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Change (Personal, Team, Culture)

Registered nurses' personality traits and work assignments

This presentation at the 2013 SHS Healthcare Systems Process Improvement Conference addresses the unique set of skills, knowledge and personal attributes for nurses in order to match individual nurses to various nursing roles. More and more, personality measures are being used to assess an individual's fit within various industries. Investigating the traits of registered nurses may provide a means to improving job performance, satisfaction and retention to meet the demands associated with nursing.

The importance of communication for patient satisfaction

Department of Industrial and Systems Engineering, Human Systems Engineering Lab, Mississippi State University
On the surface, communication appears to be a simple concept within health care. Patients talk to doctors, nurses, and staff members. Doctors explain treatment options to patients. However, many obstacles often get in the way of understandable, quality communication. In our research, we investigate the effect of communication complexity level on patients' perceived quality. The amount of communication was measured by self reports regarding the patient's visit.

Career makeover: Shaking off a shy image

This article describes how one self-described introvert addressed a perception of shyness and increased his influence at work.

Engaging frontline employees in problem solving to provide ideal care in the PICU- East Tennessee Children's Hospital

This poster presented at the 2013 Healthcare Systems Process Improvement Conference describes a staff-driven approach for improving patient care in a pediatric intensive care unit (PICU). Thanks to Mark Graban for identifying this poster.

Delivering consistent and lower cost care in the post-acute and long-term care setting

This presentation at the Healthcare System Process Improvement Conference 2013 addresses labor productivity in the post-acute setting. As labor rates continue to rise and represent the highest expense in the post-acute and long term care industries, providers are turning their attention to scheduling solutions that more appropriately align their workforce to patients' need. Traditional Industrial Engineering tools such as work measurement are leveraged to provide a more accurate definition of cost of care as well as staffing models that closely align labor to patient care demands.

Evolution of the ED

This recent article from the American Institute of Architects describes progressive improvements to ED design from the author's perspective. Examples of this evolution are provided from University Hospital in Cincinnati, Strong Memorial Hospital, Marymount Hospital, and University of Pittsburgh Mercy Hospital.

What we didn't know we didn't know - and what you can learn from it: BJC HealthCare transformation journey

This presentation at the 2012 Healthcare Systems Process Improvement Conference describes the first part of a lean Six Sigma journey at BJC HealthCare. The author provides a candid discussion of the difficulty of change in a large organization and provides important lessons for anyone undertaking a similar challenge.

Application of lean Six Sigma in healthcare, improvement of nursing shift directors - a graduate-level-directed project experience 

In this graduate-level-directed project, the workload of nursing shift directors (NSD) has been analyzed. The purpose of this study is to create a baseline metric of the existing process; collect operational data and analyze ways to improve the work efficiency by eliminating the non-value-added tasks from the daily workload; automate some of the tasks performed by NSD; and monitor and provide control methodologies for sustainability. 

Surviving the Global Healthcare Perfect Storm March 2012

While healthcare systems among the developed nations of the world differ widely, they all are facing a common challenge: How to improve care quality and outcomes while reducing costs.

W. Edwards Deming: The man and the method

This presentation provided by Doris Quinn provides some insight into the latter part of W. Edwards Deming's life as well as some of the key values, teachings and goals of his lifelong work.

PowerPoint presentation | Diary following Deming in his final years | Video presentation 

Principles as a basis for operational excellence 

In this article, Robert Miller of the Shingo Prize expounds on the need for a principle-based foundation to achieve lasting organizational improvement.

Change management: 20 simple, yet powerful tools 

In this presentation at the 2012 Healthcare Systems Process Improvement Conference, the authors provide 20 practical applications to use right now in your change efforts.

Becoming a Learning Organization 

A recent article in the Journal on Quality and Patient Safety describes how Healthcare giant, Kaiser Permanente, has spent the last several years completing a transformation initiative to improve its performance improvement capabilities. While not formally adopting a Lean or Six Sigma approach, Kaiser has developed six key capabilities that align with those methodologies including leadership priority setting and developing a problem solving culture. Kaiser uses a large number of process advisors to assist and mentor in the transformation.

Change, don't leave home without it! 

Prolific contributor to healthcare improvement Duke Rohe of MD Anderson Cancer Center provides his personal perspective on change in this paper delivered at a recent healthcare improvement conference.

Sustaining financial performance through a large scale system wide performance improvement initiative 

In this presentation at the 2011 SHS Conference, Lynn Alters describes how a system-wide performance improvement initiative improved margins by 40 percent at WellStar Health System using internal resources and fostering an environment of trust and respect. In addition to the financial benefits, the initiative created stronger leaders and will soon exceed its initial goals by three fold. 

