Quality Function Deployment and Lean Six Sigma Applications in Public Health

John W. Moran, Grace L. Duffy

Description

The public health industry has recognized the value of continuous improvement. Quality Improvement (QI) teams are engaged across the country in identifying root causes of the issues which prevent us from providing the best public health services to communities and individuals. The tools of quality, when used effectively, will truly make a difference in the public’s health. It is time to take a more advanced approach for cross functional and long-term improvements that will achieve the systems level results the public deserves.
The purpose of this book is to introduce the concepts embedded in Quality Function Deployment (QFD) and Lean Six Sigma to help Public Health professionals in their implementation of quality improvement within their agencies. The tools and techniques of QFD and Lean Six Sigma can help problem solving teams by providing insight into customer needs and wants, the design and development of customer centric processes, and mapping value streams. Both QFD and Lean Six Sigma focus on doing the most with the resources we have.
The methods in this text are the next step to harness the energy, enthusiasm, hard work, and dedication of our public health workforce to make a lasting difference. By effectively expanding the use of QI tools and techniques, we can, and will, improve our nation’s health and the health of the many communities we serve.

Sujets

• Business
• Qualité, hygiène, sécurité, environnement
• Medical
• Médecine
• Biotechnology

Informations

• Publié par: ASQ Quality Press
• Date de parution: 27 janvier 2010
• Nombre de lectures: 0
• EAN13: 9780873891905
• Langue: English
• Poids de l'ouvrage: 2 Mo

Extrait

Quality Function Deployment and LeanSix Sigma Applications in Public Health

Also available from ASQ Quality Press:

The Public Health Quality Improvement Handbook Ron Bialek, John W. Moran, and Grace L. Duffy

Lean Doctors: A Bold and Practical Guide to Using Lean Principles to Transform Healthcare Systems, One Doctor at a Time Aneesh Suneja with Carolyn Suneja

Root Cause Analysis and Improvement in the Healthcare Sector: A StepbyStep Guide Bjørn Andersen, Tom Fagerhaug, and Marti Beltz

Solutions to the Healthcare Quality Crisis: Cases and Examples of Lean Six Sigma in Healthcare Soren Bisgaard, editor

On Becoming Exceptional: SSM Health Care’s Journey to Baldrige and Beyond Sister Mary Jean Ryan, FSM

Journey to Excellence: Baldrige Health Care Leaders Speak Out Kathleen Goonan, editor

A Lean Guide to Transforming Healthcare: How to Implement Lean Principles in Hospitals, Medical Offices, Clinics, and Other Healthcare Organizations Thomas G. Zidel

Benchmarking for Hospitals: Achieving BestinClass Performance without Having to Reinvent the Wheel Victor Sower, Jo Ann Duffy, and Gerald Kohers

LeanSix Sigma for Healthcare, Second Edition: A Senior Leader Guide to Improving Cost and Throughput Greg Butler, Chip Caldwell, and Nancy Poston

Lean Six Sigma for the Healthcare Practice: A Pocket Guide Roderick A. Munro

5S for Service Organizations and Offices: A Lean Look at Improvements Debashis Sarkar

To request a complimentary catalog of ASQ Quality Press publications, call 8002481946, or visit our Web site at http://www.asq.org/qualitypress.

Quality Function Deployment and LeanSix Sigma Applications in Public Health

Grace L. Duffy

John W. Moran

William Riley

ASQ Quality Press Milwaukee, Wisconsin

American Society for Quality, Quality Press, Milwaukee 53203 © 2010 American Society for Quality All rights reserved. Published 2010 Printed in the United States of America 14 13 12 11 10 5 4 3 2 1

Library of Congress CataloginginPublication Data Duffy, Grace L.  Quality function deployment and leansix sigma applications in public health / Grace L. Duffy, John W. Moran, William Riley.  p. cm.  Includes bibliographical references and index.  ISBN 9780873897877 (casebound : alk. paper)  1. Public health—Quality control. 2. Medical care—Quality control. 3. Six sigma (Quality control standard) I. Moran, John W. II. Riley, William. III. Title.

