Value Stream Management for Lean Healthcare: The Evolution of

Healthcare QualityIDM 404 Dr. Joan BurtnerSpring 2015

Industrial Management Case Studies

Tapping et al: Chapter 1 Lecture 2

Spring 2015 IDM 404 Dr. Burtner Lecture 2 Slide 2

Quality Assurance - People

Hippocrates (460 – 370 BC) Known as the Father of Medicine “First, do no harm “

Florence Nightingale (1820-1910) Founder of modern day nursing Authored books which called attention to the importance of

cleanliness and sanitation to decrease death rates in hospitals

Dr. Ernest Codman Credited with initiating quality in healthcare Compared death rates at Boston-area hospitals

Spring 2015 IDM 404 Dr. Burtner Lecture 2 Slide 3

Quality Assurance – Joint Commission

1951 Joint Commission of Accreditation of Hospitals (JCAH) was formed

Stimulate continuous improvement Increase efficiency Strengthen public confidence Improve management of health care services Provide education on best practices

1975 Quality of Professional Services was published Quality standard Explicit, measurable criteria Retrospective outcome-focused, time-limited audits

1987 Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

Agenda for Change Quality assessment and improvement standards How well is healthcare actually provided?

Spring 2015 IDM 404 Dr. Burtner Lecture 2 Slide 4

Total Quality Management

Quality management from the customer’s point of view

1931 Walter A. Shewhart Statistician at Western Electric Plan Do Check Act (PDCA) cycle

Define problem, collect data, determine root cause Develop and implement a solution and decide on

metrics Look at before and after data comparisons Document and disseminate results, recommend next

problem investigation (continuous improvement)

Spring 2015 IDM 404 Dr. Burtner Lecture 2 Slide 5

Total Quality Management Limitations 1

In retrospect, many potential limitations were apparent Middle management resisted it Management environments were controlling

versus empowering Employees’ training and support was inadequate

Components of TQM that survived Plan Do Check Act (PDCA) cycle Quality Improvement (QI) teams and tools

Spring 2015 IDM 404 Dr. Burtner Lecture 2 Slide 6

Total Quality Management Limitations 2

Major reasons for the demise of healthcare TQM may have been Insufficient senior management support, involvement and

commitment Lack of direction on how to implement TQM Lack of a sense of urgency with respect to challenges

faced by healthcare compared to today TQM required long term commitment without providing

immediate results TQM did not provide immediate problem resolution

allowing people to pull the plug prematurely These TQM limitations are opinions of the textbook

authors.

Spring 2015 IDM 404 Dr. Burtner Lecture 2 Slide 7

Healthcare Quality Campaigns

Safer Healthcare Now (Canada)Dr. Donald Berwick (USA)

Leading advocate of patient safety Harvard Medical School Institute for Health Improvement (1991) Save 100,000 Lives Campaign Save 1,000,000 Lives Campaign Save 5,000,000 Lives Campaign

Spring 2015 IDM 404 Dr. Burtner Lecture 2 Slide 8

Healthcare Quality Campaigns -IOM

The Institute of Medicine (IOM) is an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public (www.iom.edu).

Established in 1970, the IOM is the health arm of the National Academy of Sciences,

National Academies, which comprises the National Academy of Sciences, the National Academy of Engineering, the National Research Council, and the IOM.

Spring 2015 IDM 404 Dr. Burtner Lecture 2 Slide 9

Selected IOM Publications

To Err is Human: Building a Safer Health System (1999)

Crossing the Quality Chasm: A New Health System for the 21st Century (2001)

Priority Areas for National Action: Transforming Healthcare Quality (2003)

Preventing Medication Errors:Quality Chasm Series (2006)

Rewarding Provider Performance: Aligning Incentives in Medicare (2006)

America’s Uninsured Crisis: Consequences for Health and Health Care (2009)

Spring 2015 IDM 404 Dr. Burtner Lecture 2 Slide 10

Six Sigma for Healthcare

Became popular in healthcare in the late 1990s “Customer-focused, statistically based process

improvement methodology for reducing defects based on process improvements.” (page 25)

3.4 defects per 1,000,000 opportunities for error Six Sigma green belts and black belts DMAIC

Define, measure, analyze, improve, control

Spring 2015 IDM 404 Dr. Burtner Lecture 2 Slide 11

TQM/Six Sigma for Healthcare

Six Sigma Total Quality Management

“Step-by-step” guide (DMAIC) No “instruction manual”

Focused approach to problem selection (potential impact on the bottom line)

General approach to problem selection (process improvement)

Focus on error reduction (defects per opportunity)

Focus on incremental improvement

Cross-functional Departmentalized

Structured training requirements (design of experiments and supervised projects required for certification)

Minimal training requirements (unspecified certification programs)