11. Why you are here 5 "Change happens by listening and then starting a dialogue with the people who are doing something [you don't believe] is right.“ Jane Goodall InformationWeek Daily Newsletter www.informationweek.comWeekend Edition: Saturday, March 28, 2009
17. H.O.R.S.E. Concept 8 The H.O.R.S.E. principles greatly emphasize leadership and strategic management together with Lean Six Sigma methodologies so as to hoist energetically our healthcare system in the right direction.
20. Lean, Six Sigma and Lean Six Sigma 12 Jing, G.G. “A Lean Six Sigma Breakthrough” Quality Progress. May 2009 Lean: Improvement approach aimed at improving efficiency by removing wastes Six Sigma: Improvement approach aimed at improving process capability by reducing variation Lean Six Sigma: Improvement approach aimed at combining both Lean and Six Sigma to improve efficiency and capability primarily by removing wastes and variation
21. primum non attero [first do no waste] primum non nocere First do no harm secundus non attero Second do no waste 13
22. ISO 26000 Defines Social Responsibility 14 “responsibility of an organization for the impacts of its decisions and activities on society and the environment, through transparent and ethical behavior that contributes to sustainable development, health and the welfare of society; takes into account the expectations of stakeholders; is in compliance with applicable law and consistent with international norms of behavior; and is integrated throughout the organization and practiced in its relationships” Vincent, C. “Back in Circulation” Quality Progress. May 2009
42. Institute of Medicine 21 Six Aims for Improvement Safety – Avoiding injuries Effectiveness – Services based on scientific knowledge Efficiency – Avoiding waste Patient-centered care – Care that is respectful of and responsive to individual patient preferences, needs and values Timeliness – Reducing waits and harmful delays Equitable care – Equal care to all regardless of gender, ethnicity, location and socioeconomic status Institute of Medicine Crossing the Quality Chasm: A New Health System for the 21st Century
43. Healthy People 2010 goals… 22 “…safe, effective, patient-centered, timely, efficient, and equitable care that extends the quality [and length] of life and reduce health disparities” Griffith, J.R., White, K.R. “The Well-Managed Healthcare Organization” 6th ed. Health Administration Press
44.
45. Sigma level. Describe the performance of a process relative to the specification limits.
57. Most patients (61% - 83%) in each country said health care providers did not tell them about the errors.(Schoen, et. al. Health Affairs, Web Exclusive; W5-509-W5-525)
58. Process. Y = f(x) 27 Everything is a Process “A systematic series of actions directed to the achievement of a goal” J.M. Juran Method (x) Man (x) Material (x) PROCESSING (f) Output (Y) Machine (x) Environment (x)
60. To err is human 29 “medical errors do not result from … a ‘bad apple’ problem. More commonly, errors are caused by faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them. “ I N S T I T U T E OF M E D I C I N E November 1999
61.
62. “…any characteristic that improves the product or service in the eyes of the buyer.” J. Griffith, K. White
63. Hard to define, but you recognize it when you see it ACHE Congress 2008
81. 38 Charge RN sends for next patient (Surgery) Pt leaves the OR MSA leaves OR to pick up the patient (Surgery) OR tech removes instruments MSAs clean the room Pgt arrives to holding area (Floor or Same day Surgery) Bring new instruments to the room Holding RN verify check list (Green Check List) Anesthesiologist OKs patient (Consent) X-Ray tech needed Get X-Ray tech Surgeon sign consents and mark site OR RN goes to Holding to verify if next pt is ready Patient in to the OR
82. Voice of the Customer – Affinity Test Surgeons (12) Anesthesia (4) MSAs (10) Lack of paper work readiness/Site not Marked. They are responsible for two different task (cleaning room and transportation) Lack of Pre-op evaluation on time Lack of adherence to original schedule. Short staff (3 MSA for 6 ORs) CTQ TAT (Door to Door) Delay in the tech availability Supply not stocked properly Lack of communication among OR RNs with floor RNs and Residents Insufficient C-arms Washer machine broken frequently Shortage of RNs Radiology (6) Instruments (8) Nurses (8)
83. Measure (DMAIC) 40 “If you can’t measure it, you can’t improve it” “Not everything that can be counted counts and not everything that counts can be counted” Albert Einstein
117. The philosophy: It is not acceptable to make even a very small number of defects, and the only way to achieve this goal is to prevent them from happening in the first place
118.
119. The foundation is the distinction between Internal Setup (work that occurs when the system is idle) and External Setup (work that occurs while the system is running)moresteam.com/university
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