 RA399.A3D84 2006  362.1068—dc22  2010005632

ISBN13: 978–0873897877

No part of this book may be reproduced in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher.

Publisher: William A. Tony Acquisitions Editor: Matt Meinholz Project Editor: Paul O’Mara Production Administrator: Randall Benson

ASQ Mission: The American Society for Quality advances individual, organizational, and community excellence worldwide through learning, quality improvement, and knowledge exchange.

Attention Bookstores, Wholesalers, Schools, and Corporations: ASQ Quality Press books, videotapes, audiotapes, and software are available at quantity discounts with bulk purchases for business, educational, or instructional use. For information, please contact ASQ Quality Press at 800–248–1946, or write to ASQ Quality Press, P.O. Box 3005, Milwaukee, WI 532013005.

To place orders or to request a free copy of the ASQ Quality Press Publications Catalog, including ASQ membership information, call 8002481946. Visit our Web site at www.asq.org or http://www.asq.org/qualitypress.

Printed on acidfree paper

Contents

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chapter 1: The Continuum of Quality Improvement in Public Health. . . . . . . . . . . . . Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Process Improvement in a Public Health Department. . . . . . . . . . . . . . . . . . . . . . . . . . Little “qi”. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Big “QI”. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . LargeScale Public Health System Quality Improvement. . . . . . . . . . . . . . . . . . . . . . . Big “QI,” Little “qi,” and Individual “qi” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Chapter 2: Introduction to Quality Function Deployment and LeanSix Sigma. . . . . . Introduction to Quality Function Deployment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Introduction to LeanSix Sigma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Chapter 3: An Integrated QI Approach: QFD and LSS Support Macro, Meso, Micro . . . . . . . . . . . . . . . . . . . . . . . . . Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Integrated Processes Create a System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The Human Interaction with Macro, Meso, and Micro Levels: Individual QI. . . . . . . . Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Chapter 4: Customer Focus: Revitalizing Your Organization to Become Customer Centric. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Chapter 5: Process Analysis and Waste Reduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. Understanding How a Process Is Structured. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. How to Analyze a Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Creating a Process Map. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Identifying Inefficiencies in a Process Map. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

v

xiii xv

1 1 3 3 5 6 13 15 17 19 19 22 25 26

27 27 29 33 36

37 47 47 49 49 50 50 51 54

vi

Quality Function Deployment

Process Features54. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Two Types of Process Maps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Opportunity Map56. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Value Stream Mapping Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Visualizing Patient Flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Current State Value Map59. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Future State Value Map60. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Spaghetti Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 ValueAdded Versus Time Chart. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 The Eight Types of Waste . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Chapter 6: Using the Language of Senior Management: The Bottom Line. . . . . . . . . . 67 Introduction: Show Me the Money . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 The Externally Versus Internally Focused Organization . . . . . . . . . . . . . . . . . . . . . . . . 69 Identify the Bottom Line . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Cost of Quality Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Contributions of Cost of Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Selling COQ to Leadership. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 The Bottom Line Feeds Back to the Top Line: Use QFD to Validate VOC . . . . . . . . . . 80 Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Chapter 7: Milestones and Measures: Interim and Final Reporting. . . . . . . . . . . . . . . 83 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Measurement Characteristics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Improving Performance Is About Using Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Definitions in Support of Performance Management . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Examples of the Four Components. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Does Your Agency Have a Performance Management System?. . . . . . . . . . . . . . . . . . . 94 Performance Measures95. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Reporting of Progress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 The Performance Management Cycle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Process Measures in Meso to Micro Level Department Activities. . . . . . . . . . . . . . . . . 98 Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Chapter 8: LeanSix Sigma: “Faster, Better, Smarter”101. . . . . . . . . . . . . . . . . . . . . . . . . . Rapid Cycle Change and Project Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Faster . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Better. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Smarter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Combining Lean and Six Sigma Methods and Benefits . . . . . . . . . . . . . . . . . . . . . . . . . 109 The DMAIC Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Chapter 9: The House of LeanSix Sigma Tools and Techniques . . . . . . . . . . . . . . . . . . 119 Building Blocks of House of Lean . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Steps into the House of Lean129. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The Foundation in the House of Lean . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129

