Chat with us, powered by LiveChat Performance Improvement in Health Care? Assignment Content In the Quality Improvement arena, it is essential that we explore alternative approaches to improving patient and or - EssayAbode

Performance Improvement in Health Care? Assignment Content In the Quality Improvement arena, it is essential that we explore alternative approaches to improving patient and or

 Performance Improvement in Health Care 

Assignment Content

  1. In the Quality Improvement arena, it is essential that we explore alternative approaches to improving patient and organizational based outcomes or those that can assist in improving customer satisfaction. Please view the two videos below and write a 500 word essayy regarding your opinion of how each of the videos displays how out-of-the-box approaches can be utilized by health care practitioners to improve or augment the care provided. Additionally, indicate your own idea of a non-traditional approach to assisting in care or customer service that is not displayed in one of the videos. It could be a scenario that you have encountered in your career. One video portrays the pediatric and the other, the geriatric population. › watch
    Dancing doctor brings joy to patients – YouTube
    Centerlight Music Has Power

500 words APA Format.

Chapter 5: Lean and Six Sigma Management: Building a Foundation for Optimal Patient Care Using Patient Flow Physics



Lean and Six Sigma Management Defined

Lean Management System (LMS)


Continuous Quality Improvement (CQI), Lean Management Systems (LMS), and Lean Six Sigma (LSS)

Philosophies and methods for leadership, management, improvement, and innovation

Offer approach, set of tools, and way of thinking about how to more effectively study, assess, and improve clinical flow

LMS and LSS are also broadly generalizable to other health applications

Lean and Six Sigma Management Defined

Six Sigma

Utilizes statistical methods to identify and reduce variation in processes

Developed by Motorola as an evolution of quality methods from the United States and Japan

Muda, muri, and mura

Developed by Toyota Production System

Emphasizes elimination of waste

Muda: Wasting Resources

Elimination of waste in seven resources



Motion during production

Waiting time spent during production




Examples of Waste in Health Care

Wasted inventory


Excess waiting time

Lost time


Extra work associated with poor processing of information or outdated procedures

Waste from transporting patients unnecessarily

Muri: Overburdening Staff and Equipment

Evident when physicians and staff feel overwhelmed with the level of effort required for them to:

Provide patient care

Document care provided

Address regulatory reporting requirements

Attend required meetings

Provide all the support beyond the effort required for patient care

Mura: Uneven Process Workflow

Reason for the development of “just-in-time” production systems

Tendency to batch up work and send it in “one pile” to the next step in the process


Batch reading of radiology exams

Morning blood draws

How Six Sigma Originated

Developed by Motorola after studying quality methodology practiced in Japan

Selected skilled staff with technical backgrounds and training them in advanced quality, engineering, manufacturing, and statistical methodology

Total Customer Satisfaction (TCS) Improvement Goals


Reduce all defects 10-fold every 2 years

Reduce cycle time of all core processes by 50% within 2 years

Recognized that:

Variation in process performance can lead to greater defect/error rates

Speeding up processes requires the elimination of unnecessary tasks or steps

Principles of LMS Theory

The customer defines value.

Organizations should identify the value stream in every process and seek to eliminate all wasted steps that do not add value.

Organizations should make the product (management of the patient’s care) flow through the steps of the value-added process continuously.

Organizations need subsequent steps in the process that “pull” products (patients) from the previous step rather than push them forward.

Organizations should work to continuously improve in order to reduce steps, time, costs, and the information (data) needed to serve the customer (patient).

Lean Six Sigma (LSS)

Michael George wrote that Lean Sigma Six:

Maximizes shareholder value by achieving the fastest rate of customer satisfaction, cost, quality, process speed, and invested capital

The fusion of LMS and Six Sigma is required because:

LMS cannot bring a process under statistical control.

Six Sigma alone cannot dramatically improve process speed or reduce invested capital.

Implementing LMS

Jackson and Jones wrote that organizations cannot incorporate LMS overnight.

Management must build, nurture, and support the logic and machinery that drives lean production.

Combination of LMS and Six Sigma

Now being used in health care applications

Provides a synergistic methodology for analyzing and reducing or eliminating waste in health care processes

Patient Flow as an Application of LSS

Improving process “flow” is a primary goal.

Changing organizational culture is key.

Organizations must embed a culture that:

Identifies wasteful effort

Seeks to continually improve existing processes

Designs processes for those that do not currently exist

The “ideal state” can be accomplished by integrating patient flow physics—principles that govern patient flow and variation management

Applying LSS to Patient Flow in Community Hospital Emergency Department

Approximately 65% of patients admitted to the hospital arrive via the ED.

Long wait times contribute to patient dissatisfaction and staff and community frustration.

