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PDCA, TQM

Organizing for systemwide improvement - Cutting costs without cutting corners: Lessons from Banner Health

There are two keys to successful cost-cutting in healthcare: the first - necessary but not sufficient - is to apply proven tools and tactics from industrial engineering, lean, Six Sigma, and business process reengineering; the second is to align the initiative with the organization's mission and culture and engage clinical and administrative staff across the organization to collaborate in the process. This post from the HBR Blog Network describes how Banner Health, one of the nation's largest health systems, did it.

 Complexities in the operating room - Focus on OR turnover times

Identifying the areas of improvement in an effort to reduce operation room turnaround time and the inaccuracy of surgery scheduling is explored through case study examples including first person observations from the University of Pittsburgh industrial engineering case study at UPMC Presbyterian and Montefiore Surgery Departments. This article was previously published in the proceedings of the Industrial and Systems Engineering Research Conference 2012.

JAMA - Lean management systems could actually save lives

Management systems focused on standardization strategies like lean result in better health outcomes and lower mortality rates, according to a new JAMA report based on a study from the Oregon Health and Science University.

Tools for healthcare improvement - What tools can you share?

Swati Verma, management engineer at Southwest General Health Center, contributed templates for project charters and a monthly scorecard. The newsletter committee wants to make Tools for Healthcare Improvement a regular feature with contributions from SHS members and SHS Newsletter readers. If you have a tool you've had success with, please share by e-mailing the tool with a short description to: Tools for Healthcare Improvement.

Finding the True Root Cause in the Initial Nursing Assessment using PDCA 

In this one-page presentation at the 2012 Healthcare Systems Process Improvement Conference, the authors use the Plan-Do-Check-Act (PDCA) improvement methodology enhanced with specifics from Lean and Six Sigma to make improvements in the initial nursing assessment. These improvements include the removal of process redundancies, accurate identification of patient problems and an appropriate and viable plan of care which drives improved patient outcomes.

Standardizing patient care to improve outcomes in cardiac surgery

In this presentation at the 2011 Healthcare Process Improvement Conference, Christian Rizzo of OhioHealth describes a system-wide effort to reduce sternal wound infection by leveraging lean tools such as standard work, process maps, daily gemba walks and performance metrics. OhioHealth was able to standardize care using evidenced-based practices extending from the doctors' offices to case management. This presentation demonstrates how lean tools are utilized and describes how the system was able to sustain a reduction in infections of more than 60 percent.

Undergraduates at Worcester Polytechnic Institute reduce missing medications at VA Hospital

Undergraduates Joshua Wimble, Kristine DeSotto, Casey Krawic and Zachary Theoharidis at WPI completed a project as part of their graduate requirements resulting in a reduction of missing medications at the West Roxbury campus of the VA Hospital.

Human factors engineering to reduce patient falls 

In a recent presentation at the 2011 SHS Conference, Brian H. Fillipo delivered a presentation on a comprehensive approach to reducing patient falls across seven Bon Secours hospitals in Virginia.

Adding Value to the Surgical PAT Process 

Using Lean Six Sigma tools, a hospital redesigns its PAT department process so that all charting is completed 72 hours prior to the day of surgery.

Management Engineers

Management Engineering: What is it?

Improving Medical Equipment Availability at Barnes-Jewish Hospital

One hospital details improvements to their medical equipment retrieval, cleaning, and distribution process.

Sustaining VAP Bundle Compliance in the ICU: A Model of CQI

Using Lean Six Sigma tools, a hospital redesigns and implements new ICU protocols for patients on mechanical ventilation.  The article details how the initial sustainability effort failed, but was brought back into long-run control.

Optimizing Caregiver Workflow in a PICU

Physician and Nursing roles and responsibilities within a PICU are redefined using lean tools to decrease LOS while increasing outcomes.

5 Projects, 5 Hospitals: Using DMAIC for Rapid Quality Improvements

Pressure Ulcer, Falls, Catheter-Associated UTI, Central Line Infection, and Objects Left in Surgery are addressed using process improvement methodologies.

Enhancing Hospital Health Information Management using Industrial Engineering Tools

Lean tools and simulation are used to recommend improvements to HIM operational processes.

Overview of the IHI’s Published Improvement Methods

A short overview of tools made available through IHI is presented.  The web-based Improvement Tracker and Measures tools are an introduction to a system's need for customization of both project definition and outcome measurement.

Value Stream Mapping Got You Down? The Problem May Not Be You.

