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DEA: porta d’accesso dell’ospedale

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Relazione alla Winter School, FIMM
Firenze, Dipartimento di Sanità Pubblica, 18 gennaio 2013

Published in: Health & Medicine
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  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
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DEA: porta d’accesso dell’ospedale

  1. 1. Fabrizio Gemmi, Azienda Ospedaliero Universitaria PisanaFirenze 18 gennaio 2013 Winter School - Junior Medical Leaders Il DEA porta d accesso dell ospedale l’esperienza dell’AOU Pisana FG 2013 1
  2. 2. 1)  Il DEA del Nuovo Santa Chiara 2)  Work in progress 3)  Le tecniche 2013 Winter School - Junior Medical Leaders FG 2013
  3. 3. Medicina d’Urgenza / Pronto Soccorso Medicina d’Urgenza Universitaria 1)  Il DEA del Nuovo Radiodiagnostica d’Urgenza Medicina 2 Santa Chiara Medicina 4 Medicina 5 Medicina 1 Geriatria Chirurgia d’Urgenza Terapia Intensiva DEA OrtopediaTraumatologia FG 2012
  4. 4. U.O.  Medicina  d’Urgenza  e     Pronto  Soccorso   TOTALE ACCESSI PER CODICE COLORE DURATA ATTESA (82468 / 86069) 90 78 77,560000 80 48104 7050000 43747 6040000 2010 50 2010 2011 201130000 25993 40 28 19521 30 25,720000 13496 14484 20 14,5 12,710000 10 1336 1441 0 0 Rosso Giallo Verde Bianco/Azzurro 0 - 60 min 60 - 90 min 90 min ESITO INTERVENTO ESITO INTERVENTO 65 ANNI70000 63148 (21048 / 23325)60000 16000 13831 1400050000 1200040000 2010 10000 2010 33579 8626 2011 201130000 8000 6810 5874 600020000 10778 4000 2429 8726 227110000 2000 3206 3547 0 0 Dimessi Ricoveri OBI DIMESSI RICOVERI OBI3000 2841 Degenza media: 2010 = 2.50 2500 2011 = 2.33 19252000 Peso medio DRG: 2010 = 1.0956 1500 2010 2011 = 1.1533 2011 953 9101000 500 0 Ricoverati in MU Dimessi da MU
  5. 5. ? L’urgenza è imprevedibile? 2013 Winter School - Junior Medical Leaders FG 2013
  6. 6. la ‘demand map’ Pronto Soccorso AOUP, demand map marzo - aprile 2011. (S. Pagliantini e M. Nerattini) 2013 Winter School - Junior Medical Leaders FG 2013 6
  7. 7. Ogni giorno FG 2013
  8. 8. 18 80% pazienti con decorso normale 16 14 12 10 8 6 15% pazienti con decorso complicato 4 5% pazienti difficili 2 0 0 5 10 15 20 25 30 -2 2013 Winter School - Junior Medical Leaders FG 2013
  9. 9. 0 50 100 150 200 250 01/04/12 02/04/12 03/04/12 04/04/12 05/04/12 06/04/12 2013 Winter School - Junior Medical Leaders 07/04/12 08/04/12 09/04/12 10/04/12 11/04/12 12/04/12 13/04/12 14/04/12 ricoveriprogramma7 15/04/12FG 2013 16/04/12 17/04/12 18/04/12 19/04/12 20/04/12 ricoveriinurgenza 21/04/12 22/04/12 23/04/12 24/04/12 25/04/12 variabilità)ricoveri)programma0)vs)ricoveri)in)urgenza) 26/04/12 27/04/12 28/04/12 29/04/12 30/04/12 Fonte: Direzione Medica di Presidio, Ufficio DRG
  10. 10. take home message #12013 Winter School - Junior Medical Leaders FG 2013
  11. 11. la variabilità indotta #1 dall’organizzazione supera la variabilità naturale 2013 Winter School - Junior Medical Leaders FG 2013
  12. 12. Il DEA funziona bene ! se il resto dell’ospedale funziona bene 2013 Winter School - Junior Medical Leaders FG 2013
  13. 13. mercoledì 19/12/2012 = paziente pronto per ricovero 2013 Winter School - Junior Medical Leaders FG 2013
  14. 14. il turno “classico” Consegne Cambio turno infermieri Caposala Medico riceve gestisce le informazioni da informazioni Caposala Infermieri turno Azioni che devono essere fatte notte in presenza del paziente Visita Azioni che riguardano il paziente ma che non ne richiedono la presenza Assistenza per compiti Prescrizioni Azioni che non riguardano il paziente Caposala gestisce le informazioni Consegne Cambio turno infermieri Assistenza per compiti Consegne Cambio turno infermieri2013 Winter School - Junior Medical Leaders FG 2013
  15. 15. mercoledì 19/12/2012 = paziente va in degenza 2013 Winter School - Junior Medical Leaders FG 2013
