医院门诊就医流程改进

基于信息技术的医院门诊流程再造研究

1 引言

《牛津英语大辞典》（Oxford English Dictionary）对流程（Process）的定义是，“一个或一系列连续有规律的行动，这些行动以确定的方式发生或执行，导致特定结果的实现——一个或一系列连续的操作（Operation）。”(Oxford University Press,1978)所谓的就医流程，就是病人就医开始到结束的一系列活动，它属于医院的内部行为，医院安排作用较强。医院的业务流程不同于一般企业，它是一个流程系统，由三大类流程作为支撑，分别为核心流程、支持流程和管理流程，其中核心流程又可以细分为门诊流程、急诊流程和住院流程。考虑到无论服务的“面上”，还是“量上”，对病人影响最大的流程是门诊流程。因此在本次就医流程讨论的重心放在“门诊就医流程”。

The definition of word “process” in Merriam-Webster’s Collegiate Dictionary is “a natural phenomenon marked by gradual changes that lead toward a particular result”. Hospital process is defined by patient activities from beginning to end of hospitalization. It is an internal behavior under the arrangement and control of hospital itself. The business process of hospitals is different from normal enterprises. It is a workflow system, supported by three categories of workflows, which are core workflow, supportive workflow and management workflow. The core workflow comprises outpatient workflow, emergency workflow and inpatient workflow. Taking into account the volume of outpatients and current service quality, outpatient workflow is essential to the patient satisfaction. Therefore this paper focuses on “outpatient workflow”.

有学者通过问卷调查法随机抽取200名门诊患者，对当日门诊数据及门诊各部门相关工作情况进行分析，研究发现目前我国大部分医院人均挂号至就诊时间平均为157.2 分钟，诊室诊断时间为18.89 分钟，预约至检查时间平均为106.4 分钟，取药等待时间平均为12.84 分钟(何谦, 廖清书, 刘建萍, 2005)。以上数据直观说明了医院门诊流程再造的紧迫性，如何从患者的角度考虑安排就诊过程，简化门诊流程的各个环节，减少患者在门诊的停留时间，以达到科学管理，提高门诊整体服务水平。

Some researchers interviewed 200 outpatients randomly by using questionnaires and analyzed the daily data from outpatient departments (OPD). It showed that in most hospitals in China, in average the waiting time from visit registration to doctor consultation is 157.2 minutes, the time of consultation is 18.89 minutes, the waiting time from appointment to examination is 106.4 minutes, the waiting time for pharmacy dispensary is 12.84 minutes (何谦, 廖清书, 刘建萍, 2005). The above data explicitly illustrated the immediate urgency of hospital outpatient

process reengineering. How we can re-arrange the process of outpatient visit and how we can simplify the steps to decrease waiting time are questions in order to improve OPD service by scientific management.

由于“医院流程再造(Hospital process reengineering)是一种有关作业改善的哲学，它在对原有流程深刻理解和科学分析基础上，以病人为核心，通过对原有流程进行系统性重新整合或重组，增加流程中有价值的活动，减少无价值活动，以达到改善服务质量，提高对病人特殊需要的反应速度和降低工作成本的目的”(冯薇, 2005)，本研究主要从三部分来分析医院流程再造活动：一是对现有流程的科学分析以及存在的问题剖析；二是找出现有问题原因并提出再造分析思路；三是提出改进方案，给出流程再造后的流程图。

Hospital process reengineering is a philosophy to improve operations. It is based on the profound understanding and scientific analysis, to refactoring or regrouping previous workflow operations systematically from a patient centric point of view, to increase value added activities and decrease valueless activities, for the purpose of improving service quality, accelerating response to patient and reducing cost. (冯薇, 2005). This paper analyzes the process reengineering activities in three folds. Firstly we analyze existent workflow and problems. Then we explore the reasons to the problems and paradigm to process reengineering. Thirdly, we propose improvement plan and workflow diagram after process reengineering.

2 医院传统门诊流程现状及存在的问题

OPD workflow and existent problems

2.1现状Current situation

一般看来，普通门诊大致可以区分为“挂号-诊断-检查-处方-取药-治疗”这几个过程，但在实际过程中，医院门诊流程并不是清晰的呈现出以六个流程，而出现了“五多一短”的现象，即1）医院病人集中多，2）治疗环节多，3）人群杂、病种多，4）应急变化多，5）医生变换多，6）诊疗时间短。

Theoretically, an outpatient visit can be divided into procedures of registration, diagnosis, examination, prescription, pharmacy dispensary and treatment. However, in practice, OPD workflow presents a more complicated process with a phenomenon of 1) large volume of patients, 2) complex medical tasks, 3) mixed groups of patients and miscellaneous diseases, 4) various emergency cases, 5) variation of caregivers’ services and 6) short time of consultation.