ObjectiveTo analyze the application status of Kanban management in medical service management at home and abroad and to provide a reference for lean medical management practice in China.MethodsUsing the bibliometric method, in China National Knowledge Infrastructure, Wanfang Database, CQVIP Journal Database, Springer Link, Embase and PubMed, we used “Kanban” and “Kanban management” as Chinese search terms, “Kanban system” and “two-bin system” as English search terms to search for literature published from 2009 to 2019. The number of articles published, institutions, authors, citation frequencies, key words, Kanban usage, and improved areas where Kanban was applied in were statistically described and analyzed.ResultsA total of 219 articles were retrieved. Of the 14 articles included in the study, 12 articles were published from 2015 to 2019, 8 articles were published by hospitals, and 9 articles were cited more than or equal to 3 times. The key words were basically the combinations of Kanban and related topics in the field of medical service management, such as quality control and improvement, ward service, high-quality care and process evaluation; 11 articles used Kanban alone. Kanban was used in medicine supply chain management, ward bed management, and material inventory management abroad; and was used in medicine management, emergency room patient management, medical staff performance management, operating room equipment management, and high-quality medical service management in China.ConclusionsKanban as a lean management method was introduced into the domestic medical field late, and the current research development is not balanced. Asa visual management tool, Kanban needs to be extended in the medical field. As a lean improvement tool, Kanban has positive significance in improving medical quality and patient satisfaction. It is suggested that researchers should not be limited to the existing applied research, and can study the application of Kanban in different medical service fields in combination with different lean management tools according to the actual situation of the hospital.
Ischemic stroke can lead to disruption in the oral ecology and an overgrowth of pathogenic bacteria, resulting in periodontal disease. Meanwhile, the aspiration and pulmonary infection resulted from dysphagia can increase the unfavorable prognosis. Some studies have found that there exist oral bacteria in the thrombus in myocardial infarction and ischemic stroke patients, showing that oral flora might be associated with thrombus and stroke-associated pneumonia. There are few high quality clinical studies or evidence-based guidelines. Priority should be given to high quality research that provides oral care standards, and incorporating oral care into future stroke pathways to improve the prognosis.
ObjectiveTo analyze the application status and existing problems of value stream mapping (VSM) in improving medical services at home and abroad, so as to provide decision evidence for hospitals to apply VSM to improve medical services.MethodsUsing “value stream mapping” and “value stream” as search terms, we searched PubMed, Embase, China National Knowledge Infrastructure, CQVIP Journal Database and Wanfang Database (2009-2019), and collected relevant literature on the application of VSM to improve medical services at home and abroad. We conducted bibliometric analysis after confirming the literature according to the inclusion criteria. The standardization of application of VSM was also evaluated.ResultsOf the 299 articles retrieved, 13 studies fulfilled the inclusion criteria. The publication time of the literature was distributed between 2013 and 2019. Of the 8 foreign articles included, the regions to which the first author belonged were 4 in the United States, 1 in Ireland, Norway, Lebanon and Indonesia respectively. Of the 5 included domestic articles, the regions to which the first author belonged were 2 in Zhejiang and Shanghai respectively, and 1 in Guangdong. Of the foreign literature, 5 articles did not clearly state the sample size observed when drawing VSM, 5 articles incomplete drawing elements of VSM, and 3 articles did not show VSM. Of the domestic literature, 2 articles did not clearly state the sample size observed when drawing VSM, 3 articles had incomplete drawing elements of VSM, and 1 article did not show VSM.ConclusionsVSM is relatively more used in high-income and upper-middle income countries. The medical service improvement issues for which VSM is applied are relatively single. The standardization of the application of VSM in domestic and foreign literature needs to be improved overall.
Objective To analyze the application of lean healthcare management in optimizing services in foreign operating rooms, and provide a theoretical reference for further optimizing service processes in domestic operating rooms with lean healthcare management. Methods PubMed and Web of Science databases were searched literature about lean healthcare management in optimizing foreign hospital operating room service process. The search period was from the establishment of databases to November 2024. The number of publications, publishing institutions, authors, citation frequencies, keywords, the use of lean management tools and the improvement status were analyzed.Results A total of 71 literatures were included. Among them, 17 literatures were published from 2008 to 2014, and the number of related literatures increased significantly since 2015, with 54 literatures published by 2024; 9 literatures were published by universities and 62 literatures were published by hospitals. In terms of the distribution of countries and regions where the literatures were published, there were 34 literatures from the United States, 12 from the United Kingdom, 5 from Italy, 4 from Switzerland, and 3 from Canada. The keywords basically presented the combination ofthemes related to operating room management and lean healthcare management improvement fields, such as lean six sigma, quality improvement, and operating room efficiency. The five lean tools with the highest frequency of occurrence in the 71 included literatures were value stream mapping, fishbone diagram, A3 report, PDCA cycle management, and 5S. Conclusions There is an imbalance in the development of lean healthcare management research, with the number of publications in developed countries being far higher than that in developing countries. Lean healthcare management is conducive to improving surgical safety, work efficiency, and patient-doctor satisfaction. Lean healthcare management should further adapt to the actual situation, unify the lean management indicators in operating rooms, conduct cross-departmental cooperation, maximize the effectiveness of lean improvement tools, and achieve modern medical management.