When applying value stream mapping, don't forget that sometimes patients will need to be grouped just like part families - and each of those may need a unique VSM.

In by 9 Out by 6 - Level Loading

A CT scan department has its demand smoothed.

SHS Paging Dr Toyota

Discussion of applications of lean within the OR.

Lollipops for Excellence

System-level quality and effectiveness programs are implemented using Six Sigma at a childrens' hospital in Washington DC.

SHS Attacking Waste and Variation Hospital-Wide: A Comprehensive Lean Sigma Deployment

Improvement projects in surgery, nursing, and the ED are discussed.  The process of moving a hospital towards adoption of Lean Six Sigma is also described.

SHS Development and Implementation of a Healthcare-Based Economic Evaluation Methodology

A methodology for standardized evaluation of the financial impact of operational and patient care improvements is discussed.

SHS Utilizing Industrial Engineering Student Teams to Benefit Management Engineering Efforts

An ED lean project is discussed, highlighting some advantages that undergraduates can bring when partnered with professionals in the field.

SHS Encouraging Management Engineering in Safety Net Hospitals

Several change management projects are covered in brief, moving rapidly through high-level descriptions of problem / intervention / impact steps.

SHS In by 9 out by 6 - Load Leveling

Detailed description of a lean project to improve TAT in the CT Scan department.

SHS Improved Scheduling in a for Profit Surgical Center

In a for-profit ambulatory surgical center, the current scheduling method often results in cases starting later than the initial plan.  The presentation describes an implementation of clustering as well as multiple simulations of different possibilities.

SHS Building Lean From the Ground Up

The surgical admitting process is targeted with a lean event.  Current and future state is described, the process of improvement is shown, and results are discussed.

SHS In the Quest for Performance Excellence: Deployment of Lean Manufacturing Principles in Healthcare Delivery Processes

Three successful lean projects are discussed in detail.  The ED, Radiology, and HR departments all show significant improvement.

SHS Using Lean Methodology to Improve Patient Safety and Clinical Quality

Three successful lean projects are discussed in detail.  Specimen Labeling, Surgery and Endoscopy Pre-Op, and Inpatient Nursing Crash Cart projects all demonstrate significant improvement.

SHS Improving Patient Flow from the ED to a Nursing Unit

A lean event focused on patient flow out of the ED was conducted, and results are discussed

SHS A Revolution in ED Patient Throughput Management

ED throughput process improvement projects are discussed.  The presenter is a MD.  Several changes are shown with great results.

SHS Creating a WOW! Experience At the First Point of Contact

A performance improvement team tackles a call center.  Issues and lessons learned are discussed.

SHS Size Matters; How Big Does Your ED Need to Be?

A Premier consultant discusses lessons learned from performing many Lean ED projects during her career.

SHS Optimizing Cargiver Workflow in a New Pediatric Intensive Care Unit

A lean project generated proposals for rescheduling the providers' workload. During testing of the proposals, daily departmental volume was completed significantly earlier in the day.

SHS Engaging Staff in Lean Improvements for Patient Care Settings

4 lean projects were performed - pharmacy, lab, outpatient clinic, and telemetry unit. Each project was meticulously documented in the presentation. Pre- and post- metrics are included, as well as a discussion of sustainability.

SHS A Better Way to Manage Supplies

Two supply cost projects are described, analyzed, and discussed.

SHS Sustaining VAP Bundle Compliance in the ICU: A Model of CQI

The IHI Bundle was implemented; metric changes are documented and discussed. Several nursing practices were also changed.

SHS Capturing Supply Charges in the Emergency Department: How and Why?

ED charge capture is a constant problem for hospitals. This presentation covers one system-wide approach to increasing the capture rate.

SHS Lessons Learned Implementing Lean Sigma in Healthcare

Any organization implementing lean six sigma will experience both success and failure. This presentation describes some of the "growing pains" of one system, as well as a methodical demonstration of the lean tools utilized in their improvement efforts.

SHS Beginning a Hospital Lean Improvement Journey in the Clinical Laboratory

Motivation is made for performing lean improvements within the lab.

SHS Using Lean Techniques to Improve Turnaround Time and First Case Starts in the Operating Room

Turnarounds and first case starts are improved using a variety of lean techniques. Sustainability, achievement of buy-in and metric details are also discussed.

SHS Improving Surgical Services Through Enhanced Ancillary Support

Lean improvement projects are performed within the supplies delivery function of a surgical services suite.



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