Preparing for Continuous Quality Improvement for Healthcare : Sustainability through Functional Tree Structures book cover
1st Edition

Preparing for Continuous Quality Improvement for Healthcare
Sustainability through Functional Tree Structures

ISBN 9781466567702
Published November 18, 2014 by Productivity Press
180 Pages 64 B/W Illustrations

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Book Description

This book provides a set of detailed instructions to help you construct your departmental, divisional, or organizational functional tree structure (FTS) and work towards world-class service. Preparing for Continuous Quality Improvement for Healthcare: Sustainability through Functional Tree Structures outlines a method that will enable your organization to set a stable base for future improvements that are sustainable and create breakthrough improvements in service, quality, and costs.

More importantly, the FTS method outlined in the book will provide you with the tools to build processes tailored to your customers’ specifications and standards. It will enable you to improve your department, division, and entire organization and edge ahead of your competition.

The book explains why organizations steeped in process improvement need to re-evaluate and re-establish their procedures—especially if initial outcomes have not met expectations. Illustrating key concepts with examples, case studies, and flow charts, it provides you with a clear understanding of organizational functional structure and how to document current organizational and departmental functional tree structures.

Describing how to identify a department's functional deficits, shortcomings, and waste, it explains how to select the best course of action for your organization. After reading this book, you will be able to create a pictorial representation of your organization's current functional structure and select the best course of action for achieving sustainable advancements in service, quality, and costs.

The book will help to convert your managers from a people-management mentality to one of process management—transforming leaders to educators and not guards.

Table of Contents


Defining and Delivering Quality in Healthcare
Aren’t We Already Providing the Highest Level of Healthcare Possible?

Phantom Successes
Reasons Projects Did Not Reach Their Potential Benefits
Issues that Highly Influenced a Process Improvement Team’s Lack of Success and Sustainment
Drivers of Success

Cleaning Up: Developing a Standardized, Optimized, Aligned Process
Is Your Process Standardized, Optimized, and Aligned?
Soap: Standardized
sOap: Optimized
soAp: Aligned
Summing It All Up

Know Your Processes

Functional Tree Structures
Phase I: Developing the Functional Tree Structure Diagrams
FTS Phase II: Standardize, Optimize, and Align Each Process
Step 1: Document the Current State
Step 2: Standardize
Step 3: Optimize
Step 4: Align

Selecting a Process Improvement Tool
Continuous Quality Improvement
Six Sigma
5S Concept
Standard of Work
Value Stream Map

Wrapping Up


Guide to Creating a Process Map
Process Description
Example Project Starting with Functional Tree Structure
Examples of Complete Functional Tree Structure

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Reza Ziaee, MA, MSE, MBB, PhD, FHIMSS is currently the transformational care director at Catholic Healthcare West in Las Vegas where he trains department leaders and staff on Lean and Six Sigma concepts and tools. He has over 22 years of administrative and internal consulting experience in healthcare and has completed over 100 projects focused on healthcare operations redesign/innovation and quality improvement. He is a Six Sigma Master Black Belt and a Lean expert. He holds a PhD in applied statistics and quality engineering from Wayne State University, a MSE in industrial and systems engineering from the University of Michigan, and an MA in economics from the University of Detroit. He is a frequent speaker for the Healthcare Information & Management Systems Society.

James Bologna, MBA
is currently a vice president of the Business Research Group where he guides strategy development, brand awareness, campaigns, product and service expansion, pricing, service quality, and product development. He has over 25 years of experience in healthcare market and economic research, consulting, education, and project management and has proven success in feasibility studies of multiple hospital acquisitions, service offerings analyses, and development of merger strategies. He holds an MBA from Wayne State University with a concentration in operations research and a BS degree in industrial engineering from the University of Michigan. He has written extensively on issues on consumer-directed health plans, product design process improvement, and economics.


