VVH Patient Services Department Welcome Packet
VVH has undertaken a number of marketing and population health projects to attract new patients. As part of this work their leader, Julie Hammond, has decided that it would be helpful for new patients to understand the breadth of VVH services and to provide a tangible acknowledgment of their appreciation for choosing VVH.
Therefore, the Patient Services department has developed a process to create a bag/packet for each new primary care patient in their system. The process includes 5 steps:
Station 1: Look up the new patient in the Electronic Record, generate name label
Station 2: Grab VVH bag and insert folder
Station 3: Take folder out and add in general VVH information
Station 4 Look up patient’s age/sex and then proceed to shelf to grab the correct healthcare wellness item, add item to gift bag.Station 5: Add bow to top of bag – inspect to assure that all items are correctly included.
Five employees in Patient services met to create their first set of bags as an experiment. They collected processing data for the first 20 bags and the data is included in this website as VVH Patient Packet Process Data.xls. Throughput data was also collected on every 5th bag. Quality data was also collected. The team noticed that their process was not very efficient and many of the team spent too much time waiting.
ACTION TO BE TAKEN FOR THIS QUESTION: Do a six brief sigma analysis on the current state process and make recommendations for improvement.
Chapter 9
Quality Improvement in Healthcare
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
Defining Quality
• Organization’s perspective
• Performance (design) quality
• Conformance quality
• Customer’s perspective
• Garvin’s eight dimensions
• Parasuraman, Zeithaml, and Berry’s five dimensions
• Institute of Medicine
• Quality Assurance Project
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
Cost of (Poor) Quality
• External failure: costs associated with failure after the
customer receives the product or service
• Internal failure: costs associated with failure before the
customer receives the product or service
• Appraisal: costs associated with inspecting and evaluating
the quality of supplies and/or final product/service
• Prevention: costs incurred to eliminate or minimize
appraisal and failure costs
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
Developing a Quality Dashboard
1. Choose performance indicators that reveal the health of the
organization
2. Assess performance based on key and historical benchmarks
3. Identify potential causes of poor performance in order to deploy
continuous improvements
4. Communicate effectively throughout the management structure
5. Assure data integrity and reliability
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
Quality Dashboard
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
Six Sigma
• Philosophy
• Eliminate defects through prevention and process
improvement
• Methodology
6
• Team-based approach to process improvement using
the DMAIC cycle
• Set of tools
• Quantitative and qualitative statistically based tools
• Goal
• 3.4 defects per million opportunities (DPMO)
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
Successful Six Sigma
• Top management support
• Use of quantitative measures
• Culture and leadership
• Extensive training
• DMAIC approach
• Team-based projects
• Impact on organization’s financials
6
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
DMAIC Process
• Define
• Measure
• Analyze
• Improve
• Control
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
DMAIC Process: Define
• Project team chooses a project on the basis of strategic
objectives of the business and the needs or requirements
of the customers of the process
• Characteristics of “good” projects:
• Save or make money for the organization
• Produce measurable process outcomes
• Relate clearly to organizational strategy
• Are supported by the organization
• Critical to Quality Measures (CTQs) are minimum
performance standards desired by the customer
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
DMAIC Process: Measure
PROCESS
INPUT
Key
process
input
variables
(KPIV)
OUTPUT
Key
process
output
variables
(KPOV)
CUSTOMERS
Critical
to
quality
(CTQ)
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
DMAIC Process
• Analyze
• Analyze collected data to determine the root causes
• Improve
• Identify, evaluate, and implement the improvement
solutions
• Control
• Put controls in place to ensure process improvement gains
are maintained
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
Seven Basic Quality Tools
Check Sheet
Fishbone
Diagram
Run Chart
Histogram
Pareto Chart
Flow Chart
Scatter
Diagram
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
Statistical Process Control (SPC)
• SPC is a statistics-based methodology for determining when
a process is moving “out of control.”
• All processes have variation in output.
• Some of the variation is inherent in the process (common).
• Some of the variation is due to assignable (special) causes.
• SPC is aimed at discovering variation due to assignable
causes and correcting those causes.
