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Value Stream Management for Lean Healthcare: The Evolution of Healthcare Quality

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Value Stream Management for Lean Healthcare: The Evolution of Healthcare Quality IDM 404 Dr. Joan Burtner Spring 2010 Industrial Management Case Studies – PowerPoint PPT presentation

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Title: Value Stream Management for Lean Healthcare: The Evolution of Healthcare Quality


1
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

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
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
Total Quality Management
  • Quality management from the customers 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
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

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

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 (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.
  • Major Reports
  • To Err is Human Building a Safer Health System
    (1999)
  • Crossing the Quality Chasm A New Health System
    for the 21st Century (2001)

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

9
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)
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