Essentials for the improvement of healthcare using Lean & Six Sigma

450 Pages·9.685 MB·English

by  D H Stamatis

Healthcare / Quality Improvement
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Whatever means we use to measure and rank healthcare delivery in the United a
States — we can all agree that without significant reform, the prognosis is grim. m
Recently, we were subjected to much discussion about reform, but that discussion a
was more about government’s role than improving medical outcomes. t
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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 H
concerns that can be ameliorated with minimal government intervention. Detailing eE
immediate paths for improvement fundamental to primary care, hospitals, and s
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managed care, Dr. Stamatis — s
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• Introduces needed mechanics of change, especially the transition of
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hierarchical groups to interactive inclusionary teams responsible for n
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initiating, refining, and implementing quality improvements t
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• Focuses on customer satisfaction as a key indicator of quality a
• Explains how Lean and Six Sigma tools can be readily applied to healthcare r
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• Spotlights primary care, including how to define and redesign its process s

and develop better metrics
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• Presents IT applications that will improve billing, documentation, o
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and patient care
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• Examines Malcolm Baldrige National Quality Award criteria as they n
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apply to healthcare
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• Illustrates quality improvements and best practices through real-world
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case studies L

• Encourages actionable steps with a companion CD that includes eI
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Six Sigma forms and formulas, Lean improvement tools, and other a
quality tools and worksheets.
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Whether we think that advances in technology and medicine, coupled with freedom &
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of choice, make the U.S. healthcare system the best in the world, or whether we
believe growing costs, regulatory morass, and our tort-obsessed culture drop it v
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e
to the bottom; it is painfully evident that the processes currently employed and
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the subsequent defensive medicine philosophy that has resulted will not be able to x
meet the future demands of an aging, continually diversifying society. Through
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Six Sigma and Lean, this text moves the focus from reactive controls to the S
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proactive efficiency required to implement the sort of real and sustainable quality i
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improvements that will allow us to forge a system that is all about wellness.

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K12058 a
ISBN: 978-1-4398-4601-8
90000
www.crcpress.com
9 781439 846018
www.productivitypress.com
K12058 cvr mech.indd 1 10/20/10 3:04 PM
Essentials for the
Improvement of
Healthcare Using
Lean & Six Sigma
D.H. Stamatis
Productivity Press
Taylor & Francis Group
270 Madison Avenue
New York, NY 10016
© 2011 by Taylor and Francis Group, LLC
Productivity Press is an imprint of Taylor & Francis Group, an Informa business
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© 2011 by Taylor & Francis Group, LLC

Contents
Preface......................................................................................................xiii
Acknowledgments...................................................................................xvii
Introduction.............................................................................................xix
 1  The.Four.Critical.Issues.in.Healthcare...............................................1
Introduction ...........................................................................................1
Occurrence of Errors or Mistakes in the Delivery of Treatment ..............2
Recognition of the Uninsured .................................................................5
Cost of Delivery of Healthcare ...............................................................7
Doctor’s Fee ...................................................................................7
Insurance Fee ...............................................................................12
Medication (Prescription Drugs) .................................................13
Technology ..................................................................................14
Hospital Costs .............................................................................15
Efficiency ..............................................................................................17
Summary ..............................................................................................19

References .............................................................................................19
Selected Bibliography ............................................................................21
 2  Directions.of.Improvement.in.Healthcare........................................23
Introduction .........................................................................................23
Primary Care ........................................................................................23
Hospital Care ........................................................................................25
Managed Care ......................................................................................29
Summary ..............................................................................................35
References .............................................................................................35
Selected Bibliography ............................................................................36
v
© 2011 by Taylor & Francis Group, LLC
vi  ◾  Contents
 3  The.Mechanics.of.Change................................................................39
Introduction .........................................................................................39
Typical Participants in a Healthcare Team ............................................41
Boundary Conditions ...........................................................................41
Sample Roles and Responsibilities of Team Members ...........................41
Implementation of the Team .................................................................46
Decision Making ..................................................................................51
Decision-Making Tools.........................................................................52
8D ...............................................................................................55
When to Use 8D ................................................................56
The 5 Whys .................................................................................56
IS/IS NOT ..................................................................................57
Measuring Effectiveness of a Team .......................................................58
Relationships between Internal and External Teams .............................65
Summary ..............................................................................................66
References .............................................................................................67
Selected Bibliography ............................................................................67
 4  The.Transition.of.Groups.to.Teams..................................................69
Introduction .........................................................................................69
Internal Development of the Team .......................................................73
Stage 1: Forming..........................................................................73
Stage 2: Storming ........................................................................74
Stage 3: Norming ........................................................................75
Stage 4: Performing .....................................................................75
Stage 5: Ending ...........................................................................76
Summary ..............................................................................................78

