Solutions to the Healthcare Quality Crisis

Description

Healthcare around the world is in crisis as a result of complex structural and strategic problems that will require solutions at a very high level. This book demonstrates that effective solutions based on modern quality management principles can be applied to alleviate many problems locally within healthcare institutions. It is designed to support doctors, nurses, technicians, and administrators who are interested in applying quality management principles and the tools of Lean Six Sigma to improve healthcare within their own institutions. The book should also be of interest to politicians, policy makers and government officials wrestling with healthcare issues.
The book presents a wide selection of examples of the applications of Lean Six Sigma originally published in two of ASQ’s journals, Quality Progress and Six Sigma Forum Magazine over the past few years. Each case illustrates some aspect of how to improve quality and reduce waste in healthcare institutions, whether in the direct delivery of healthcare or on the equally important administrative side. Some of the cases are from large metropolitan hospitals and others are from smaller institutions. Most of the cases show what has worked, while a few show pitfalls or obstacles to be avoided.
Chapter 1 presents some of the basic notions of Lean Six Sigma quality management, explains key concepts and terminology, and makes the reading of the cases easier. The introduction is followed by Chapter 2 presenting six articles of a general nature written by healthcare professionals from a variety of healthcare institutions engaged in quality improvement: how they achieved their results and what they learned. Chapter 3 provides eight detailed cases that describe specific applications of Lean Six Sigma to healthcare. Finally, Chapter 4 provides a discussion of lessons learned and where we go from here.
This book is specifically intended for healthcare professionals with no previous background, knowledge, or experience with Lean Six Sigma. More broadly, it should be of interest to anyone interested in healthcare quality: doctors, nurses, pharmacists, technicians, healthcare administrators, consultants, concerned citizens, politicians, policy analysts, government officials, etc. These cases from American and European healthcare organizations of the use of Lean Six Sigma are documented by pioneering front line healthcare professionals ─ doctors, nurses and healthcare administrators ─ willing to take personal responsibility and show leadership to improve quality and reduce the escalating costs of healthcare.
This book is not about theory. It is a book for doers, showing healthcare providers how to do it. It shows how they can take their destiny in their hands and do something about healthcare quality and costs.

Sujets

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

Informations

• Publié par: ASQ Quality Press
• Date de parution: 06 février 2009
• Nombre de lectures: 0
• EAN13: 9780873894586
• Langue: English
• Poids de l'ouvrage: 3 Mo

Extrait

Solutions to
the Healthcare
Quality CrisisAlso available from ASQ Quality Press:
Lean-Six Sigma for Healthcare: A Senior Leader Guide to Improving Cost
and Throughput, Second Edition
Greg Butler, Chip Caldwell, and Nancy Poston
The Public Health Quality Improvement Handbook
Ron Bialek, Grace L. Duffy, and John W. Moran, editors
Lean Six Sigma for the Healthcare Practice: A Pocket Guide
Roderick A. Munro
A Lean Guide to Transforming Healthcare: How to Implement Lean Principles
in Hospitals, Medical Offices, Clinics, and Other Healthcare Organizations
Thomas G. Zidel
Improving Healthcare Using Toyota Lean Production Methods: 46 Steps
for Improvement, Second Edition
Robert Chalice
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, Joseph A. Muzikowski, and Patricia K. Stoltz, editors
Benchmarking for Hospitals: Achieving Best-in-Class Performance without
Having to Reinvent the Wheel
Victor Sower, Jo Ann Duffy, and Gerald Kohers
The Certified Six Sigma Green Belt Handbook
Roderick A. Munro, Matthew J. Maio, Mohamed B. Nawaz, Govindarajan Ramu,
and Daniel J. Zrymiak
Six Sigma for the New Millennium: A CSSBB Guidebook, Second Edition
Kim H. Pries
The Certified Six Sigma Black Belt Handbook, Second Edition
T. M. Kubiak and Donald W. Benbow
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.Solutions to
the Healthcare
Quality Crisis
Cases and Examples of
Lean Six Sigma in Healthcare
Søren Bisgaard, Editor
The work on this book has been generously supported
by the Eugene and Ronnie Isenberg Endowment.
ASQ Quality Press
Milwaukee, WisconsinAmerican Society for Quality, Quality Press, Milwaukee 53203
© 2009 by ASQ
All rights reserved. Published 2009
Printed in the United States of America
15 14 13 12 11 10 09 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data
Solutions to the healthcare quality crisis : cases and examples of lean six sigma in
healthcare / Søren Bisgaard, editor.
p. cm.
Includes bibliographical references and index.
ISBN 978-0-87389-769-3 (soft cover : alk. paper)
1. Health services administration—Quality control. 2. Six sigma (Quality
control standard) I. Bisgaard, Søren, 1951-

