1. Value Stream Management for Lean Healthcare: The Evolution of Healthcare Quality ISE 491 Fall 2009 Process Improvement in Healthcare Lecture 2

2. Fall 2009ISE 491 Dr. Burtner Lecture 2 Slide 2 Quality Assurance - People Hippocrates (460 – 370 BC)  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

3. Fall 2009ISE 491 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?

4. Fall 2009ISE 491 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)

5. Fall 2009ISE 491 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  Insufficient senior management support  Lack of a sense of urgency WRT challenges faced by healthcare compared to today  TQM did not provide immediate problem resolution Components of TQM that survived  PDCA cycle  Quality Improvement (QI) teams and tools

6. Fall 2009ISE 491 Dr. Burtner Lecture 2 Slide 6 Healthcare Quality Campaigns Institute of Medicine  To Err is Human: Building a Safer Health System (1999)  Crossing the Quality Chasm: A New Health System for the 21 st Century (2001) Dr. Donald Berwick  Leading advocate of patient safety  The Institute for Health Improvement (1991)  Save 5,000,000 Lives Campaign (mid 1990s)

7. Fall 2009ISE 491 Dr. Burtner Lecture 2 Slide 7 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 Table on page 26 compares Six Sigma and TQM on a few variables