Transforming care at the bedside: increasing patient satisfaction through employee engagement and teamwork at Our Lady of Lourdes Medical Center, Camden, New Jersey

Nursing leaders at Our Lady of Lourdes Medical Center in Camden, New Jersey, engaged staff to improve patient and employee satisfaction and reduce staff turnover on a medical-surgical unit using the Transforming Care at the Bedside (TCAB) model developed by Robert Woods Johnson Foundation and the Institute for Healthcare Improvement. The team focused on a set of directed methodologies and conducted a number of experiments that resulted in dramatic improvement.

Cowboys and pit crews: 2011 Harvard Medical School commencement address

Popular author and speaker Atul Gawande challenged the 200 graduates of the 2011 Harvard Medical School to pursue a more systematic approach to delivering healthcare. He used pit crews and cowboys as examples of working as a system.

Meaningful Use: A brief overview for Society of Health Systems

Prevailing misperception is that implementing any EHR complies with HITECH ACT requirements and incentive qualification. EHR implementation is only one part of meaningful use. Meaningful Use depends on workflow, evidence based clinical practice, measurement and reporting. In this presentation prepared for SHS by Kevin Martin, meaningful use is described along with the practical applications for organizations providing clinical care.

Undergrauates in action - Utilizing lean techniques for improved patient and information flow, UMass Memorial Hospital

Students at Worcester Polytechnic Institute and in coordination with UMass' Center for Innovation and Transformational Change examined how lean tools can eliminate non-value added work, improve resource management, and create lean flow at the UMass Memorial Hospital. After implementing a number of changes, the team saw a reduction in patient throughput time, elimination of defects in the chart tracking process, and a decrease in stocked inventory.

Total productive maintenance in the OR - A case study at Kadlec Regional Medical Center

A team at Kadlec Regional Medical Center in Richland, Wash., took a lean approach to improving the availability and reliability of anesthesia related equipment in the OR. The team included physicians, staff, and external consultants. The article describes the background of total productive maintenance and how it was applied by a multidisciplinary team including physicians, OR staff, and clinical engineering. View related photos 

The journey to eliminating preventable harm - Nationwide Children's Hospital

In this presentation at the 2011 Society for Health Systems conference, Cindy Hafer provides a comprehensive look at how Nationwide Children's Hospital in Cincinnati is moving to eliminating all preventable harm to patients through a comprehensive safety initiative.

Case Study on transforming care at the bedside (TCAB), Good Samaritan Hospital

At a recent Premier Breakthroughs Conference and Exhibition, clinical and performance improvement staff at the 370-bed Good Samaritan Hospital in Suffern, New York presented a case study of improvement on a nursing unit using the TCAB model.

8 ways to cut labor costs in your hospital

Rachel Fields summarized the opinion of Dennis Patterson, chairman of The Collaborative for Healthcare Leadership, on the top ways to cut labor expenses in hospitals.

Indiana hospital pharmacy saves $1 million annually with lean improvements

Pharmacy leaders at Elkhart General Hospital, in Elkhart, Ind., applied a number of lean concepts resulting in lower operational costs and improved patient care.

Helping a hospital shine

In an article previously published in Industrial Engineer magazine, industrial engineering researchers at Clemson University assisted Cannon Memorial Hospital in Pickens, S.C., in a number of hospital-wide and service specific improvements resulting in increased efficiency.

Barnes-Jewish Hospital featured for process improvement efforts 

The stltoday.com website recently featured efforts at Barnes-Jewish Hospital in St. Louis to provide improved patient-centered-care using a number of lean management principles. A number of examples of process improvement in the OR and peri-operative services are discussed.

Dartmouth Institute for Health Policy and Clinical Practice takes lead on data and analysis for national collaboration for reducing healthcare costs 

The Dartmouth Institute for Health Policy and Clinical Practice, TDI, has been selected to support a national collaboration aimed at reducing costs for high-volume, high-cost chronic and acute medical conditions that have high cost variation. Dartmouth-Hitchcock Medical Center, Cleveland Clinic, Denver Health, Geisinger Health System, Intermountain Healthcare and the Mayo Clinic have teamed together to take on such things as knee-replacement surgery where there is up to 50 percent cost variation.

The art of implementing Lean from AORN Management Connections

A recent article in AORN Management Connections by Carina Stanton describes how three healthcare organizations are implementing lean.

Strategies for Leading through Change: People Matter

Effective leadership is the most important consideration for successfully implementing organizational change. In this paper presented at the 2010 SHS/ASQ Healthcare Division annual conference in Atlanta, Dr. Norka Saldaña describes a comprehensive change leadership model based on the current literature and her extensive experience in industry.

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?

An Introduction to External Funding for Health Care Improvement

Management engineers may need money to implement healthcare improvement.  This article outlines several potential funding sources.