Selected Bibliography ............................................................................78
 5  Logistical.Issues.of.Teams................................................................79
Introduction .........................................................................................79
To Meet or Not to Meet .......................................................................80
Setting Objectives .................................................................................81
Selecting Participants ............................................................................83
Creating an Agenda ..............................................................................83
Establishing Meeting Roles and Ground Rules .....................................84
Meeting Leader ............................................................................85
Facilitator ....................................................................................85
Participants ..................................................................................85
Recorder ......................................................................................86
Ground Rules ..............................................................................86
© 2011 by Taylor & Francis Group, LLC
Contents  ◾  vii
Room Setup ..........................................................................................87
Room ...........................................................................................87
Other Considerations .........................................................88
Equipment ...................................................................................88
Supplies .......................................................................................89
Facility Considerations ................................................................89
Starting a Meeting ................................................................................90
Establishing Team Strategies and Objectives ...............................90
Involving All Team Members and Building Team Consensus .....91
Applying Active Listening Skills ..................................................92
Leading a Brainstorming Session .................................................93
Handling Difficult Situations ......................................................95
Keeping the Meeting on Track ....................................................96
Meeting Minutes .........................................................................98
Summary ..............................................................................................98
Selected Bibliography ............................................................................99
 6  The.Effects.of.Change.in.Healthcare...............................................101
Introduction .......................................................................................101
What Are We Trying to Accomplish? .................................................101
How Do We Know Whether the Change Is Indeed an
Improvement? ..................................................................................103
What Are the Changes That Will Result in Expected Improvement? ......104
Testing Changes .................................................................................107
Summary ............................................................................................107
References ...........................................................................................108
Selected Bibliography ..........................................................................108

 7  Customer.Satisfaction....................................................................109
Introduction .......................................................................................109
Customer Service Attributes ................................................................115
Approach for Healthcare Service Quality Improvement ......................117
Develop Feedback Systems for Customer Service Quality....................117
Implementation .........................................................................118
Measurement ......................................................................................118
Competition ...............................................................................119
Management Leadership .............................................................119
Employee Empowerment ...........................................................122
Six Ps and S Model .............................................................................123
Considerations in Defining the Customer (Patient) for Healthcare .....123
Developing a Patient Satisfaction Instrument ............................134
© 2011 by Taylor & Francis Group, LLC
viii  ◾  Contents
Preliminary Steps to an Effective Survey ...................................137
Healthcare Concerns about Customer Satisfaction (CSat) .........138
Insubstantial Theory .........................................................139
Haphazard Execution .......................................................139
Measurement Confiscation ...............................................141
Inappropriate Application .................................................142
Summary ............................................................................................145
References ...........................................................................................145
Selected Bibliography ..........................................................................147
 8  Understanding.the.Process.............................................................149
Introduction .......................................................................................149
Failure Mode and Effect Analysis (FMEA) .........................................154
Systems Thinking ...............................................................................156
Poka-Yoke (Mistake Proofing/Error Proofing) ....................................157
Advance Practice Quality Planning (APQP) .......................................159
Measurement ......................................................................................163
Project Management ...........................................................................164
Process of Project Management .................................................167
Key Integrative Processes ...........................................................168
Project Management and Quality ..............................................168
Generic Seven-Step Approach to Project Management ..............170
Phase 1. Define the Project ...............................................170
Phase 2. Plan the Project ..................................................171
Phase 3. Implement the Plan ............................................171
Phase 4. Track Progress and Complete the Project ............172
Process Flowchart ...............................................................................172
Value Process Mapp ing .......................................................................176
Summary ............................................................................................176
References ...........................................................................................177
Selected Bibliography ..........................................................................178
 9  Using.Six.Sigma.Methodology.for.Improvement...........................179
Introduction .......................................................................................179
Define .................................................................................................187
Measure ..............................................................................................189
Analyze ...............................................................................................191
Improve ..............................................................................................193
Control ...............................................................................................194
Design for Six Sigma ...........................................................................195
Define ........................................................................................205
© 2011 by Taylor & Francis Group, LLC
Contents  ◾  ix
Characterize...............................................................................206
Optimize ...................................................................................207
Verify .........................................................................................208
Special Note ........................................................................................209
Synthesis of Lean Thinking and Six Sigma .........................................210
Lean Six Sigma Healthcare .................................................................211
Conclusions ........................................................................................213
Summary ............................................................................................214
Note ....................................................................................................214
References ...........................................................................................214
Selected Bibliography ..........................................................................216
 10 Using.Lean.Methodology.for.Improvement...................................219
Introduction .......................................................................................219
Lean Enterprise versus Lean Organization ..........................................223
Applying the Hoshin Method .............................................................229
Lean Is Not a Toolbox. It Is a Way of Thinking about Work ..............234
Tools Used in Lean .............................................................................237
5S ..............................................................................................237
Value Stream Mapping ..............................................................240
Construction of a VSM ....................................................241
The Seven VSM Tools.......................................................250
Quick Changeover—SMED Setup Reduction ..........................253
SMED Example ...............................................................255
Theory of Constraints ................................................................259
Kanban ......................................................................................259
Push versus Pull ................................................................259
Kaizen .......... .............................................................................262
A Final Note for the Lean Discussion .................................................262
Summary ............................................................................................264
References ...........................................................................................264
Selected Bibliography ..........................................................................264
 11 Understanding.Measurement.........................................................267
Introduction .......................................................................................267
Level I (System or Hospital) ................................................................269
Level II (Departments) .......................................................................269
Level III (Operational Issues) ..............................................................270
Monitoring Measurements ..................................................................272
Investigative Measurements ................................................................272
Understanding Variation ....................................................................276
© 2011 by Taylor & Francis Group, LLC