1st Edition

Essentials for the Improvement of Healthcare Using Lean & Six Sigma

By D.H. Stamatis Copyright 2011
    464 Pages 73 B/W Illustrations
    by Productivity Press

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    Essentials for the Improvement of Healthcare Using Lean & Six Sigma is all about real and immediate quality improvement. Written by D.H. Stamatis, a renowned expert in organizational development and quality, the book addresses concerns that can be ameliorated with minimal government intervention.

    Detailing immediate paths for improvement fundamental to primary care, hospitals, and managed care, the book:

    • Introduces much-needed mechanics of change, including transitioning from hierarchical groups to interactive inclusionary teams
    • Focuses on customer satisfaction as a key indicator of quality
    • Explains how Lean and Six Sigma tools can be readily applied to healthcare
    • Spotlights primary care, including how to define and redesign its process and develop better metrics
    • Presents IT applications that will improve billing, documentation, and patient care
    • Examines Malcolm Baldrige National Quality Award criteria as it applies to healthcare
    • Illustrates quality improvements and best practices through real world case studies
    • Includes downloadable resources with Six Sigma forms and formulas, Lean improvement tools, and other quality tools and worksheets

    Whether you think advances in technology and medicine, coupled with freedom of choice, makes the U.S. healthcare system the best in the world, or whether you believe growing costs, regulatory morass, and a tort-obsessed culture drop it to the bottom; it is evident that the processes currently employed and the subsequent defensive medicine philosophy that has resulted will not be able to meet the future demands of our aging society. Through Six Sigma and Lean, this text moves the focus from reactive controls to the proactive efficiency required to implement real and sustainable quality improvements that will allow us to forge a system that is all about wellness.

    The Four Critical Issues in Healthcare
    Occurrence of Errors or Mistakes in the Delivery of Treatment
    The Recognition of the Uninsured
    Cost of Delivery of Healthcare
    Doctor’s Fee
    Insurance Fee
    Medication (Prescription Drugs)
    Hospital Costs

    Directions of Improvement in Healthcare
    Primary Care
    Hospital Care
    Managed Care

    The Mechanics of Change
    Typical Participants in a Healthcare Team
    Boundary Conditions
    Sample Roles and Responsibilities of Team Members
    Implementation of the Team
    Decision Making
    Decision-Making Tools
    When to Use 8D
    The 5 Whys
    Measuring Effectiveness of a Team
    Relationships between Internal and External Teams

    The Transition of Groups to Teams
    Internal Development of the Team
    Stage 1: Forming
    Stage 2: Storming
    Stage 3: Norming
    Stage 4: Performing
    Stage 5: Ending

    Logistical Issues of Teams
    To Meet or Not to Meet
    Setting Objectives
    Selecting Participants
    Creating an Agenda
    Establishing Meeting Roles and Ground Rules
    The Meeting Leader
    The Facilitator
    The Participants
    The Recorder
    Ground Rules
    Room Setup
    Other Considerations
    Facility Considerations
    Starting a Meeting
    Establishing Team Strategies and Objectives
    Involving all Team Members and Building Team Consensus
    Applying Active Listening Skills
    Leading a Brainstorming Session
    Handling Difficult Situations
    Keeping the Meeting on Track
    Meeting Minutes

    The Effects of Change in Healthcare
    What Are We Trying to Accomplish?
    How Do We Know Whether the Change Is Indeed an
    What Are the Changes that Will Result in Expected Improvement?
    Testing Changes

    Customer Satisfaction
    The Customer Service Attributes
    Approach for Healthcare Service Quality Improvement
    Develop Feedback Systems for Customer Service Quality
    Management Leadership
    Employee Empowerment
    The Six Ps and S Model
    Considerations in Defining the Customer (Patient) for Healthcare
    Developing a Patient Satisfaction Instrument
    Preliminary Steps to an Effective Survey
    Healthcare Concerns about Customer Satisfaction (CSat)
    Insubstantial Theory
    Haphazard Execution
    Measurement Confiscation
    Inappropriate Application

