04-国际最佳医院管理论坛

International

BestHospitalManagementForum1LeanManagementandAccreditationORISTHISAGOODMARRIAGE?DNVGL-Highlyskilledpeopleacrosstheworld2300+offices100countries16,500

employeesManagingriskMaritimeFood&BeverageTransportationIT&TelecomHealthcareAutomotiveEnergyPublicSectorDefenseDNV’scorecompetence–ManagingriskBusinessAssurance-ourbroaderviewinanutshellBeliefTomorrow’ssuccessfulcompanieswillcreatevaluebymeetingtheworld’seconomic,socialandenvironmentalneeds.PositionAworld-leadingcertificationbodyformanagementsystems,products,persons,supplychainsandfacilities.PeopleWeare2000highlyskilledemployeeswithareasontogetupinthemorning.PresenceWehelp70000customersin187countries,inmostindustries,alongentirevaluechains.PartnershipWorkingwithourcustomerstotakeabroaderviewinordertobuildsustainablebusinessperformanceandcreatestakeholdertrust.InnovationCertification,verification,assessment,trainingandsustainabilityadvisoryservicesthathelpcompaniesmeetchangingdemands.4Certification&VerificationTrainingAssessmentManagementSystemCertification,ProductAssurance,CertificationofPersons,SustainabilityReportingAssurance,industryspecificservices,supplychainmanagement,waterfootprint,localclimatechangetradingschemes.RiskAssessment,gapanalysis,ISRS™AssessmentAccreditedtrainingcourses(IRCA)andpublictraining,in-housetraining.Resultsinacertificateorstatementofcompliance.Supportsreliabledecisionmaking.Learninghowtoimprovefromaglobalperspective.SUSTAINABLEBUSINESSPERFORMANCEHowwedeliverassuranceSustainabilityAdvisorySustainabilityStrategyandMateriality,StakeholderengagementCompellingreports,CRandSustainabilityBenchmarking(Tomorrow’sValue™Benchmark)HowtoachievesustainablebusinessperformanceIndustryspecificservicesFood&Beverage,HealthcareHEALTH&SAFETYENERGYRESOURCEFOOTPRINTINFORMATION&ITSOURCINGSUPPLYCHAINMANAGEMENTQUALITYENVIRONMENT5HealthcareRelatedServicesInternationalInternationalAccreditationHospitalsPrimaryCareProvidersManagingInfectionRiskManagementsystemsISO9001(Quality)ISO14001(Environment)ISO27001(InformationSecurity)ISO50001(EnergyManagement)OHSAS18001(Safety)Local(including)NIAHOAccreditation(USA)ONA(Brazil)NHSLA(England)HKZ(Netherlands)NIAZ(Netherlands)CommunityEquipmentCodeofPracticeSchemes(UK)UNE179003(Spain)NTA8009(Netherlands)MacmillanQualityEnvironmentMark®/PatientCentredCare(UK)AcuteStroke(US)ComprehensiveStroke(US)6ManagementSystemCertificationOurservicesQuality:ISO9001,ISO/TS16949,TickIT,TL9000.Environment:ISO14001,EMAS,FSCChainofCustody.Energymanagement:ISO50001.Healthandsafety:OHSAS18001.SocialResponsibility:SA8000

(ISO26000notcertifiable).Supplychainmanagement:ResponsibleSupplyChainProcess(RSCP).Supplychainsecurity:ISO28000,TAPA.Informationsecurity:ISO27001.ITservicemanagement:ISO20000.Businesscontinuitymanagement:ISO22301.Industryspecificstandards.No.ofcompanieswithISOcertificationworldwide:ISO9001:1012720ISO14001:285844DarcyCooperManagerQuality&EnvironmentalSystemsNSK7DNVGLHealthcareAccreditationArisk-basedapproachtopatientsafetyandcareDemandforquality&accountabilityincreasesneedforasystematic,risk-basedapproachtopatientcentredcare.Increaseincaredemandsqualityverification.Riskrequiressystematicmanagement.Managingeveryoperationalaspectinamoresustainableriskbasedmannertoreducevariationinprocesses.(reducenegativeenvironmentalimpactandefficiencyimprovements(waste,energyuse,informationsecurity,etc.)8HealthcareOurservices:HospitalAccreditationtoDNVGLstandardsManagingInfectionRiskDisease-specificcertificationsManagementsystemscertificationTraining2,400HEALTHCAREORGANISATIONS