Factory Physics modeling

Used to improve understanding of patient flow through ED

Box plot

Introduced by John Tukey

Uses robust summary statistics and actual data points

Especially useful for comparing distributions across groups

Box Plot of 2002-2005 Patient Arrivals by Hour of Day

Box Plot of 2002–2005 Patient Arrivals by Hour of Day

Emerging Questions

How does this demand pattern support decisions and lead to more effective staffing up- and downstream?

What are the optimal levels of staffing to meet patient demand?

Does the nature of the demand vary over the course of the day?

Are there certain “chief complaints” or issues that are seen more often during a certain time of the day or on particular days of the week?

Does the type of staff skills needed differ at various times of the day or on certain days of the week?

What should the organization do, if anything, to be prepared to handle the variation and demand outliers including during mass casualty or pandemic events?

Impact of Applying LSS to Patient Flow in Community Hospital ED

Incorporating process and flow data can:

Facilitate effective handling of patient demand and utilization of resources

Provide input as to where process improvements can be applied to reduce waiting time, poor staff utilization, and other wasteful aspects

Applying Factory Physics principles led to:

Better-managed patient volume

Better provider and staff scheduling

Higher patient and care provider satisfaction

Applying LSS to Patient Flow in Community Hospital Mammography Service

Beginning of effort:

Took 8 weeks to move through the diagnostic journey to treatment

After assessment and utilization of LSS:

Journey reduced to one week or less

Significant because earlier identification and treatment of cancer increases the likelihood of clinical outcomes, satisfaction, and overall quality of life

The Patient Flow Physics Framework

Recognizes all processes consist of:




Must be able to characterize and manage patient flows in three arenas:

Flow into the patient care process

Flow through the patient care process

Flow out of the patient care process

Patient Flow Into the ED

Consequence of patient flows from:

Emergency medical services

Nursing homes

Transfers from other hospitals

Direct patient admits (outside physician referrals)

Walk-in patients

Patient Flow Through the ED

Function of:

ED resource utilization

Variability associated with differences between ED providers

Physicians, physician assistants, and nurse practitioners

Beds are a key ED resource.

Rule of thumb:

Vertical patients should remain vertical.

Horizontal patients should remain horizontal.

Patient Flow Out of the ED

Crucial to avoid overly long stays

ED boarded patients

Admitted to hospital, yet “blocked” from being transported to in-patient units

Reasons for ED boarding:

Lack of transport personnel

Unavailability of consulting physicians (consults)

Insufficient beds

Significant issue during busy winter season

Patient Flow and the VUT Equation

Average patient flow care time is increased by anything that:

Increases variation (V)

Increases the utilization of resources (U)

Operates in processes designed to take a long time (T)

Average Patient Flow Care Time equals:

Variation (V)  Utilization (U)  Process Time (T)


Two types:

Common cause variation or natural variation

Special cause variation or artificial variation

Causes can be detected with control charts

Analysis must be applied to a specific process, individual or group, period of time, or the use of specific material or equipment

Causes of Variation

Demand for patient flow into the processes

Differences in patient needs

Differences in how care is delivered by clinical staff

Reliability of patient care and handoffs to avoid errors, and rework

Availability of resources outside current patient care processes

Strategies for Managing Variation

Learn the patterns of demand.

Standardize care for typical patients.

Put population data to work.

Learn from other organizations dealing with high variability.

Create buffers.


Impacted by:

Available staffing capacity each hour to handle variation in demand

Availability of resources

Sufficient availability of inventory

Financial resources to access services

The time to complete clinical and administrative activities

Resources for training and other staff development


Must be available across the basic value stream

Can address by building in “slack”

Uncommitted staff, space, and equipment

Generic High-Level Health Care Value Stream

Strategies for Keeping Utilization of Key Resources Low

Keeping key resources utilized less than 80% of the time

Understanding variation in demand and patients

Applying box plots of variation


Includes activities or tasks within each step and the space between steps

Delays can occur during handoffs and transitions.

Group boundaries also contribute to “white space” management challenges.

Reducing transition time between steps helps:

Reduce patient anxiety

Determine clinical concerns earlier

Reduce the effort for treatment needed if caught earlier

Honor the patient’s personal time

Impact of the Process on Time

The design of a patient care process can determine the minimal amount of time a patient will spend, flow through, and out of a process if there were no impediments or variation in the process.

Addition of nonvalue-added steps in the process may only add time, potentially increases variation, and increased opportunity for errors.

Reducing the Length of Time Spent in the Patient Flow Care Process

May require staff to:

Eliminate or reduce nonvalue-added process tasks or steps, such as unnecessary waiting times

Implement LMS to draw attention to time spent on identifying and reducing nonvalue-added process steps

Create value-stream managers that control all resources needed for their service lines

Lean Management System (LMS)

Major functions of management in Lean organizations:

Maintaining or controlling the existing processes

Improving existing processes

Performance management

Occurs through continuous improvement

Emphasizes staff development, socio-technical (belief) systems, and change management

Lean Management System Model

Lean Management System Model

Four P Model

Problem solving for continuous organizational learning and alignment to objectives and plans

People are respected, challenged, engaged and developed

Processes are improved and stabilized based on customer defined “value”

Philosophy of long-term focus

Leader Standard Work

In LMS, best practices or standards are clearly spelled out in detail and often posted in activity areas.