Improving Medical Equipment Availability at Barnes-Jewish Hospital

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

Centralized Database plus Socialized Medicine equals Distributed Risk

This paper details the errors in medical history records that can occur over time within the present U.S. system, and proposes a solution.

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.

Recruiting Change: Process and Productivity Improvement in Human Resources

A traditional process improvement methodology leads to changes within a hospital's HR department. Results from time studies, swim lanes and simulation are used to support the proposed solutions.

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.

Pioneers of Industrial Engineering and Health Care : Part 1

This article profiles Frank Gilbreth and Henry Ford.  Gilbreth initiated the study of time and motion in the OR, and Ford was the first to attempt to decrease wasted motion among nursing staff.

Enhancing Hospital Health Information Management using Industrial Engineering Tools

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

Additional Thoughts Regarding our Roundtable with the Experts

Karen Martin describes the steps needed to ensure an improvement effort is successful at a system level, and ways for a performance improvement consultant to continuously improve their professional skills.

SHS Roundtable with the Experts: Summarizing Health Care Improvement Challenges

Four experts discuss various health care issues and potential solutions.  The implementation of lean, the importance of sustainability, the necessity of crafting appropriate technology solutions, and the ultimate need for improvements to come from within an organization are covered.

The ABCs of Excelling in the Workforce

A list of suggestions for new college graduates entering the work force.

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.

In by 9 Out by 6 - Level Loading

A CT scan department has its demand smoothed.

SHS Time-release fix: 5S is the little big secret for improving health care

5S theory and implementations are discussed

SHS Helping a Hospital Shine

Lean tools are used to redesign processes throughout a hospital.

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 Redesigning Emergency Department Care Delivery Focusing on Patient Safety

An ED is redesigned after patient flows were modelled using queuing theory.

SHS Simulation Medication: Studies Show Patient Flow Improvement

The process of creating and achieving approval of an ED simulation is discussed.

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 Creating A Patient Centered Access Management System

Improvements to a provider appointment-making system are motivated, tested, and sustained

SHS Education, Ceritification, Participation, Mentoring - Building a Career and a Future

What are the parts of a rewarding career as an engineer in health care?  This presentation proposes an answer.

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 Pursuing Process Excellence - What's Holding You Back?

Why do some improvement projects fail and others succeed? What are some big-picture concepts that could move organizations to success with process improvement projects?  This is a big-picture discussion of several issues.

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 Reaching New Levels of Patient Safety Through Improved Specimen Labeling

Results of a hospital-wide specimen labeling lean project is discussed.

SHS Productivity and Quality Indicator Monitoring

A productivity monitoring system is installed and used to manage budget

SHS Establishing Nursing Staffing Requirements in an Imaging Environment

A study is done to improve the communication between and expense of the nursing staff associated with all imaging modalities.

SHS Get em In - Get em Out

Multiple projects and results are discussed in the goal to continuously improve patient flow.

SHS StaffingMatrix - A Powerful Tool for Balancing Staffing and Demand

A hospital implements improvements in staffing to hourly changes in RN demand.

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 Enhancing Performance Excellence: Total Emergency Services Redesign

All processes in an ED are redesigned, with multiple outcomes showing improvement.

SHS The Journey Toward a Lean ED

A 100,000 annual visit hospital ED is redesigned using lean principles. Wait times decrease and pt satisfaction and revenue increases.  Simulation shows further viability of new processes.  This presentation is made by a MD who became a lean coach.

SHS Applying Redesign Principles to Design ED and Hospital Patient Flow Processes

This is an overview of several lean redesign projects in the ED with overall solutions discussed and analyzed.

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 Turning the ED into Your Hospital's New Front Door

Multiple projects are performed to improve an ED.  Problems are stated and results are given.

SHS Going Beyond - Finding New Ways to Analyze Revenue Cycle Performance Improvement

Issues with billing denials can be addressed by creating and addressing a Pareto chart of top reasons for lack of payment.  This is analyzed through implementation.

SHS Using Six Sigma to Improve ICU Patient Flow

A Lean Six Sigma project focusing on ICU throughput times is completed.  Lessons learned and successes are shared.

SHS Key Performance Indicators: Relevant Metrics that Sell Results and Drive Ongoing Improvement

A discussion of the importance of metric and measurement accuracy during execution of improvement projects.

SHS Lean Concepts for the Service Industry: Healthcare Pharmacy Example

A lean project is done with a general physician clinic and an outpatient pharmacy; results are discussed.

SHS Improve Outpatient Clinic Access and Service with Lean Six Sigma

A lean project is done at a cardiac clinic.  Problem is to reduce wait time for an appt and cycle time of the appointment.  Results are discussed.