    Understanding the Process
    Failure Mode and Effect Analysis (FMEA)
    Systems Thinking
    Poka-yoke (Mistake Proofing/Error Proofing)
    Advance Practice Quality Planning (APQP)
    Project Management
    The Process of Project Management
    Key Integrative Processes
    Project Management and Quality
    A Generic Seven-Step Approach to Project Management
    Phase 1. Define the Project
    Phase 2. Plan the Project
    Phase 3. Implement the Plan
    Phase 4. Track Progress and Complete the Project
    Process Flowchart
    Value Process Mapping

    Using Six Sigma Methodology for Improvement
    Design for Six Sigma
    Special Note
    Synthesis of Lean Thinking and Six Sigma
    Lean Six Sigma Healthcare

    Using Lean Methodology for Improvement
    Lean Enterprise versus Lean Organization
    Applying the Hoshin Method
    Lean Is Not a Toolbox. It Is a Way of Thinking about Work
    Tools Used in Lean 5S
    Value Stream Mapping
    Construction of a VSM
    The Seven VSM Tools
    Quick Changeover—SMED Setup Reduction
    SMED Example
    Theory of Constraints
    Push versus Pull
    A Final Note for the Lean Discussion

    Understanding Measurement
    Level I (System or Hospital)
    Level II (Departments)
    Level III (Operational Issues)
    Monitoring Measurements
    Investigative Measurements
    Understanding Variation

    Primary Care
    Understanding the Process
    Practice Redesign
    Step 1: Select a Registry
    Step 2: Identify a Template
    Step 3: Protocols (Standardize the System of Care)
    Step 4: Self-Management Support (Using Diabetes as a Model)
    Patient-Centered Medical Home (PCMH)
    Lean Strategy for Primary Care
    Facilitate the Project Using Leadership Skills
    "Lean" the Practice
    Using Lean Six Sigma
    Special Note on Measurement
    Note 1: Understanding the Customer and the Process
    Note 2: Chronic Model
    Note 3: Medical Home
    Primary Care Example
    Concerns and Comments
    Secondary Concerns

    Immediate Applications for Information Technology (IT) in Healthcare
    Billing and Administration
    Electronic Documentation
    Patient Care
    Health IT Focused on Improving Patient Care
    Population (Proactive) Care
    Whole-Patient (Planned) Care
    Change Concepts
    Use of Models, Including Models of the Desired Care System and Models of Improvement
    Focus on a Practical, Patient-Oriented View of
    Functionality and What It Should Be Able to Accomplish
    Use of Learning Strategies to Accelerate Progress in
    Testing and Applying Change Ideas
    Specific Change Ideas
    Implications for Spread
    Data Structures to Support Improvement
    Dense Display of Data
    Transferability of Data
    Optimal Design of Alerts and Reminders
    Designs that Are Patient-Centric (Patient-Controlled)
    Personal Health Records (PHRs), Communications,
    Home as Hub

    Project Selection
    The Link between Quality Function Needs and Overall
    Strategic Plan
    The Link between Strategic Plan and Quality Plan
    The Theory of Variation (Common and Special Causes)
    The Quality Function Mission Is Very Important in
    Strategic Planning
    Metrics and Goals that Drive Organizational Performance
    Resource Requirements to Manage the Quality Function
    How Is Robustness Incorporated into Six Sigma and Lean
    What Is the Significance of the Project?
    What Is the Cost of Poor Quality?
    What Is Customer and CTQ Identification?
    What Is the Significance of a Data Collection Plan?
    Measurement for Projects
    What Are Some of the Common Formulas Used in Six Sigma?
    Specific Project Expectations of the DMAIC Model for
    Each Phase

    Understanding and Utilizing ISO 9000 Standards
    New Accreditation Option for Hospitals: National Integrated
    Accreditation for Healthcare Organizations (NIAHO)
    Medical Devices
    The Certification Process

    Understanding and Utilizing the Malcolm Baldrige National Quality Program

    Most chapters include an introduction, summary, notes, and references


    Dr.Stamatis is a specialist in Management Consulting, Organizational Development and Quality Science. He has taught Project Management, Operations Management, Logistics, Mathematical Modeling and Statistics for both graduate and undergraduate levels at Central Michigan University, University of Michigan, and Florida Institute of Technology.