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
Statistical Process Control (SPC)
Out of
Control
Sample
Mean Wait Time (minutes)
40
35
+/- 1
30
+/- 2
+/- 3
25
20
0
5
10
15
20
25
Day
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
30
SPC: Out-of-Control Situations
Sample More
Than +/-Than
3 Standard
Errors
Mean
One One
Sample
More
+/3 from
Standard
Errors from Mean
UCL=3
UCL=3
_
X=0
_
X=0
LCL=-3
LCL=-3
Observation
Observation
8 or More
Samples
Above
8 or More
Samples Above
(or Below)(or
Mean Below)
Mean
Observation
14 or More
Samples Oscillating
14 or More
Samples
Oscillating
6 or More
Increasing
(or
6 or More Samples
Samples Increasing
(or Decreasing)
Decreasing)
UCL=3
UCL=3
_
X=0
_
X=0
LCL=-3
LCL=-3
Observation
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
Statistical Process Control (SPC)
Current Wait Time
Wait Time Goal
50% of
patients
wait more
than 30
minutes
15
20
25
30
35
Wait Time (minutes)
40
45
10% of
patients
wait more
than 30
minutes
15
20
25
30
35
Wait Time (minutes)
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
40
45
Process Capability
• A measure of how well the process can produce output
that meets desired standards or specifications
• Compares process specifications (set by the customer
or management) to control limits (the natural or
common variability in the process)
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
Process Capability
Cp and Cpk
USL − LSL
Cp =
and is estimated by
6
USL − LSL
ˆ
Cp =
6s
x − LSL USL − x
C pk = min
or
and is estimated by
3
3
x − LSL USL − x
ˆ
C pk = min
or
3s
3s
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
Process Capability
Cp and Cpk
1.5 shift
USL
LSL
3.4
DPM
O
-7
-6
-5
-4
-3
-2
-1
0
1
2
3
4
5
6
7
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
Rolled Throughput Yield
Proportions
Step 1
Step 2
Step 3
Step 4
95/100
error-free
products
95/100
error-free
products
95/100
error-free
products
95/100
error-free
products
Step 1
Step 2
Step 3
Step 4
100 in
95 error-free
“products” out
95 in
90 error-free
“products” out
90 in
86 error-free
“products”
out
86 in
81 error-free
“products”
out
Actual
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
Quality Function Deployment (QFD)
House of Quality
Correlation
matrix
Customer
requirements
Importance
Technical
requirements
Relationship
matrix
Competitive
assessment
Importance weight
Specifications
or
target values
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
QFD Example
Customer
needs
Goal: develop a system to ensure
that diabetes patients receive
preventive exams
Knowledge that it is time for an office visit
Knowledge of why follow-up is needed
Convenient to schedule
Known appointment length
Appointment on time
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
Time knowledge
Why knowledge
Convenient
Appointment length
Appointment time
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
On-Time
Appointment
Appointment
Length Range
Time to
Schedule
Information
on Need
Subsequent
Notification
Technical
responses
Initial
Notification
QFD Example (cont’d)
Time knowledge
5
Why knowledge
3
Convenient
4
Appointment length
3
Appointment time
4
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
On-Time
Appointment
Appointment
length range
Time to
Schedule
Information
on Need
Initial
Notification
Importance:
Patient desire
Cost
Competitive
advantage
Subsequent
Notification
QFD Example (cont’d)
Time knowledge
5
Why knowledge
3
Convenient
4
Appointment length
3
Appointment time
4
On-Time
Appointment
Appointment
Length range
Time to
Schedule
Information
on Need
Initial
Notification
Relationships:
Strong = 5
Medium = 3
Weak = 1
Subsequent
Notification
QFD Example (cont’d)
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
Appointment time
4
Why knowledge
Convenient
Time to
Schedule
3
Information
on Need
5
On-Time
Appointment
Appointment length
5
3
4
3
Appointment
Length range
Time knowledge
Subsequent
Notification
Relationships:
Strong = 5
Medium = 3
Weak = 1
Initial
Notification
QFD Example: Replace Icons with Numbers
5
3
3
5
5
3
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
3
4
3
4
Convenient
Appointment length
Appointment time
Time to
Schedule
Information
on Need
3
On-Time
Appointment
Why knowledge
5
Appointment
Length range
5
Subsequent
Notification
Time knowledge
Initial
notification
QFD Example:
Multiply by
Importance and
Sum
5
3
3
5
27
29
5
5
25
15
15
20
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
QFD Example
+
3
Convenient
4
Appointment length
3
5
3
Appointment time
4
3
5
27
29
3
Time to
Schedule
Why knowledge
5
Information
on Need
5
Subsequent
Notification
Time knowledge
Initial
Notification
On-Time Appointment
+
Appointment
length range
Relationships:
+ = Strong positive
− = Strong negative
Technical
correlations
5
5
25
15
15
20
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
QFD Example (cont’d)
3
Convenient
4
Appointment length
3
5
3
Appointment time
4
3
5
27
29
3
Time to
Schedule
Why knowledge
5
Information
on Need
5
Subsequent
Notification
Time knowledge
Initial
Notification
On-Time Appointment
Appointment
length range
Target:
100 diabetics/month;
85% compliance
5
5
25
15
15
20
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
QFD Example: Outcome
To: Dan McLaughlin
From: Southview Clinic
Dear Dan,
You had an appointment with Dr. Adams about six months ago, and it is now time
for another visit. We need to check your blood pressure, do some blood tests, and
adjust your prescriptions if needed. We would like to review these preventive
procedures in advance, so please see www.southview.com/prev22.
