1. Value Stream Management for Lean Healthcare: The Evolution of Healthcare Quality
IDM 404 Dr. Joan Burtner
Spring 2015
Industrial Management Case Studies
Tapping et al: Chapter 1 Lecture 2

2. Quality Assurance - People
Hippocrates (460 – 370 BC)
Known as the 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 2018
IDM 404 Dr. Burtner

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 2018
IDM 404 Dr. Burtner

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 2018
IDM 404 Dr. Burtner

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 2018
IDM 404 Dr. Burtner

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 2018
IDM 404 Dr. Burtner

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 2018
IDM 404 Dr. Burtner

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 (
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 2018
IDM 404 Dr. Burtner

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 2018
IDM 404 Dr. Burtner

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 2018
IDM 404 Dr. Burtner

11. TQM/Six Sigma for Healthcare
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 2018
IDM 404 Dr. Burtner