Preparing for Continuous Quality Improvement in Healthcare is a fascinating, yet practical, approach to sustainable change for human service systems and institutions. It simply and comprehensively maps out a step-by-step approach to programmatic and structural change that regular people can understand and apply. Reza Ziaee is a master at his craft and teaches us all that systematic change can be pretty basic.

I wish I had his book in my back pocket when I was the state director of Michigan's Department of Human Services
—Ismael Ahmed, Senior Adviser to the Chancellor, and Associate Provost of Metropolitan Impact, University of Michigan, Dearborn

The United States Healthcare delivery system is frequently incomprehensible and expensive - just try to find out what the cost of your proposed care will be ahead of time. With a succession of changes in reimbursement methods, healthcare has been in a chaotic transition. The provision of care is not driven by patient centered needs and is highly unfair and fundamentally flawed due in large part to the philosophy that a market based solution can work. Unfortunately, market based solutions have not precipitated a significant improvement in care and have clearly failed to meet the needs of most Americans.

So what is a healthcare leader to do in this chaotic mess? For the last three decades, we have all experienced the costly and impressive ‘consultants’ who have promised programs (process improvement, TQM, CQI, Six Sigma, Lean, Optimization and many others) but have not produced long-term solutions or benefits and worse yet they have not provided a clear path for management to follow.

Reza Ziaee, PhD and James Bologna, in their highly readable and insightful book
Preparing for Continuous Quality Improvement in Healthcare, present a comprehensive approach to understanding and controlling the myriad of processes in a healthcare organization. Ziaee and Bologna analyze our current healthcare situation, identify its many failings, and then introduce the concept of Functional Tree Structures, which is a robust tool for process understanding and improvement. This book explains the concepts of stabilizing, optimizing, and aligning processes and gives examples how to follow a more structured program that leads to sustainable improvements.

Preparing for Continuous Quality Improvement in Healthcare Ziaee and Bologna give us a comprehensive and evidence based method for actually making system wide changes. And if we have the courage to embrace this straightforward method with enlightened leadership, it will result in the best healthcare system possible.
—Dr. Frank Balestrieri, Anesthesiologist, Banner Medical Group

Performance improvement is a critical component to the health and well being of healthcare organizations today. As decreased reimbursement pressures continue to deplete operating profits, organizations must find other ways of managing costs rather than the old method of just reducing staff. Many have already reaped the benefits from the ‘low hanging fruit’ initiatives.

The authors of this book have put together an easily read and understandable roadmap to help any organization improve their operating efficiencies. I highly recommend this book and the methods described within
—Mark S. Johnson MA, CPA, FACHE, COO/CFO, Norwood Hospital, Norwood, Massachusetts

Preparing for Continuous Quality Improvement in Healthcare
offers an illuminating perspective on building a sustainable environment of quality improvement in healthcare. This is not another ‘project of the day’ methodology, but a full model that will leave you with a better health care environment – better outcomes, better care and lower cost.
—Deborah Dahl, Vice President, Patient Care Innovation, Banner Health

Reza and James touch on very powerful concepts which allow for the visualization of an organization through Functional Tree Structures (FTS). It provides an elegant contextual understanding of the detailed attributes of an organization and provides leadership with compelling logic for change. FTS also delivers clarity in understanding where improvement will help the organization through a unified understanding of the interrelated functions. FTS provides the platform for lasting change and ongoing viability.

Given the immense complexity inherent in the provision of health services, performance improvement using traditional approaches has not consistently provided consistent ROIs. Many organizations risk demise unless they can manage the task of implementing meaningful, and repeatable, process improvements at a faster pace. I believe that FTS provides a powerful catalyst for performance improvement and ongoing measurement. Following the tools and concepts presented in this book, organizations have greater assurance that goals are met and performance improvement gains are held. Finally, FTS can be used across the entire organization to assess whether the strategic goals and objectives have been met or sustained.

—Shane Wolverton, Senior Vice President, Comparion Medical Analytics