Yalın yönetim sistemlerinin hastanelere uyarlanması ve bir hastane uygulaması
Adaptation of lean management systems in hospitals and a case study
Yazar: DUDU BİLGİÇ
Danışman: DOÇ. HATİCE CAMGÖZ AKDAĞ
İstanbul Teknik Üniversitesi / Fen Bilimleri Enstitüsü / İşletme Mühendisliği Ana Bilim Dalı
Derece: Yüksek Lisans, 2016
Konu: Mühendislik Bilimleri = Engineering Sciences

Özet:
Günümüzde artan rekabet ortamında firmaların bu duruma ayak uydurabilmeleri gün geçtikçe çok daha zorlasmaktadır. Organizasyonların varlığını sürdürebilmeleri, müşteri taleplerine mümkün olduğu kadar fazla cevap vererek, pazar paylarını artırabilmeleri ile mümkün olabilmektedir. Bunun yolu da sürekli iyileştirmedir ve bu noktada Yalın Düşünce devreye girmektedir. Uzun yıllar boyunca imalat sektöründe kullanılmış ve yaraları açık bir şekilde görülmüştür. Yalın üretim sisteminin, son yıllarda yapılan çalışmalarda hizmet sektöründe de uygulanabileceği görülmektedir.
İşletmelerin başarılı olmaları ve bu başarılarını devam ettirebilmeleri için, müşterilerini iyi tanımaları ile yakından ilgilidir. Özellikle Sağlık sektörü düşünüldüğünde, imalat sektöründe önemli olan kavramlar sağlık sektörünün de hedefleridir. Hastaneler gibi süreçlerinde insan üzerine değer katan faaliyetleri olan hizmet kuruluşları her zaman hastaların taleplerine istenildiği şekilde karşılık verememektedir. Sistemde darboğaz ve israflar bulunabilmektedir. Bunların sonucunda da beklemeler meydana gelmektedir. Hastanelerden hizmet bekleyen kişilerin hasta insanlar olduğu  düşünüldüğünde, sistemde mevcut olan bu israf ve darboğazların olabildiğince hızlı olarak ortadan kaldırılması çok daha önem kazanmaktadır. İmalat sektöründe yalın üretim teknikleri olarak bilinen hizmet sektöründe ise yalın yönetim teknikleri bu noktada yardımcı olmaktadır. Bu yaklaşımda birçok araç ve teknikler bulunmaktadır. Bu teknikler yardımıyla israfları ve darboğazları ortadan kaldırarak, iyileştirmelerde bulunularak maliyetleri düşürerek hastaların taleplerini en iyi şekilde karşılanması amaçlanmaktadır.
Bu çalışmada Yalın Düşüncenin, hizmet sistemlerine uygulanabilirliği ve imalat sistemlerinde sağlanan faydaların hizmet sistemlerinde de ulaşılabilirliği araştırılmıştır. Hastanelerde yalın felsefe yardımıyla sistem performansının iyileştirilebileceği vurgulanmıştır.  Bu amaçla Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesinin kan alma bölümü incelenmiştir. Bu hastanelerde çalışanlar dinlenmiş olup, birebir görüşmeler yapılmıştır. Sonrasında seçilmiş katılımcılar ile, grubunun ayrıntılı bilgi ve fikirlerini belirlemek amacıyla 19.11.2015 tarihinde, Beyoğlu Kamu Hastaneleri Genel Sekreterliği binasında bir Odak Grup Çalışması yapılmıştır. Çalışma İstanbul Teknik Üniversitesi Öğretim Görevlisi Doç. Dr. Hatice Camgöz Akdağ yönetimde, Beyoğlu Kamu Birliği Hastaneleri' inde çalışan 21 kişi katılımıyla gerçekleştirilmiştir. Katılımcılara öncelikle bazı bilgiler verilip, çalışma amacı aktarılmıştır. Oturum öncesinde sorular belirlenmiş olup bu sorular katılımcılara yöneltilerek onların sorunları, fikirleri dinlenmiştir. Bu çalışmada yapılan değerlendirmeler sonucunda  Şişli Hamidiye Etfal Hastanesi' inde mevcut kan alma bölümü süreci değerlendirilip yeni önerilerde bulunulmuştur. Yalın Düşünce araçları yardımıyla sistem performansının iyileştirilebileceği vurgulanarak, yeni süreç tasarlanmıştır ve bu sistemin uygulanabilirliği değerlendirilmiştir.