RA399.A3S58 2009
362.1068—dc22 2009013276
ISBN: 978-0-87389-769-3
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 T. 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 in the United States of America
Printed on acid-free paperTable of Contents
List of Figures and Tables vii
Preface xi
Acknowledgments xvii
Introduction: The Need for Quality Improvement in
Healthcare 1
Part I: General Articles on Lean Six Sigma
in Healthcare
Healthcare’s Horizon: From Incremental Improvement
to Designing the Future 23
Richard Stahl, Bradley Schultz, and Carolyn Pexton
Dutch Hospital Implements Six Sigma: Even Small Projects
Can Make a Big Difference 41
Jaap van den Heuvel, Ronald J. M. M. Does, and Søren Bisgaard
A Quest for Quality 49
Rosanne Zimmerman, Rhonda Smith, Christopher Fernandes,
Teresa Smith, and Ayad Al darrab
Taking Performance to a Higher Level: How Six Sigma
Helped a Rural Hospital Achieve a Cultural
Transformation 59
Greg Stock
Engaging Physicians in Lean Six Sigma 65
Chip Caldwell, Jim Brexler, and Tom Gillem
Learning from Mistakes 75
Diana Shaw, Denni O. Day, and Elizabeth Slavinskas
vvi Table of Contents
Part II: Cases and Examples of the Use of
Lean Six Sigma in Healthcare
Hospital Reduces Medication Errors Using DMAIC
and QFD 85
Yani Benitez, Leslie Forrester, Carolyn Hurst, and Debra Turpin
Faster Turnaround Time 97
Angelo Pellicone and Maude Martocci
Lean Six Sigma Reduces Medication Errors 107
Grace Esimai
Quality Intervenes at a Hospital 119
Jennifer Volland
Toward Error-Free Lab Work 129
Nancy B. Riebling, Susan Condon, and Daniel Gopen
Healthcare Department Reduces Cycle Time and Errors:
Project Adds Revenue of About $202 per Patient 141
Donna Powers and Mary Paul
Standardizing Healthcare Projects: Generic Templates Are
Useful for Early DMAIC Phases 151
Ronald J. M. M. Does, Thijs Vermaat, Henk de Koning,
Søren Bisgaard, and Jaap van den Huevel
Conclusion: Quality Improvement and Innovation 169
About the Editor 179
Index 181List of Figures and Tables
Introduction
Figure I.1 Effective medical care requires medical science and
medical management as equal partners. . . . . . . . . . . . . . . . . 2
Figure I.2 Summary flowchart of the steps of the define, measure,
analyze, improve, and control cycle used in Lean
Six Sigma. ........................................ 6
Figure I.3 A typical organizational structure for deploying Lean
Six Sigma within a healthcare organization. ............. 10
Healthcare’s Horizon
Figure 1 Response variables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Figure 2 Formula for effective results. ......................... 25
Figure 3 Capability analysis: report turnaround time. ............. 26
Figure 4 Design process map. ................................ 29
Figure 5 The wall of change efforts. ........................... 30
Table 1 Process improvement/solution design continuum. . . . . . . . . . 32
Table 2 Quality function deployment for new emergency and
trauma center—requirements. . . . . . . . . . . . . . . . . . . . . . . . . 33
Figure 6 Quality function deployment for new emergency and
trauma center—results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Figure 7 Emergency and trauma center Pareto chart. . . . . . . . . . . . . . 36
Figure 8 Kano’s model. ..................................... 37
Figure 9 DFSS process. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
A Quest for Quality
Table 1 Summary of continuous quality improvement project
results. ........................................... 53
viiviii List of Figures and Tables
Taking Performance to a Higher Level
Table 1 Thibodaux Regional’s pillars of excellence and the
Six Sigma related projects. ........................... 60
Figure 1 The primary reasons for defects in catheterization lab. ..... 61
Figure 2 Accounts receivable cause and effect diagram. ........... 62
Table 2 Actual savings amounts. ............................. 63
Table 3 Medication management project—order entry phase. ...... 63
Engaging Physicians in Lean Six Sigma
Figure 1 Comparison of total cost to pharmacy cost. .............. 67
Figure 2 Drug cost distribution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Table 1 Stakeholder buy-in analysis. .......................... 68
Figure 3 Emergency department physician length of stay
variation. ......................................... 69
Learning from Mistakes
Figure 1 Problem-solving process. ............................ 76
Hospital Reduces Medication Errors Using
DMAIC and QFD
Table 1 Hierarchy of nurses’ needs. . . . . . . . . . . . . . . . . . . . . . . . . . . 90
Figure 1 Quality function deployment matrix. ................... 91
Figure 2 Pugh selection matrix. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
Figure 3 Control chart of medical transcription errors per bed. . . . . . 94
Faster Turnaround Time
Figure 1 High level process map. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Figure 2 Cause and effect diagram. . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Figure 3 Control impact matrix. .............................. 102
Figure 4 Turnaround time by each step in process. . . . . . . . . . . . . . . . 103
Figure 5 Change over time. .................................. 104
Figure 6 Individual and moving range chart. .................... 105
Figure 7 Control chart for Four Cohen as of June 10, 2005. . . . . . . . . 105
Lean Six Sigma Reduces Medication Errors
Figure 1 Pharmacy error Pareto diagram. . . . . . . . . . . . . . . . . . . . . . . 110 List of Figures and Tables ix
Figure 2 February and March errors by pharmacy employees. ...... 110
Figure 3 February and March errors showing positive trend.