  16. 16. mercoledì 19/12/2012 = paziente va in degenza = paziente pronto per ricovero 2013 Winter School - Junior Medical Leaders FG 2013
  17. 17. Visual hospital 24:7:365 2013 Winter School - Junior Medical Leaders FG 2013
  18. 18. P4EP 24:7:365 2013 Winter School - Junior Medical Leaders FG 2013
  19. 19. pianificazione 24:7:365 2013 Winter School - Junior Medical Leaders FG 2013
  20. 20. take home message #22013 Winter School - Junior Medical Leaders FG 2013
  21. 21. Allineare i processi di lavoro #2 Sincronizzare l’offerta con la domanda 2013 Winter School - Junior Medical Leaders FG 2013
  22. 22. Il layout influisce ? sull’organizzazione del lavoro? 2013 Winter School - Junior Medical Leaders FG 2013
  23. 23. DEA Nuovo Ospedale Santa Chiara FG 20132013 Winter School - Junior Medical Leaders
  24. 24. diagnostica 10 box OBI visita Ingresso e triage DEA Nuovo Ospedale Santa Chiara 2013 Winter School - Junior Medical Leaders FG 2013
  25. 25. DEA Nuovo Ospedale della Spezia (progetto definitivo) 2013 Winter School - Junior Medical Leaders FG 2013
  26. 26. 26 box visita DEA Nuovo Ospedale della Spezia diagnostica (progetto definitivo) ingresso  e   triage   ambulatori OBI e HDU 2013 Winter School - Junior Medical Leaders FG 2013
  27. 27. take home message #32013 Winter School - Junior Medical Leaders FG 2013
  28. 28. Spostamenti, accumulo e #3 trasporti sono tipici muda 2013 Winter School - Junior Medical Leaders FG 2013
  29. 29. 2) Work in progress2013 Winter School - Junior Medical Leaders FG 2013
  30. 30. Il Gemba walk del lunedì 2013 Winter School - Junior Medical Leaders FG 2013
  31. 31. Gli  even8  Kaizen  2013 Winter School - Junior Medical Leaders FG 2013
  32. 32. Revisione delle casistiche rispetto alla nuova mission Elaborazioni M. Cristofano e D Benvenuti, Ufficio DRG, UO Direzione Medica di Presidio 2013 Winter School - Junior Medical Leaders FG 2013
  33. 33. Operation management 2013 Winter School - Junior Medical Leaders FG 2013
  34. 34. Innescare la dinamica PULL Making Hospital Work – M. Baker, I. Taylor2013 Winter School - Junior Medical Leaders FG 2013
  35. 35. Innescare la dinamica PULL Making Hospital Work – M. Baker, I. Taylor2013 Winter School - Junior Medical Leaders FG 2013
  36. 36. 2013 Winter School - Junior Medical Leaders FG 2013
  37. 37. VISUAL HOSPITAL Cause ritardo dimissione Esempio report Referente VH: Luglio 2012 PROBLEMATICA DESCRIZIONE ORE 9:00 ORE 11:00 ORE 14:00 ORE 17:00 In attesa per mancanza documentazione A 37 41 5 0 necessaria per la dimissione B In attesa arrivo ambulanza 28 32 33 7 In attesa arrivo parenti per portare via il C 17 13 7 0 paziente D In attesa farmaci 17 14 0 0 E Manca il posto letto in struttura o ADI 16 11 10 10 F Manca accoglienza temporanea della famiglia 1 1 1 1 Manca lattivazione percorso dimissioni G 0 0 0 0 complesse per ripensamento dei familiari H Mancano presidi 0 0 0 0 I Letto da sanificare 3 2 5 1 L Letto rotto 0 0 0 0 M Intera stanza inagibile 0 0 0 02013 Winter School - Junior Medical Leaders FG 2013
  38. 38. Un piano per ogni paziente P4EP 2013 Winter School - Junior Medical Leaders FG 2013
  39. 39. Il primo passo verso il P4EP 2013 Winter School - Junior Medical Leaders FG 2013
  40. 40. Stumenti semplici Visual Management: Standardizzare P4EP: Rendere gli sprechi Sincronizzare le attese Sostenere le condizioni critiche VISIBILI il processo 2013 Winter School - Junior Medical Leaders FG 2013
  41. 41. L’obiettivo: Rendere il processo visibile al team Facilitare un sistema di allerta 2013 Winter School - Junior Medical Leaders FG 2013
  42. 42. Gestire la variabilità Visualizzare il caso fuori controllo Intervenire 2013 Winter School - Junior Medical Leaders FG 2013
  43. 43. Obiettivo: Pianificare Condividere Intervenire Consolidare una prassi di gestione condivisa della pianificazione del percorso per ogni paziente 2013 Winter School - Junior Medical Leaders FG 2013
  44. 44. casi=167 casi=166 casi=254 2013 Winter School - Junior Medical Leaders FG 2013