ACCREDITEDORCERTIFIEDKaleidaHealthSystem9RisksinHealthCare–ScaleoftheProblem/Informalwayofdoingthings医疗风险-问题规模/非正规操作USHarvardMedicalPracticeStudy1991:3.7%ofinpatientepisodesleadtoinjury据美国哈佛医学中心1991年研究：3.7%住院患者会受到损伤USIOM1999:Estimates1millionexcessinjuriesduetomedicalerrorEstimates44,000to98,000unnecessarydeathseachyearduetomedicalerrorUSdeathrateequivalentto2to3jumbojetcrashesevery2days据USIOM1999估计大约1百万医疗损伤源自医疗失误大约每年44000到98000非必要性死亡源自医疗失误UKDH2000,2003&2006:850,000admissionsleadtoanadverseevent据UKDH2000,2003和2006年研究850000个入院案例反而导致负面事故10RisksinHealthCare–ScaleoftheProblem/Informalwayofdoingthings医疗风险-问题规模/非正规操作11Hugevariationinqualityandsafetyacrossprovidersandregions(Schusteretal1998,Grol2001):30-40%ofpatientsdon”treceiveevidence-basedcare20-25%ofcareisnotneededorispotentiallyharmful全球各地大量存在质量和安全问题30-40%病人没有得到有依据的治疗20-25%治疗是非必要的或者有潜在危害的Informalwayofdoingthings-howthingsasdoneherewithoutproactiveattentiontosafetyvulnerabilitiesandmitigatingrisk非正规操作-没有事前预计安全性和将地风险TheProblem问题Thereisa1in3MillionChanceofanAccidentinanAirplane飞机失事的可能性是300万分之一Thereisa1in300ChanceofanAdverseEventinaHospital

医疗事故的几率是300分之一

WHO

12PatientsforPatientSafetyinChina:acrosssectionalstudy中国的患者安全：分类研究1000surveyquestionnairestudyforpatientsontheirunderstandingofmedicalerrors,infection,medicationsafety,andotheraspectsofpatientsafety-with959returned1000份对于患者的问卷调查，基于他们对医疗失误、感染、医疗安全和其它患者安全的认识-收回959份65%wantfulldisclosureoferrors65%希望完全披露失误187hadexperiencedmedicalharmor19%187人（19%）曾经历过医疗危害68%willingtoaskcaregiversaboutwashinghands

68%想询问护工如何洗手Majorityneededmoreinformationaboutpatientsafety大多数人表示需要关于患者安全的更多信息ZhangQ,LiY,LiJ,MaoX,ZhangL,YingQ,WeiX,ShangL,ZhangM.SourceWestChinaHospital/SchoolofMedicine,SichuanUniversity,Chengdu610041,China.2013来源：四川大学附属华西医院13It’sNotJustthePatient不只是患者Humanbeingsmakemistakesbecausethesystems,tasks,andprocessestheyworkinarepoorlydesigned”人们犯错的原因源自他们工作的系统，目标和流程设计欠佳。

