Abstract：
OBJECTIVE: This study investigates how a hospital can increase the flow of patients through its emergency department by using benchmarking and process improvement techniques borrowed from the manufacturing sector.
METHODS: An in-depth case study of an Australasian public hospital utilises rigorous, multi-method data collection procedures with systems thinking to benchmark an emergency department (ED) value stream and identify the performance inhibitors.
RESULTS: High levels of value stream uncertainty result from inefficient processes and weak controls. Reduced patient flow arises from senior management\'s commitment to simplistic government targets, clinical staff that lack basic operations management skills, and fragmented information systems. High junior/senior staff ratios aggravate the lack of inter-functional integration and poor use of time and material resources, increasing the risk of a critical patient incident.
CONCLUSIONS: This research is limited to a single case; hence, further research should assess value stream maturity and associated performance enablers and inhibitors in other emergency departments experiencing patient flow delays.
CONCLUSIONS: This study illustrates how hospital managers can use systems thinking and a context-free performance benchmarking measure to identify needed interventions and transferable best practices for achieving seamless patient flow.
CONCLUSIONS: This study is the first to operationalise the theoretical concept of the seamless healthcare system to acute care as defined by Parnaby and Towill (2008). It is also the first to use the uncertainty circle model in an Australasian public healthcare setting to objectively benchmark an emergency department\'s value stream maturity.
METHODS: An in-depth case study of an Australasian public hospital utilises rigorous, multi-method data collection procedures with systems thinking to benchmark an emergency department (ED) value stream and identify the performance inhibitors.
RESULTS: High levels of value stream uncertainty result from inefficient processes and weak controls. Reduced patient flow arises from senior management\'s commitment to simplistic government targets, clinical staff that lack basic operations management skills, and fragmented information systems. High junior/senior staff ratios aggravate the lack of inter-functional integration and poor use of time and material resources, increasing the risk of a critical patient incident.
CONCLUSIONS: This research is limited to a single case; hence, further research should assess value stream maturity and associated performance enablers and inhibitors in other emergency departments experiencing patient flow delays.
CONCLUSIONS: This study illustrates how hospital managers can use systems thinking and a context-free performance benchmarking measure to identify needed interventions and transferable best practices for achieving seamless patient flow.
CONCLUSIONS: This study is the first to operationalise the theoretical concept of the seamless healthcare system to acute care as defined by Parnaby and Towill (2008). It is also the first to use the uncertainty circle model in an Australasian public healthcare setting to objectively benchmark an emergency department\'s value stream maturity.
摘要：
目的：本研究调查了医院如何通过使用从制造业借用的基准和流程改进技术来增加患者通过急诊科的流量。
方法：对澳大利亚一家公立医院进行了深入的案例研究，多方法数据收集程序，系统考虑对急诊科（ED）值流进行基准测试并确定性能抑制剂。
结果：由于流程效率低下和控制薄弱，导致了高水平的价值流不确定性。患者流量的减少源于高级管理层对简单化政府目标的承诺，缺乏基本运营管理技能的临床工作人员，和支离破碎的信息系统。高初级/高级工作人员比率加剧了缺乏职能间整合和时间和物质资源利用不善，增加危重患者事件的风险。
结论：这项研究仅限于一个案例；因此，进一步的研究应评估价值流成熟度以及其他经历患者流延迟的急诊科的相关性能推动者和抑制剂。
结论：这项研究说明了医院管理者如何使用系统思维和无环境绩效基准措施来确定所需的干预措施和可转移的最佳实践，以实现无缝的患者流动。
结论：这项研究首次将无缝医疗保健系统的理论概念应用于Parnaby和Towill（2008）定义的急性护理。它也是第一个在澳大利亚公共医疗保健环境中使用不确定性圈模型来客观地衡量急诊科的价值流成熟度。
方法：对澳大利亚一家公立医院进行了深入的案例研究，多方法数据收集程序，系统考虑对急诊科（ED）值流进行基准测试并确定性能抑制剂。
结果：由于流程效率低下和控制薄弱，导致了高水平的价值流不确定性。患者流量的减少源于高级管理层对简单化政府目标的承诺，缺乏基本运营管理技能的临床工作人员，和支离破碎的信息系统。高初级/高级工作人员比率加剧了缺乏职能间整合和时间和物质资源利用不善，增加危重患者事件的风险。
结论：这项研究仅限于一个案例；因此，进一步的研究应评估价值流成熟度以及其他经历患者流延迟的急诊科的相关性能推动者和抑制剂。
结论：这项研究说明了医院管理者如何使用系统思维和无环境绩效基准措施来确定所需的干预措施和可转移的最佳实践，以实现无缝的患者流动。
结论：这项研究首次将无缝医疗保健系统的理论概念应用于Parnaby和Towill（2008）定义的急性护理。它也是第一个在澳大利亚公共医疗保健环境中使用不确定性圈模型来客观地衡量急诊科的价值流成熟度。