  45. 45. Dimessi gg. di Degenza REPARTI Posti letto Totali degenza media 1° Medicina 1. Medicina 2 UNIV. 22 20 470 384 2.884 3.262 5,90 8,07 semestre Medicina 4 Medicina 5 34 18 648 367 5.538 3.206 8,32 8,35 Medicina Urg. SSN 16 1.163 2.820 2,39 2010 Medicina Urg. UNIV TOTALE 12 122 404 3.436 2.110 19.820 5,07 5,60 Dimessi gg. di Degenza REPARTI Posti letto Totali degenza media 1° Medicina 1. Medicina 2 UNIV. 22 16 379 394 2.504 2.796 6,31 6,77 semestre Medicina 4 22 453 3.947 8,40 Medicina 5 18 407 3.321 7,81 Medicina Urg. SSN 16 1.283 3.169 2,43 2011 Medicina Urg. UNIV TOTALE 18 112 577 3.493 3.110 18.847 5,23 5,23 Dimessi gg. di Degenza REPARTI Posti letto Totali degenza media 1° Medicina 1. Medicina 2 UNIV. 22 16 485 540 3.101 3.051 6,39 5,49 semestre Medicina 4 18 487 3.528 6,99 Medicina 5 18 453 3.224 6,83 2012 Medicina Urg. SSN 16 1.198 3.361 2,76 Medicina Urg. UNIV 18 673 3.374 4,88 TOTALE 108 3.836 19.639 5,002013 Winter School - Junior Medical Leaders FG 2013
  46. 46. 3) Le tecniche2013 Winter School - Junior Medical Leaders FG 2013
  47. 47. Go see Kaizen2013 Winter School - Junior Medical Leaders FG 2013
  48. 48. Go see2013 Winter School - Junior Medical Leaders FG 2013
  49. 49. Misure 1.  Measures should be at place of work and encourage the behaviour of the front-line staff. 2.  Measures are for management decision making. (Go see at place of work). 3.  Principle 1) always takes priority over 2). Da Ian Taylor e Marc Baker, 2010 2013 Winter School - Junior Medical Leaders FG 2013
  50. 50. 50
  51. 51. Kaizen2013 Winter School - Junior Medical Leaders FG 2013
  52. 52. 2013 Winter School - Junior Medical Leaders FG 2013
  53. 53. Azione di miglioramento di un intero flusso di valore o di un singolo processo per creare più valore con minor spreco 2013 Winter School - Junior Medical Leaders FG 2013
  54. 54. 2013 Winter School - Junior Medical Leaders FG 2013
  55. 55. L’organizzazione a piramide rovesciata riconosce una zona del valore, dove gli operatori incontrano direttamente i nostri clienti (principalmente pazienti) ed una zona di supporto che deve far si che la zona del valore funzioni al meglio 55 2013 Winter School - Junior Medical Leaders FG 2013
  56. 56. process kaizen 2 livelli system or flow kaizen 2013 Winter School - Junior Medical Leaders FG 2013
  57. 57. Si occupa di temi generali 2 livelli system or flow kaizen 2013 Winter School - Junior Medical Leaders FG 2013
  58. 58. process kaizen 2 livelli Si concentra su processi individuali: È il kaizen per i gruppi di lavoro e team leaders 2013 Winter School - Junior Medical Leaders FG 2013
  59. 59. Tratto da “Lean Lexicon” Lean Enterprise Institute, 2006 2013 Winter School - Junior Medical Leaders FG 2013
  60. 60. Metodi  convenzionali   Metodi  lean   Quindi  ….   Elaborare  i  problemi   Andare  dove  si  svolge  il   Go  to  see   all’interno  degli  uffici   lavoro   Coinvolgere  quelli  che   Coinvolgere  gli  al8  livelli   stanno  nella  zona  del   RispeGo  per  le  persone   di  management   valore   Seguire  le  voci  più  for8   Usare  i  da8   Misure   Testare  rapidamente  le   Lavorare  su  supposizioni   PDCA   soluzioni  2013 Winter School - Junior Medical Leaders FG 2013
  61. 61. RispeGo  per  le  persone  le persone che fanno uncerto lavoro vengonocoinvolte nel miglioramento: ascoltando le loro idee,mettendoli nelle condizioni diindividuare come procederee consentendo di attuare imiglioramenti. 2013 Winter School - Junior Medical Leaders FG 2013
  62. 62. PDCA  2013 Winter School - Junior Medical Leaders FG 2013
  63. 63. take home message #42013 Winter School - Junior Medical Leaders FG 2013
  64. 64. Eludere i problemi non #4 consente di migliorare l’organizzazione 2013 Winter School - Junior Medical Leaders FG 2013
  65. 65. No problem is problem James P. Womack 2013 Winter School - Junior Medical Leaders FG 2013

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