早期筛查、围产期营养干预等项目进行了分级服务探索。结果妇幼健康项目的分级实施,提高了目标疾病的早发现、早诊断、早干预率。结论通过帮助基层筹建科室、培训人员、规范技术标准、完善转诊制度,使妇幼健康项目实现了在基层筛查、县级确诊、市级干预治疗,建立起以强基层为重点的市县乡三级服务模式,提升了妇幼健康服务的可及性和资源利用效率,改善了群众满意度。

围绝经期女性健康管理刍议

围绝经期是妇女一生中一个具有特殊生理特点的阶段,随着雌激素水平的下降而引发的一系列生理、病理和心理变化严重影响着这一群体的身心健康,甚至影响工作和生活质量。该文通过对围绝经期女性面临的主要健康问题及健康服务需求状况进行分析,探讨应用健康管理方法进行有效干预的方法步骤,持续改善其健康状况,平稳渡过围绝经期。