LucienLeape14DNVsAccreditationProgram15Designedto:BeastrategicassetforthehospitalPromotepatientcentredcareCreatetransparencyinclinicalandsupportprocessesandrisksAllowhospitalstotailortheirresponsebasedoninternalandexternalcontextEnableproactiveriskbaseddecisionsEnablehospitalstoberesponsiveandadapttochangeCreatequalityandpatientsafetyimprovementopportunitiesthroughorganisationallearningBenefitsofaLEANSystemModelProvidesanintegratingframeworkClarifiessysteminteractionsFacilitatescommunicationsEmbodies“thestory”PromotesconsistencyofpurposeEnhancesnewemployeetraining16DNVsAccreditationProgramImplementationrequiresHospitalsto:CreateownershipthroughouttheorganisationAdoptasystemsandprocessapproachtomanagementIdentifyandgeneratedataandinformationtoallowinformedmanagementdecisionsWorksystematicallyandcooperativelywithafocusoncontinualimprovement1718ThefirstblushofloveandmarriageORLeanManagementandAccreditation19AccreditationrequirementAftertheorganizationidentifiesaproblem,theyaretoexaminetheissueandtakeitpasttheoneplacethattheissuewasfoundandtheprocess:IdentifyingtherootcausethatledtotheproblemIdentifytheactionstakentocorrecttheproblemintheaffectedareasand/orprocesses;Identifyotherareasand/orprocesses(ifapplicable)thathavethepotentialtobeaffectedbythesameissue;Identifytheprocessorsystemchangesthatwillbemadetoensurethattheproblemdoesnotreoccur;Identifytheperformancemeasure(s)and/orothersupportingevidencethatwillbemonitoredtoensuretheeffectivenessofthecorrectiveaction(s)taken.RootCauseanalysis,Failure,modeandeffectanalysisetc..20LeanManagementRequirementLeanmanagementisanapproachtorunninganorganizationthatsupportstheconceptofcontinuousimprovement,alongtermapproachtoworkthatsystematicallyseekstoachievesmall,incrementalchangeinprocessesinordertoimproveefficiencyandquality.Valuestreammappingisaleanmanagementmethodforanalysingthecurrentstateanddesigningafuturestatefortheseriesofeventthattakeaproductorserviceformitsbeginningthroughtothecustomer.21AccreditationandLeanMangementCoreworkoftransformationis:ChangingthecultureChanginghowwerespondtoproblemsHowwethinkaboutpatientsHowwethinkaboutourselvesHowweinteractwitheachother22LeanManagementNotonlyinhealthcareManufacturingServicecompaniesRetailersgovernmentagenciesWhenleanthinkinggoesonlyskindeepandmanagementdoesnotchange,improvementscannotbesustainedandsavingsneverquitehitthebottomline.23LeadersmustlearntodothisratherthantoknowtheanswersGosee,askwhy,showrespect.”24Notalwayshappyandleadersarefrustrated25HealthcarePeople“Get”LeanHealthcareisthediagnosisandtreatmentofillnessLeanisthediagnosisandtreatmentofprocesses2627TransformationHasTwoElements

TechnicalandSocialTechnicalToolsandTechniquesPursuitofPerfectionValueStreamThinkingDisconnectedProcessImprovementToolsDeploymentSocialToolsandTechniquesLearningOrganizationAdvancedTeambuildingEmployeeEmpowermentEmployeeEngagementThePathtoLeanBuildingaTrueLeanCultureMeanswinning“oneheartandsoulatatime”EachindividualcomestoafullcommitmentattheirownindividualpaceBepatient-somewhoembraceitslowlybecomethestrongestadvocatesYouknowyou’retherewhenallemployeesengageinidentifyingandeliminatingwasteeveryday2829Internationallymandatedtools&stds-(eg.useofchecklists,reporting,etc)国际强制工具和标准（例如检查列表的使用等等）

AchieveMasteryofsystems对体系和安全问题实施有效管理WorkingforHighReliabilityofProcessNationalRegulatoryBodies国家管理机构StandardizedTraining,Credentialling标准化的培训和认证30Safetyeffortsinhealthcareoftenrunupagainsttraditionalaspectsofmedicine’sculture.医疗领域有关安全的注意事项常常有悖于传统的医药文化。Rigidlyestablishedhierarchies严格的层级管理制度，Reluctancetoacknowledgehumanfallibility不愿意承认人类易犯错误的特性McCarthy&Blumenthal麦卡锡和布鲁门撒尔

31Youhavetogettoknowandrespecteachother32PersonCenteredCare以人为中心Mutualrespectisthefoundationofanytruedialoguebetweenhumans人与人之间相互尊重是任何真正的对话的基础Acoordinatedeffortisessential.Thisisespeciallytruewithdiffering