SHS Gain Competitive Advantage by Aligning Process Improvement with Hospital Strategy

Changing managerial thought is a process; this presentation demonstrates one way that managers are forced to confront the reality of differing goals/expectations of other managers they must work with.

SHS Originality & How to Become More Than You Are

Resources are described and analyzed that could enable the viewer/reader to improve their skills and talents.

SHS Optimization of Surgical Scheduling

An OR's case scheduling process is studied; improvement projects are proposed.

SHS Improving Patient Care - Case Carts and the Operating Room

Reasons for delay in creation of case carts are addressed.  SPD often has inefficient workarounds as part of their daily routine.

SHS Continued Barriers to Operational and Financial Performance in Surgical Services

Surgical services projects often have many barriers to success; this presentation helps illuminate and identify where they may be for your hospital.

SHS Streamlining Your OR

A hospital undertakes a systemic improvement of their OR suite.  The process and final results are detailed.

SHS How Change Management Transformed a Multi-site GI Practice

Replacing manual processes and disparate systems with a multi-site Gastroenterology electronic medical record system in a large multispecialty practice had many challenges.

SHS Change Management-The Key to Successfully Re-engineering Health Care Solutions

The presentation is a discussion of change management proposals and policies.. Some are successful yet some fail miserably.

SHS Ways and Wonders of Change?

Key success factors for change as well as the keys to team dynamics are considered and explained within this paper.

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 Applying SHS Conference Learnings Back at the Ranch

Emergent Care was redesigned to decrease wait time significantly.

SHS Managing Variability in Patient Flow - Data, Process, Sustainability

Methods of confronting and smoothing the variability of patient flow are discussed.

SHS Weekend Services: The Patient is Here, So Why Aren't We?

A 848-bed hospital is experiencing long LOS and targets ancillary service availability as one potential source of improvement. The project discussed tracks the data, demonstrates immediate results, and suggests future improvements.

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 World of Innovation: Beyond Productivity at The Ohio State University Medical Center

A system-wide reporting tool for each cost center is developed and implemented. It is adopted as part of the budgeting process.

SHS Medication Administration and the Complexity of Nursing Workflow

Task analysis of an RN's shift on a med/surg unit is performed, using spaghetti maps and other lean tools. Integration of a new medicine delivery system is studied to examine how RN efficiency is affected.

SHS Our Lean Journey Continues and What A Year It's Been!

Lean projects at Kaiser Permanente are detailed and discussed. The report is a system-level presentation showing many departmental improvements.

SHS Lean in the Laboratory and Radiology: A Patient Throughput Imperative

Lean improvements within the radiology suite and laboratory workspace yield notable improvements. Project benefits are discussed.

SHS 5S An Entire Hospital System in 5 Months

A system-wide rollout of 5S was performed. Results as well as lessons learned are discussed.

SHS Health System Examples of Long Term 5S Success

5S implementation strategies at multiple systems of varying sizes are presented and contrasted.

SHS A Better Way to Manage Supplies

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

SHS Enhancing Hospital Health Information Management Using Industrial Engineering Tools

Lean principles are utilized during analysis and transformation of a HIM department. Results and lessons learned are discussed.

SHS Delivering Faster Lab Turnaround Through Lean

Lab collection and processing techniques are examined and improved. Results are discussed.

SHS Transforming Organizational Culture

A senior member of the Johnson&Johson consulting group discusses his approach to organizational culture change and the importance of sustained leadership commitment.

SHS Under Pressure - Efforts to Reduce Hospital Acquired Bed Sores

Root cause analysis was conducted to determine reasons for bed sores. This presentation and paper is the result of their team's effort. Sustainability and ongoing improvements are discussed.

SHS 5 Projects, 5 Hospitals: Using DMAIC for Rapid Quality Improvement

System-wide implementation of Lean Six Sigma has resulted in many successes. This presentation discusses the rationale for their overall strategy.

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 "Never Events" and HACs - You Break It, You Buy It

Medicare's changes to payment require a higher degree of awareness from hospitals nationwide. This presentation addresses some of the concerns and discusses mitigation efforts currently underway.

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 Premium Pay - Are You Paying Too Much for Your Labor?

HCA discusses its methodology for monitoring its usage of premium pay to ensure they use as little as possible.

SHS Connecting the Revenue Cycle to the World Wide Web

A pre-registration Internet interface was successfully developed. Lessons learned and sustainability are also discussed.

SHS Reducing Inventory Waste Through Material Pull

A pull system is implemented within a surgical suite, saving on inventory cost. Other accomplishments and lessons learned are discussed.

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 Pursuing Process Excellence in Health Care

This presentation motivates the approach to management of a hospital as continuous improvement of many systems.

SHS A Six Sigma Approach to Denials Management

Payment denials were decreased, resulting in a cost savings of $1.6 million annually. This project steps through the list of improvements made.

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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