ANALYSIS OF EFFICIENCY OF PRIMARY PREVENTIVE VISIT OF PATIENT TO OBSTETRICIAN-GYNECOLOGIST BASED ON LEAN PRODUCTION METHODS

Aim. Assessment of the efficiency of the application of lean production methods in the process of delivery of obstetric and gynecological care at an outpatient visit in order to increase satisfaction of the population with delivery of medical services. Materials and Methods. The study included the processes of delivery of medical care in the obstetrics and gynecology profile in the outpatient clinic of the Ryazan Interdistrict Hospital. To measure and analyze the processes used in a health organization, methods used in lean production were applied: timekeeping (time was measured in seconds, distance in meters), mapping of the value stream – construction of a map of the current and target condition of the primary preventive visit of patients to an obstetrician-gynecologist, evaluation of the efficiency of processes. Results. The results of the study of the current state of the primary preventive visit of a patient to an obstetrician-gynecologist showed that the process efficiency ratio is 4.51%. Analysis of the efficiency of the process «Examination of patient by an obstetrician-gynecologist» showed that the efficiency coefficient reached 20.52%. There was also found 42.66% deviation of the actual time of a visit to a doctor from the normative time. Construction of a value stream map of the current state of primary preventive visit to an obstetrician-gynecologist, identification and analysis of causes of problems existing in the process and their elimination, allowed to improve the efficiency of a primary preventive visit by 16.2% without attraction of additional resources, and to bring the actual time of a preventive visit to an obstetrician-gynecologist in correspondence with the load norm according to the order of delivery of medical care of obstetrics and gynecology profile. Conclusions. 1) Introduction of a process approach into management of a health organization allows to consider all medical and non-medical measures as a single whole and helps optimize the activities of a health organization. 2) Low efficiency of the initial preventive visit to an obstetrician-gynecologist is due to a long stay of patients in the registry, waiting at the doctor's office and a long time of reception by the doctor. 3) The analysis of the efficiency of «Primary preventive visit of a patient to an obstetrician-gynecologist» and «Examination of a patient by an obstetrician-gynecologist» processes showed that the detected losses can be cancelled out by use of methods and tools of lean production. 4) Construction of a digital system within a unified state healthcare information system, introduction of information technologies into the activities of a health organization improves the efficiency of the organization and improves the availability and quality of medical care. 5) An important condition for preservation of improvements in the activities of a health organization is standardization of the optimized processes. 6) Application of the methods and tools of lean production in combination with the process approach in managing a health organization helps increase the efficiency of the primary care activity.