Contents

The Roof for House of Lean . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Chapter 10: Incremental Versus Redesign Strategies. . . . . . . . . . . . . . . . . . . . . . . . . . . . Phase 1—Focus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Phase 2—Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Phase 3—Negotiation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Phase 4—Redesign. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Phase 5—Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Laws of Core Process Redesign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Chapter 11: Developing the QFD Team . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Types of Teams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The Value of Teams to QFD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Preparing Individuals to Be Effective Team Members . . . . . . . . . . . . . . . . . . . . . . . . . . Develop Individuals into an Effective Team . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Team Decision Making. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The DecisionMaking Process. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Attributes of a Good Decision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Influence and Control Issues for Team Effectiveness . . . . . . . . . . . . . . . . . . . . . . . . . . . The Problem Statement as a Vehicle for Norming . . . . . . . . . . . . . . . . . . . . . . . . . . . Develop Measures to Maintain Process Improvement . . . . . . . . . . . . . . . . . . . . . . . . . . Set the Time Frame for Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Establish a Communication Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Chapter 12: Conducting a QFD Study. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Chapter 13: Navigating the QFD Matrices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Appendix A: The Matrix of Matrices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Appendix B: QFD Software . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Appendix C: List of QFD Reference Books. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . About the Authors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

vii

130 130 130 131 135 135 136 137 138 139 140 140 143 144 147 149 150 153 153 155 156 158 159 160 161 163 164 165 173 182 183 185 187 189 191

Figure 1.1 Figure 1.2 Figure 1.3

Figure 1.4 Figure 1.5 Figure 1.6 Figure 1.7 Figure 1.8 Figure 1.9 Figure 2.1 Figure 3.1 Figure 3.2 Figure 3.3 Figure 3.4 Figure 4.1 Figure 4.2 Figure 4.3 Figure 4.4 Figure 4.5 Figure 4.6 Figure 4.7

Figure 5.1 Figure 5.2

Figures and Tables

Continuous quality improvement system in public health.. . . . . . . . . . . . . . MPHCQI model for improvement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Chart for lobby wait time, Dakota County Health Department WIC program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . General approach to use the basic tools of quality improvement . . . . . . . . . General approach to use the advanced tools of quality improvement . . . . . . Carver County local alert confirmation test flowchart . . . . . . . . . . . . . . . . . . Carver County local alert confirmation test cause and effect . . . . . . . . . . . . Future state flowchart of optimized HAN test notification. . . . . . . . . . . . . . Continuous quality improvement system in public health. . . . . . . . . . . . . . . Process flow comparisons of predecessor methodologies . . . . . . . . . . . . . . . The QFD/VOC integrated fulfillment approach . . . . . . . . . . . . . . . . . . . . . . General model of processbased health department performance . . . . . . . . . The integration of technology, infrastructure, and personnel . . . . . . . . . . . . The mechanics of an integrated approach to QI . . . . . . . . . . . . . . . . . . . . . . Client relationship model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Which process steps impact customer needs? . . . . . . . . . . . . . . . . . . . . . . . . Cause and effect diagram of poor customer service . . . . . . . . . . . . . . . . . . . Factors to obtain the VOC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Kano model. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Understanding/interpreting the voice of the customer. . . . . . . . . . . . . . . . . . Understand the overlapping, conflicting, and distinct needs of each customer group. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Basic symbols for a process map . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Basic process map for childhood immunization clinic. . . . . . . . . . . . . . . . .

ix

2 3

5 9 10 11 12 14 15 24 28 29 34 35 38 40 41 43 44 45

46 52 53