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

1. Value Stream Management for Lean Healthcare: The Evolution of Healthcare Quality ISE 491 Fall 2009 Process Improvement in Healthcare 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 ISE 491 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? ISE 491 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) ISE 491 Dr. Burtner

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 ISE 491 Dr. Burtner

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 21st Century (2001) • Dr. Donald Berwick • Leading advocate of patient safety • The Institute for Health Improvement (1991) • Save 5,000,000 Lives Campaign (mid 1990s) ISE 491 Dr. Burtner

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 ISE 491 Dr. Burtner