Essentials for the Improvement of Healthcare Using Lean & Six Sigma  book cover
1st Edition

Essentials for the Improvement of Healthcare Using Lean & Six Sigma

ISBN 9781439846018
Published November 30, 2010 by Productivity Press
463 Pages - 73 B/W Illustrations

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Book Description

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 a companion CD 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.

Table of Contents

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

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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.