RESULTS OF THE STANDARD’s IMPLEMENTATION ON ORGANIZING OUTPATIENT CARE DELIVERY IN THE TOMSK REGION
Authors:   Siberian State Medical University, Tomsk, Russian Federation, Deev I.A. , Kobyakova O.S. ,   Siberian State Medical University, Tomsk, Russian Federation, Boykov V.A. ,   Siberian State Medical University, Tomsk, Russian Federation, Shibalkov I.P. ,   Siberian State Medical University, Tomsk, Russian Federation, Baranovskaya S.V. ,   Siberian State Medical University, Tomsk, Russian Federation, Protasova L.M. ,   Siberian State Medical University, Tomsk, Russian Federation, Shnaider G.V. ,   Siberian State Medical University, Tomsk, Russian Federation, Suvorova T.A. ,   Siberian State Medical University, Tomsk, Russian Federation
Published: December 2020

Significance. Within the territory of the Tomsk region, experience of medical organizations in applying lean manufacturing technologies to improve individual processes of outpatient care delivery was summarized and presented in the format of a unified document - Standard for organizing outpatient care in the Tomsk region, which regulated common approaches towards polyclinic work organization. The purpose of the study is to evaluate effectiveness of implementing the Standard for organizing outpatient care in the Tomsk region. Methods. The Standard included 14 sections regulating activities of structural divisions of polyclinics and individual aspects of the work organization of medical organizations. To assess effectiveness of the Standard's activities, a list of indicators has been developed and monitored on a monthly basis. To implement the project, each polyclinic has developed a detailed tactical implementation plan with a deep decomposition of activities, specifying deadlines and responsible persons. Results. Plans’ analysis after the first four weeks of the Standard's implementation failed to show any statistically significant results. However, starting from the second month of the implementation, significant differences in performance indicators were found in polyclinics with different levels of implementation. Decrease in the number of complaints about organization and quality of medical services is associated with introduction of the Standard’s sections, including organization of call centers, introduction of the 5s system at workplace, use of aid chains by employees, as well as changes in approaches to routing patients (booking an appointment for consultation and follow-up appointments during initial appointment, activities of offices of routine care organization, etc.). In addition, the number of complaints from citizens was significantly lower in polyclinics that optimized the work of treatment rooms, implemented the system of patient’ evaluation of the polyclinic and improved navigation. Conclusion. The systematic application of lean manufacturing technologies to optimize activities of polyclinics can increase efficiency of their functioning. However, improvement of certain parameters that characterize effectiveness of medical organizations turned out to reversible, which is of interest from the point of view of the development of measures aimed at increasing lifespan of the effect of the implemented changes. Scope of application. The study results can be useful by managers of medical organizations when implementing a lean manufacturing system and by regional authorities in the field of public health when coordinating such projects.