Value Stream Management for Lean Healthcare: The Evolution of Healthcare Quality IDM 404 Dr. Joan Burtner Spring 2010 Industrial Management Case Studies Tapping et al: Chapter 1 Lecture 2

Spring 2010IDM 404 Dr. Burtner Lecture 2 Slide 2 Quality Assurance - People Hippocrates (460 – 370 BC)  Father of Medicine  First, do no harm Florence Nightingale ( )  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 2010IDM 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 2010IDM 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 2010IDM 404 Dr. Burtner Lecture 2 Slide 5 Total Quality Management Limitations Many potential limitations apparent in retrospect  Middle management resisted it  Management environments were controlling versus empowering  Employees’ training and support was inadequate Major reasons for 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 Components of TQM that survived  Plan Do Check Act (PDCA) cycle  Quality Improvement (QI) teams and tools

Spring 2010IDM 404 Dr. Burtner Lecture 2 Slide 6 Healthcare Quality Campaigns Safer Healthcare Now (Canada) Dr. Donald Berwick (USA)  Leading advocate of patient safety  Harvard Medical School  The Institute for Health Improvement (1991)  Save 100,000 Lives Campaign  Save 1,000,000 Lives Campaign  Save 5,000,000 Lives Campaign

Spring 2010IDM 404 Dr. Burtner Lecture 2 Slide 7 Healthcare Quality Campaigns -IOM Institute of Medicine  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 (  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. National AcademiesNational Academy of SciencesNational Academy of EngineeringNational Research Council Major Reports  To Err is Human: Building a Safer Health System (1999)  Crossing the Quality Chasm: A New Health System for the 21 st Century (2001)

Spring 2010IDM 404 Dr. Burtner Lecture 2 Slide 8 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 2010IDM 404 Dr. Burtner Lecture 2 Slide 9 TQM/Six Sigma for Healthcare Six SigmaTotal 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-functionalDepartmentalized Structured training requirements (design of experiments and supervised projects required for certification) Minimal training requirements (unspecified certification programs)