Abstract:
In today's world, the companies in increasingly competitive environment adapt to this situation is much more difficult day by day. The organizations can survive, giving as much as possible to satisfy customer demand; it is possible by increasing their market share. The way for this is continuous improvement and Lean Thinking activate at this point. It is used in the manufacturing sector for many years and have been seen clearl
Lean production system aims to meet the customers' expectations by producing high quality products at low cost. It is aimed at producing zero inventory, zero-defect quality for these purposes. Human intelligence is the most important source for Lean manufacturing. Human resources should be used as multifunctional and participating. The production function must be able to respond to demand. Lean manufacturing is not a project or a fashion. It is the way of life and must be applied consistently.
Lean is not only a production technique, the service area of product development is an approach that can be applied in many areas of public service and commercial activities are emerging new examples every day.
Lean approach in all types of manufacturing industries; hospitals, insurance companies, banks, educational institutions, including the service sector; Civil society organizations; whether private, public institutions want to get any company, institution, organization and the success of the organization and contain the main principles can be adopted and applied in improving efficiency. The approach and techniques, product design services, management, administrative and commercial business processes which are in lean approach can be applied in the same issue.
The technique used in Lean Thinking principles and tools might differ from institution to institution is universal and is proven effective and successful in the world, it has been developed based on many applications.
The business success and to be able to continue this success, recognizing best customers is closely related. Especially if the health sector is concerned, the concepts that are important in the manufacturing sector are also the targets in the health sector. Service provider that adds value on human activities in the process, such as hospitals can not always respond to the demands of patients as required. Bottlenecks and waste can be found in the system. The results of these, waiting is occurred. If the thinking waiting people is patient for hospital services, it is very important more quickly as possible to eliminate these bottlenecks and waste in the current system. In the manufacturing sector, the service industry known as lean manufacturing techniques, lean management techniques can help at this point. There are many tools and techniques in this approach. With these techniques help, eliminate waste and bottlenecks, are aimed to meet the demands of patients in the best way, lowering costs by making improvements.

Lean approach, hospitals are able to change the organization and form of government, hospital errors, decrease waiting times which allows them to increase the quality of patient care, remove the obstacles in the working and management supporting the service flow and allow patient-centered health services approach. If lean manufacturing methods are applied in the health sector will provide quite useful results. However, bias should be removed. If these prejudices are overcomed with applying lean management system, it will provide superiority in tough competition environment. At this point, lean transformation is required in overcoming these prejudices and resistance. The progress will be much more difficult due to the unwillingness and resistance of people. For this reason it is necessary to convince people to become involved providing resistance during the process of change. However, it could require quite patience during this process of change.
One of the most important difference from other systems in the Lean philosophy is that the employees one to be involved in the process. Employees are experiencing a problem themselves and the details are best known by themselves. Getting together to exchange ideas on the idea of the exact solution of the problem is very important for this approach. Progress should be monitored along with the employees. In addition, the need to be clean communications in the place which have clear responsibility.
The Lean approach is quite a human-oriented philosophy. It is not possible to not to talk about education in a process that is people-oriented. Everyone working from the lower level up to the highest levels should be inform and train related to this lean process and also they should be organized. These trainings should be provided continously. At the same time it is important that training trainers for the continuity of this process.
Hospitals are quite important around health care. The important reason for this, the most of resources are consumed in the health sector. Therefore, these bottlenecks in the hospitals must be removed, it is quite expensive source of productivity should be increased and waste must be also removed expeditiously. Lean tools and techniques come into play for it. Lean thinking in the health sector, strengthen the staff to use lean tools in solving the difficulties and bottlenecks. It provides opportunities for the employees to develop themselves. In addition, it provides improvements in health facilitates by reducing the costs of operating and by improving the capacity.
In hospital laboratories, the results of the analysis of blood samples is intended to be delivered in the shortest time with the least resources to patients and doctors. In the realization of this objective can be benefit from lean manufacturing techniques and principles. The main point is to ensure the flow of lean thinking. All operations are performed to ensure the flow. It is very important where flow has a pause, which activities not to create value. When the flow in the laboratory is investigated with aspect of lean thinking, it is evaluated that what should be considered the break in flow. In this perspective, if the process evaluate processes, it can be observed, all waiting in the process prevent the resumption of the flow.
One of the most important cause of waste arise from the work order. Workplace layout in laboratories usually not based on the movement of workers or the flow of blood samples, it is determined on the basis of the section.
Workplace layout, is of considerable importance in reducing walk the need for employees. A settlement which has taken into account the flow of blood samples, has very important implications for the elimination of waste that occurs due to the employees walking. In lean thinking instead of trading as the batch, pieces are flow applications. Batch implementing in this process means that it is first transaction pieces wait to latest piece. This means the increase of the flow time. With the reduction of waste and improving, the flow will provide substantial gains in the process.
In this study, Lean Thinking, in which the benefits of the services provided in the service system, the applicability of the system and the availability of manufacturing systems have been investigated. For this purpose, laboratuary Sisli Etfal Traning and Research Hospital was examined. Individual interviews were conducted in these hospitals. After these interviews, on 11.19.2015 a focus group study has been conducted with selected participants, in order to determine the details and ideas of the group in the Beyoglu Public Hospitals General Secretariat. The focus group study was carried out 21 people in attendance who is working in the Beyoğlu Association of Public Hospitals with the management of Istanbul Technical University Academic Staff Assoc. Prof. Dr. Hatice Camgöz Akdağ. Firstly, some information was given to participants, study objective was expressed. Before the focus group study, the questions are prepared and determined the problems with these questions help, also taken their ideas for handling. It is emphasized that it can be improve system performance with the lean philosophy help in the hospitals. The results of this study, Şişli Hamidiye Etfal Traning and Research Hospital's laboratuary was evaluated and were made suggestions. It is emphasied that Lean Thinking tools can help improve system performance and the new process is designed, also evaluated the applicability of this system.