Leveraging Lean in Healthcare

The Four Critical Issues in Healthcare Occurrence of Errors or Mistakes in the Delivery of Treatment The Recognition of the Uninsured Cost of Delivery of Healthcare Doctor's Fee Insurance Fee Medication (Prescription Drugs) Technology Hospital Costs Efficiency Directions of Improvement in Healthcare Introduction Primary Care Hospital Care Managed Care The Mechanics of Change Typical Participants in a Healthcare Team Boundary Conditions Sample Roles and Responsibilities of Team Members Implementation of the Team Decision Making Decision-Making Tools D When to Use D The Whys IS/IS NOT Measuring Effectiveness of a Team Relationships between Internal and External Teams The Transition of Groups to Teams Internal Development of the Team Stage 1: Forming Stage 2: Storming Stage 3: Norming Stage 4: Performing Stage 5: Ending Logistical Issues of Teams To Meet or Not to Meet Setting Objectives Selecting Participants Creating an Agenda Establishing Meeting Roles and Ground Rules The Meeting Leader The Facilitator The Participants The Recorder Ground Rules Room Setup Room Other Considerations Supplies Facility Considerations Starting a Meeting Establishing Team Strategies and Objectives Involving all Team Members and Building Team Consensus Applying Active Listening Skills Leading a Brainstorming Session Handling Difficult Situations Keeping the Meeting on Track Meeting Minutes The Effects of Change in Healthcare What Are We Trying to Accomplish? How Do We Know Whether the Change Is Indeed an Improvement? What Are the Changes That Will Result in Expected Improvement? Testing Changes Customer Satisfaction Introduction The Customer Service Attributes Approach for Healthcare Service Quality Improvement Develop Feedback Systems for Customer Service Quality Implementation Measurement The Six Ps and S Model Considerations in Defining the Customer (Patient) for Healthcare Developing a Patient Satisfaction Instrument Preliminary Steps to an Effective Survey Healthcare Concerns about Customer Satisfaction (CSat) Insubstantial Theory Haphazard Execution Measurement Confiscation Inappropriate Application Understanding the Process Failure Mode and Effect Analysis (FMEA) Systems Thinking Poka-yoke (Mistake Proofing/Error Proofing) Advance Practice Quality Planning (APQP) Measurement Project Management The Process of Project Management Key Integrative Processes Project Management and Quality A Generic Seven-Step Approach to Project Management Phase 1. Define the Project Phase 2. Plan the Project Phase 3. Implement the Plan Phase 4. Track Progress and Complete the Project Process Flowchart Value Process Mapping Using Six Sigma Methodology for Improvement Define Measure Analyze Improve Control Design for Six Sigma Define Characterize Optimize Verify Special Note Synthesis of Lean Thinking and Six Sigma Lean Six Sigma Healthcare Conclusions Using Lean Methodology for Improvement Lean Enterprise versus Lean Organization Applying the Hoshin Method Lean Is Not a Toolbox It Is a Way of Thinking about Work Tools Used in Lean 5S Value Stream Mapping Construction of a VSM The Seven VSM Tools Quick Changeover--SMED Setup Reduction SMED Example Theory of Constraints Kanban Kaizen Some Additional Items Concerning Lean Push versus Pull A Final Note for the Lean Discussion Understanding Measurement Introduction Level I (System or Hospital) Level II (Departments) Level III (Operational Issues) Monitoring Measurements Investigative Measurements Understanding Variation Primary Care Understanding the Process Practice Redesign Step 1: Select a Registry Step 2: Identify a Template Step 3: Protocols (Standardize the System of Care) Step 4: Self-Management Support (Using Diabetes as a Model) Patient-Centered Medical Home (PCMH) Lean Strategy for Primary Care Facilitate the Project Using Leadership Skills "Lean" the Practice Using Lean Six Sigma Special Note on Measurement Note 1: Understanding the Customer and the Process Note 2: Chronic Model Note 3: Medical Home Primary Care Example Concerns and Comments Secondary Concerns Immediate Applications for Computer Technology (IT) in Healthcare Billing and Administration Electronic Documentation Patient Care Health IT Focused on Improving Patient Care Population (Proactive) Care Whole-Patient (Planned) Care Measurement Change Concepts Use of Models, Including Models of the Desired Care System and Models of Improvement Focus on a Practical, Patient-Oriented View of Functionality and What It Should Be Able to Accomplish Use of Learning Strategies to Accelerate Progress in Testing and Applying Change Ideas Specific Change Ideas Implications for Spread Data Structures to Support Improvement Dense Display of Data Transferability of Data Customization Optimal Design of Alerts and Reminders Designs That Are Patient-Centric (Patient-Controlled) Personal Health Records (PHRs), Communications, Home as Hub Project Selection The Link between Quality Function Needs and Overall Strategic Plan The Link between Strategic Plan and Quality Plan The Theory of Variation (Common and Special Causes) The Quality Function Mission Is Very Important in Strategic Planning Metrics and Goals that Drive Organizational Performance Resource Requirements to Manage the Quality Function How Is Robustness Incorporated into Six Sigma and Lean Methodologies? What Is the Significance of the Project? What Is the Cost of Poor Quality? What Is Customer and CTQ Identification? What Is the Significance of a Data Collection Plan? Measurement for Projects What Are Some of the Common Formulas Used in Six Sigma? Specific Project Expectations of the DMAIC Model for Each Phase Understanding and Utilizing ISO Standards Third Accreditation Option for Hospitals: National Integrated Accreditation for Healthcare Organizations (NIAHO) Medical Devices The Certification Process Understanding and Utilizing the Malcolm Baldrige National Quality Program Epilogue Index Each chapter begins with an Introduction and concludes with a Summary, References, & Selected Bibliography