Objective To explore the impact of community healthcare workers’ (CHWs) knowledge, attitude and practice (KAP) on the influenza vaccination among elderly people. Methods By means of simple random sampling, 1 residential quarter of each communities, 2 communities of each districts, 5 districts of Chengdu city were randomly selected, and the elderly equal to or more than 60-year-old were on-site investigated. Meanwhile, the questionnaire survey was conducted among healthcare workers in the selected communities. Results There were 4 KAP factors played a positive role in influenza vaccination among elderly people: CHWs’ affirmation of the effectiveness of influenza vaccine, explicitly knowing the focus groups for influenza vaccination, recommendation of vaccination in flu season when the elderly visits, and participation in flu-related education activities. When the accuracy rate of each factor got improved by 1%, the influenza vaccination rate would improve by 2.747%, 1.299%, 0.864%, 0.602%, respectively. Conclusion The knowledge, attitude and practice of HCWs have impacts on the influenza vaccination rates of elderly people. They are significant to improve the influenza vaccination rates of the elderly.
The increasing need for healthcare services in rural areas cannot be satisfied because of the lack of healthcare professionals, and poor medical education and training. These result in the low competency of rural healthcare workers. Therefore, the medical education system needs to be reformed in order to improve healthcare human resources in rural areas.
Value-based healthcare (VBHC) is an important guideline for current and future healthcare services. In practice, VBHC should be the best goal of public welfare of healthcare service. Meanwhile, VBHC and cost-effectiveness analysis together provide scientific evidence for healthcare decision-making. Pay by value is inevitable in the next stage of the reform of the payment system of medical insurance, and the health service system should be reconstructed based on VBHC. Finally, the challenges of VBHC implementation are discussed.
At present, China has entered an aging society facing the dual challenges of “growing old before becoming affluent” and “aging without adequate preparation”, leading to significant eldercare pressures. With the rapid development of smart healthcare, the elderly population’s diverse, differentiated, and personalized medical demands have become increasingly prominent, presenting new challenges for geriatric healthcare services. This article elaborates and analyzes the elderly healthcare policies and the healthcare challenges faced by the elderly under China’s national strategy for actively addressing population aging. It also introduces the practical experience of intelligent elderly medical assistance in West China Hospital of Sichuan University from the aspects of enhanced appointment coordination mechanisms, refined treatment workflow optimization, and upgraded patient-centered service provisions. The research ultimately proposes actionable management strategies to achieve intelligent continuity in geriatric care delivery.
It is one of the priorities of the new round of healthcare reform to develop regional healthcare alliances through vertically integrating resources. This paper reviews the framework and characteristics of Shanghai’s healthcare system, and then analyzes its strengths and weaknesses, underscoring Shanghai’s exploration in the vertical integration of medical resources as a response to the pressing issues in healthcare. The paper outlines the main tasks and groundwork of the Shanghai healthcare alliance initiative and gives an outlook on the expected outcomes. It ends with some thoughts on the problems and challenges confronting regional healthcare alliances in Shanghai.
Objective To review the adverse event of hysterectomy caused by postoperative infection after cesarean section, formulate prevention and control strategies in combination with risk assessment tools, promote the standardization of perioperative management, reduce the medical burden on pregnant women, and improve patient satisfaction. Methods The two adverse events of hysterectomy caused by postoperative infection after cesarean section that occurred in the obstetrics ward between October and November 2024 were selected as the research objects. A root cause analysis and risk assessment team composed of personnel from multiple departments was established. Through interviews, observations, and data review, the potential failure modes and causes were sorted out. The risk priority number (RPN) was calculated to determine the high-risk factors. Improvement strategies were formulated and implemented. After two-month implementation, the RPN scores and the compliance of various measures before and after the implementation were compared. Results Before the improvement, the total RPN of the healthcare failure mode and effects analysis was 367.8. When rechecked in January 2025, the total RPN after the improvement dropped to 105.7, and no serious adverse events occurred again. The compliance and passing rates of various operations significantly increased: the intervention rate for maternal malnutrition rose from 17.5% to 48.6%, the passing rate of appropriate timing for prophylactic use of antimicrobial agents before surgery increased from 50.5% to 81.0%, the compliance rate of scrubbing the vagina with disinfectant before surgery increased from 15.0% to 60.0%, the implementation rate of standardized skin disinfection during surgery rose from 66.7% to 95.2%, the passing rate of aseptic techniques and hand hygiene operations during surgery increased from 75.0% to 95.2%, and the timely submission rate of specimens from infected patients increased from 29.4% to 47.6%, and all these differences were statistically significant (P<0.05). Conclusion The combination of healthcare failure mode and effect analysis and root cause analysis can effectively improve adverse events during the perioperative period, optimize the perioperative management of cesarean section, and reduce the risk of infection.