A lack of standardized work increases variation and can produce very strange data distributions.

A generalized approach can restrict flow and slow down processes.

Leader Standard Work for Activities Completed Many Times Each Day

Leader Standard Work for Activities Completed Many Times Each Day

Modified from Creating a Lean Culture (Mann, D., 2015, pp. 58–59).

Leader Standard Work for Activities Completed at Least Once Daily

Leader Standard Work for Activities Completed At Least Once Daily

Modified from Creating a Lean Culture (Mann, D., 2015, pp. 58–59).

Leader Standard Work for Activities Completed Weekly or Less Frequently

Leader Standard Work for Activities Completed Weekly or Less Frequently

Modified from Creating a Lean Culture (Mann, D., 2015, pp. 58–59).

Direct Contact Between Management and Frontline Workers

Builds trust

Provides opportunities for much learning, data collection, and problem identification before it is filtered by middle management

Allows managers to directly observe how buffers are managed

Helps managers understand the value streams

Motivates staff to stay focused and continually improve

Visual Controls

Should always begin with some type of “as is” value stream or process map

Process map or flowchart

Visual representation of the care process created with information provided by team members

Helps clinicians:

Clarify through visualization what they know about their environment

Determine what they want to improve about it

ED Process Map

Emergency Department Process Map Example

Health Care Metrics

Ideal health care metrics might include:

Cycle time

Patient wait times

Medical errors

Scheduling errors

Patient volumes

Provider volumes

Takt times

Every metric should include a numerical target.

Need to be “stretch goals” to help motivate improvements

Data Collection

Ideally, data would be automatically collected by the electronic health record (EHR).

Data points need to be collected for every patient or transaction for any desired time period.

Data needs to be easily exported into a standard data format that facilitates data analysis.

Huddle Board Template

Huddle Board Template

Run Chart

Average ED process cycle times for sampled patients on November 15, 2016

Average ED Process Cycle Times for Sampled Patients on November 15, 2016

Control Chart

XbarR door-to-doctor times for sampled patients on November 15, 2016

XbarR Door-to-Doctor Times for Sampled Patients on November 15, 2016

Box Plot

Box plot for physicians to assess their decision times

Box Plot for Physicians to Assess Their Decision Times

Pareto Chart

Missing chart elements from a coding QA review

Missing Chart Elements From a Coding QA Review

Pitch Chart

Pitch chart for RCM chart reviews

Pitch Chart for RCM Chart Reviews

Training Matrix

Staff skills and cross-training matrix

Staff Skills and Cross-Training Matrix

Overlay Run Chart

Overlay run chart for number of patients and staff by times

Overlay Run Chart for Number of Patients and Staff by Times

Staff Suggestions and Their Implementation

Staff Suggestions and Their Implementation

Trend Chart for Suggestions Made and Implemented by Staff

Trend Chart for Suggestions Made and Implemented by Staff

Daily Accountability

Management actively engages with staff:

When they “go to the gemba”

During huddles

During regular follow-up discussions on clinical improvement projects

Going to “where the work occurs” is the best place to collect real time data.

Waste Walk Tool

Waste Walk Tool

Questions to Ask During Gemba Walks

What are your team’s targets or goals today?

How well are you meeting these targets (facts)?

What is your plan or planned actions to close the performance gap?

How can I help you implement your ideas?

Huddle Boards

Focus of 10- to 15-minute stand-up meetings that might involve different staff at different levels

Opportunity to:

Briefly review the highlights of KPI data

Focus on positive and negative variation

Examples of Huddle Boards

Huddle Board Example 1

Huddle Board Example 2


Preferred way method of staff development and improving accountability

Managers show workers respect by:

Asking how something should be done rather than telling them the correct way to complete a task

Modeling appropriate behaviors

Using shaping and modeling to help staff perfect new skills


LMS and LSS offer an approach, a set of tools, and a way of thinking about how to more effectively assess and study clinical flow.

These methodologies are widely applicable in studying and improving quality and efficiency of health processes.

Improving clinical teamwork is an important factor in improving patient outcomes.

























Related Tags

Academic APA Assignment Business Capstone College Conclusion Course Day Discussion Double Spaced Essay English Finance General Graduate History Information Justify Literature Management Market Masters Math Minimum MLA Nursing Organizational Outline Pages Paper Presentation Questions Questionnaire Reference Response Response School Subject Slides Sources Student Support Times New Roman Title Topics Word Write Writing