Applying the Toyota production system to decrease the time required to transport patients undergoing surgery from the general ward to the operating room and reviewing the essence of lean thinking.

Background: Sending a patient to the operating room is the first step in surgery. Delayed patient transport causes the patient to go hungry for a longer time, aggravating the patient's physical discomfort and psychological stress. The issue of delays in transporting inpatients to the operating room has rarely been discussed in the literature. The Toyota production system is a famous and excellent scientific method of reducing waste and increasing efficiency. Our goal is to use the Toyota method to decrease the time required to transport the inpatient to the operating room and to review the concepts underlying lean thinking. Methods: We employed an A3 8-step problem-solving process. A current value stream map featuring numerical data (concerning 46 patients) measured in the workplace was developed. The total time spent on transport was 53 min, but we expected patients to be transported within 30 min. We hoped to reduce the time wasted by half, i.e., by 23*50% = 12 min. These 12 min were saved by reducing the time spent on "waiting for an attendant at the ward" by 9 min and the time spent on "elevator transport" by 3 min. According to the value stream map featuring the time measurements, the root causes of delayed transportation can be divided into process-related, attendant-related, and elevator-related factors. We formulated 5 countermeasures. The ECRS (Eliminate, Combine, Rearrange, Simplify) technique was used to rearrange, combine, and simplify the existing process. Hospital executives established norms for attendant prioritization of work and rules for elevator use. Results: According to the original indicators, all goals were attained. "Total time spent" decreased by 62.3%. The time required for attendants to report to the nursing station decreased by 56.5%. The time spent on elevator transport decreased by 44.4%. We developed a process for future use based on information-assisted patient and staff identification. Finally, we standardized successful processes. Conclusion: The seemingly trivial factors that delay patient transport are associated with seven types of waste. The A3 8-step problem-solving process is useful in this context. In proposing this improvement process, we believe that we are following the spirit of the Toyota production system.

Patient Safety and Staff Well-Being: Organizational Culture as a Resource.

The present study examines the relationship between patient safety culture and health workers' well-being. Applying the conservation of resources mechanism, we tested theory-based hypotheses in a large cross-disciplinary sample (N = 3232) from a Taiwanese metropolitan healthcare system. Using the structural equation modeling technique, we found that patient safety culture was negatively related to staff burnout (ß = -0.74) and could explain 55% of the total variance. We also found that patient safety culture was positively related to staff work-life balance (ß = 0.44) and could explain 19% of the total variance. Furthermore, the above relationships were invariant across groups of diverse staff demography (gender, age, managerial position, and incident reporting) and job characteristics (job role, tenure, and patient contact). Our findings suggest that investing in patient safety culture can be viewed as building an organizational resource, which is beneficial for both improving the care quality and protecting staff well-being. More importantly, the benefits are the same for everyone in the healthcare services.

Post-Pandemic Patient Safety Culture: A Case from a Large Metropolitan Hospital Group in Taiwan.

Patient safety is the core goal of medical institutions. The present study focuses on the patient safety culture and staff well-being admit the COVID-19 pandemic. In a large metropolitan hospital group, 337 employees who had participated in the quality improvement interventions completed an anonymous questionnaire of patient safety culture and personal well-being. The multiple regression analyses indicated that managerial role, seniority, female gender and direct contact with a patient were significantly related to the positive attitude on overall or certain dimensions of safety culture. Multivariate analysis also found that dimensions of teamwork climate, safety climate, job satisfaction and stress recognition as patient safety culture predicted staff exhaustion. Finally, comparing with the available institutional historic data in 2018, the COVID group scored higher on the working condition dimension of patient safety culture, but lower on the stress recognition dimension. The COVID group also scored higher on exhaustion. In the post-pandemic era, there seems to be an improvement on certain aspect of the patient safety culture among hospital staff, and the improvement is more prevalent for managers. However, exhaustion is also a poignant problem for all employees. These findings can inform hospital decision-makers in planning and implementing future improvements of patient safety culture and promoting employee well-being and resilience. Our findings also reveal directions for future research.