We have two openings available next week, on Tuesday at 8:30 am and Thursday at
2:30 pm, to see Dr. Adams. Click on one of these days to make the appointment, or
e-mail us with dates and times that work for you.
We appreciate you continuing your care with us, and Dr. Adams looks forward to
seeing you.
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
Taguchi Methods
• Quality is related to the distance from some target
value rather than “good” or “bad”
• Further from the target is worse
• Design of experiments (DOE)
• Design for Six Sigma (DFSS)
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
Benchmarking
• Process of identifying, understanding, and
adapting outstanding practices and processes
to improve organizational performance
Best
• Steps in benchmarking:
• Determine what to benchmark
• Determine how to measure it
• Gather information and data
• Implement the best practice within the
organization
Your
organization
Range
of
values
Worst
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
Mistake Proofing (Poka-Yoke)
• A mechanism that either:
• Prevents a mistake from being
made
• Makes the mistake
immediately obvious
• Eliminates errors
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
Riverview Generic Drug Project
Riverview Drug Prescription Process
Information
on drugs
Drug doesn’t work
Patient
needs
drug
Clinician
prescribes
drug
Type of
drug
Generic
Drug
efficacy
Drug
works
End
Drug
works
Non-Generic
Drug
doesn’t
work
Drug
efficacy
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
End
Riverview Generic Drug Project:
Drug Type and Availability
Generic
20%
65%
35%
15%
Non-Generic,
Generic
Available
Non-Generic,
Generic Not
Available
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
Nongeneric prescriptions
where a generic is
available/month
Riverview Generic Drug Project
Clinician Prescriptions
20
15
10
5
0
Davis
Jones
Smith
Clinician
Swanson
Anderson
Prescriptions/month
Nongeneric Prescriptions Where There Is a Generic Available
20
15
10
5
0
O
Microsoft Excel® screen shots reprinted with permission
from Microsoft Corporation.
W
J
V
B
H
M
A
C
I
G
D
K
L
Drug
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
T
U
N
P
Q
R
D
ef
in
e
M
ea
su
re
A
na
ly
Im ze
pr
ov
e
C
on
tr
ol
DMAIC Process
Seven Quality Control Tools
Tools and Techniques
Cause-and-Effect Diagram
Run Chart
Check Sheet
Histogram
Pareto Chart
Scatter Diagram
Flowchart
x
x
x
x
x
x
x
x
x
x
x
x
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
DMAIC Process: Other Tools
Tools and Techniques
Bar graph
Line graph
Pie chart
5 whys/root cause
FMEA
Hypothesis testing
Regression analysis
Control chart
Process capability
Simulation
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
DMAIC Process: Other Tools (cont’d)
Tools and Techniques
Quality function deployment
Poka-yoke
Brainstorming
Benchmarking
Project planning
Charters
Gantt chart
Tree diagram
Force field analysis
Activity-based costing
Balanced scorecard
Cost and benefit analysis
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
End of Chapter 9
Copyright © 2022 Foundation of the American College of Healthcare Executives.
Not for sale.
Order an Essay Now & Get These Features For Free:
Turnitin Report
Formatting
Title Page
Citation
Outline
