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Introduction to Healthcare

Quality Management

Continuous Improvement

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Continuous Improvement

• Analyzing performance of various processes and

improving them repeatedly to achieve quality

objectives

– Some performance problems can be resolved quickly,

but in other situations an in-depth evaluation may be

required.

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The Improvement Step

• Find and fix the cause of

unfavorable performance.

• Two factors influence the

decision to initiate improvement:

– Results of performance assessment

– Improvement priorities

Measurement How are we

doing?

Assessment Are we meeting expectations?

Improvement How can we improve

performance?

Yes

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Common Steps of Performance

Improvement

1. Define the improvement goal

2. Analyze current practices

3. Design and implement improvements

4. Measure success

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Improvement Models

• Walter A. Shewhart

• W. Edwards Deming

Act Plan

Check Do

See Exhibit 5.4 PDSA Improvement Project on page 119

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Improvement Models

Rapid Cycle Improvement

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Improvement Models

FOCUS-PDCA FADE

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Improvement Models: Lean

• Lean: Eliminate inefficiencies adversely

affecting performance.

• Lean’s project goal is to minimize waste.

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Five Lean Principles

1. Specify Value

2. Identify value

stream

3. Flow4. Pull

5. Perfection

& eliminating

waste

Define and

understand the

process that

creates value for

the customer

Create smooth and

continuous development

of value though out the

process

Produce only what

the customer is

demanding, when

they demand it

Relentlessly

eliminate waste

from the value

stream

Define value from the customers

perspective

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House of Lean

Process management

Stable & capable processes

Standardised methods

Eliminate Waste

Just In

Time Jidoka

Quality Cost Delivery & Agility

Deliver

exactly what

the customer

wants, when

they want it

with minimal

waste

Detect &

resolve

abnormalities

that threaten

quality and

delivery

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Types of Waste (Muda)

• Movement

• Waiting

• Overprocessing

• Defects

• Inventories

• Transportation

• Design

• Overproduction

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Exercise Process Thinking and Waste

Purpose This exercise focuses on process thinking and the types of

waste in a process

Silent reflect on

your own

(4 minutes)

Individually, respond to the following question:

What are the most prevalent types of waste (Muda) in a

process (or activity) that you are very familiar with?

Group

discussion

In group, select one of these processes, list the steps of this

process and identify1-3 types of waste for every step in the

process (20-25).

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1. Performance problem identified

2. Evaluate current work processes

3. Identify areas of opportunity

4. Find root causes of problems

5. Design better way of working

6. Create implementation plan

7. Identify expected improvements

8. Make process changes and measure results

Lean Project Steps

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Lean Improvement Techniques

• 5S Methodology

• Kanban

• Mistake-proofing

• Value stream map

• Visual control

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The 5S Methodology

Reduce waste

Maintain and

continually

improve the

workplace

Sort

Straighten

Sanitize

Standardize

Sustain

Separate unnecessary from

necessary items

Designate a place for all

necessary items

Create written and visual

standards to help

maintain 5S

Implement systems to monitor

standards

Make 5S part of the company culture

Clean the work area

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Improvement Models: Six Sigma

• Six Sigma: Reduce performance variability

– Goal: Create processes that operate within Six Sigma quality.

– The higher the sigma level, the lower the defect rate.

• 1 sigma = 32% defect rate

• 2 sigma = 5% defect rate

• 6 sigma = 99.999% defect free (near perfect)

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What is Sigma?

 The term sigma used in statistics to represent standard deviation from mean value, an indicator of the degree of variation in a set of a process.

 Sigma measures how far a given process deviates from perfection. For example, the following 2 sets of data have same mean but different sigma:

 First set: 15, 15, 15, 14, 16. Mean = 15, Sigma = 0.707

 Second set: 2, 7, 14, 22, 30. Mean = 15, Sigma = 11.27

Which set of data is more spread out?

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What is Six Sigma?

• A highly disciplined (or structured) improvement methodology

that enables organizations to deliver better or nearly perfect

products and services.

• It is a Quality Philosophy and the way of improving performance

by knowing where you are and where you could be.

• A methodology to measure and improve company’s performance,

practices and systems

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DMAIC – Six Sigma Project

Methodology

1. Define

2. Measure

3. Analyze

4. Improve

5. Control

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Define

• Describe the problem in operational terms

• Drill down to a specific problem statement

(project scoping)

• Identify customers and CTQs, performance

metrics, and cost/revenue implications

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Measure

• Understand causal relationships between

process performance and customer value.

Y = f(X)

where Y = customer CTQs and X represents critical

input variables that influence Y

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Data Collection Issues

• What questions are we trying to answer?

• What type of data will we need to answer

the question?

• Where can we find the data?

• Who can provide the data?

• How can we collect the data with minimum

effort and with minimum chance of error?

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Analyze

• Focus on why defects, errors, or excessive

variation occur

– Experimentation and verification to verify

Y = f(X) relationships

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Improve

• Improve the X variables so as to improve Y

– Idea generation

– Brainstorming

– Evaluation and selection

– Implementation planning

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Control

• Maintain improvements

–Standard operating procedures

–Training

–Checklist or reviews

–Statistical process control charts

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Improvement Models:

Lean Six Sigma Lean Six Sigma: Eliminate waste and reduce process variation

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Performance Improvement

Models

• Organizations don’t choose one approach

to the exclusion of the others.

• The approach most likely to achieve

improvement goals for a particular project

is used.

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Continuous Improvement

• Various improvement models

are used to improve healthcare

quality.

• The different models share a

common thread of analysis,

implementation, and review.

Measurement How are we

doing?

Assessment Are we meeting expectations?

Improvement How can we improve

performance?

Yes