Value Stream Management for Lean Healthcare The Evolution

Value Stream Management for Lean Healthcare: The Evolution of Healthcare Quality ISE 468 ETM 568 Dr. Joan Burtner Spring 2017 Healthcare Process Improvement Tapping et al: Chapter 1 Lecture 2

Quality Assurance - People l Hippocrates (460 – 370 BC) Ø Ø l Florence Nightingale (1820 -1910) Ø Ø l Known as the Father of Medicine “First, do no harm “ 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 Ø Ø Credited with initiating quality in healthcare Compared death rates at Boston-area hospitals Spring 2017 ISE 468 ETM 568 Dr. Burtner Lecture 2 Slide 2

Quality Assurance – Joint Commission l 1951 Joint Commission of Accreditation of Hospitals (JCAH) was formed Ø Ø Ø l 1975 Quality of Professional Services was published Ø Ø Ø l Stimulate continuous improvement Increase efficiency Strengthen public confidence Improve management of health care services Provide education on best practices Quality standard Explicit, measurable criteria Retrospective outcome-focused, time-limited audits 1987 Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Ø Ø Ø Agenda for Change Quality assessment and improvement standards How well is healthcare actually provided? Spring 2017 ISE 468 ETM 568 Dr. Burtner Lecture 2 Slide 3

Total Quality Management l l Quality management from the customer’s point of view 1931 Walter A. Shewhart Ø Ø 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 2017 ISE 468 ETM 568 Dr. Burtner Lecture 2 Slide 4

Total Quality Management Limitations 1 l In retrospect, many potential limitations were apparent Ø Ø Ø l Middle management resisted it Management environments were controlling versus empowering Employees’ training and support was inadequate Components of TQM that survived Ø Ø Plan Do Check Act (PDCA) cycle Quality Improvement (QI) teams and tools Spring 2017 ISE 468 ETM 568 Dr. Burtner Lecture 2 Slide 5

Total Quality Management Limitations 2 l Major reasons for the demise of healthcare TQM may have been Ø Ø Ø l 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 2017 ISE 468 ETM 568 Dr. Burtner Lecture 2 Slide 6

Healthcare Quality Campaigns Safer Healthcare Now (Canada) l Dr. Donald Berwick (USA) l Ø Leading advocate of patient safety Ø Harvard Medical School Ø Institute for Health Improvement (1991) Ø Save 100, 000 Lives Campaign Ø Save 1, 000 Lives Campaign Ø Save 5, 000 Lives Campaign Spring 2017 ISE 468 ETM 568 Dr. Burtner Lecture 2 Slide 7

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 2017 ISE 468 ETM 568 Dr. Burtner Lecture 2 Slide 8

Selected IOM Publications Ø Ø Ø To Err is Human: Building a Safer Health System (1999) Crossing the Quality Chasm: A New Health System for the 21 st 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 2017 ISE 468 ETM 568 Dr. Burtner Lecture 2 Slide 9

Six Sigma for Healthcare l l l Became popular in healthcare in the late 1990 s “Customer-focused, statistically based process improvement methodology for reducing defects based on process improvements. ” (page 25) 3. 4 defects per 1, 000 opportunities for error Six Sigma green belts and black belts DMAIC Ø Define, measure, analyze, improve, control Spring 2017 ISE 468 ETM 568 Dr. Burtner Lecture 2 Slide 10

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) Spring 2017 ISE 468 ETM 568 Dr. Burtner Lecture 2 Slide 11