Table of Contents
Preface ix
Chapter 1 Why Is Performance Improvement the "Big New Thing"? 1
Background 5
Improving the Quality of Care 8
Patient Safety-A Specific Quality Goal 10
Reducing Cost 14
Quality Frameworks 15
When will Quality Become "Job 1"? 17
Discussion Questions 18
References 19
Chapter 2 Define Phase Tools 21
Background 21
Project Charter 22
Voice of the Customer 26
CAHPS Surveys and the Voice of the Customer 30
National CAHPS Benchmarking Database 31
Other Methods of Listening to the Voice of the Customer 32
Kano Model 35
Procedure for Kano Model process 37
Tips and tricks 38
Stakeholder Analysis 39
Procedure for stakeholder analysis and diagram 41
Tips and tricks 41
Process Mapping 41
Procedure for creating a process flowchart 42
Tips and tricks 43
SIPOC Process Map 44
Procedure for SIPOC process map 44
Tips and tricks 45
Brainstorming, Brainwriting, and Nominal Group Technique 47
Procedure for brainstorming 47
Variants-brainwriting and nominal group technique (NGT) 48
Multivoting 49
Affinity diagrams 51
Critical-To-Quality (CTQ) Analysis 53
Procedure for creating a CTQ tree 54
Completion of the Define Phase 55
Discussion Questions 56
References 57
Chapter 3 Measure Phase Tools 59
The Essence of the Measure Phase 59
Measure Phase Tools 61
Process Maps 61
Performance Evaluation and Review Technique (PERT) Chart 62
Deployment Flowchart 69
Prioritization Matrix 72
Process Cycle Efficiency (Value Added Ratio) 76
Time Value Analysis (TVA) 79
Pareto Charts 80
Run Charts 83
Control Charts 88
Failure Mode and Effects Criticality Analysis (FMECA) 95
Deliverables in the Measure Phase 100
Data Collection and Analysis Plan 100
Measurement System Analysis 103
Baseline Performance-Calculating Process Sigma 105
Finishing the Measure Phase 107
Further Reading 108
Discussion Questions 108
Chapter 4 Analyze Phase Tools 111
The Essence of the Analyze Phase 111
Elements of the Analyze Phase 112
Root Cause Analysis (RCA) 113
Cause and Effect (C & E) Diagram 117
Statistical Methods of Establishing Relationships 120
Pearson Correlation Coefficient 121
Hypothesis Testing 125
Confidence Interval 131
Analysis of Variance (ANOVA) 133
Regression Analysis 138
Brainstorming in the Analyze Phase 141
Deliverables of the Analyze Phase 141
Discussion Questions 143
References 144
Chapter 5 Improve Phase Tools 145
The Essence of the Improve Phase 145
Elements of the Improve Phase 146
Framework for the Improve Phase 146
Traditional Improvement Tools 148
Change Management 148
Project Plan 150
Failure Mode and Effects Analysis (FMEA) 151
Kaizen 152
6S 158
Prioritization Matrix 163
Deployment Flowchart 163
Pilot Testing 165
Six Sigma Tools 168
Completing the Improve Phase 173
Discussion Questions 173
References 174
Chapter 6 Control Phase Tools 175
The Essence of the Control Phase 175
Elements of the Control Phase 176
Framework for the Control Phase 176
Control Phase Tools 181
Flowcharts 181
Standardization and Institutionalization of Process Changes 183
Training Plans and Programs 191
Monitoring Plans 195
Poka Yoke 196
Audit Plans 199
Control Charts 201
Process Sigma Level 209
Control Phase Deliverables 210
Discussion Questions 210
Other Resources 211
Risk Adjustment 212
References 212
Chapter 7 LSS Case Studies in Health Care 215
Miami Baptist Hospital 216
Pocono Medical Center (PMC), East Stroudsburg, PA 218
Nebraska Medical Center Peggy D. Cowdery Patient Care Center 221
Radia, Inc 224
Providence St. Joseph Medical Center (PSJMC), Burbank, CA 229
North Shore-Long Island Jewish Health System, New York City 234
Discussion Questions 240
References 241
Chapter 8 DMAIC in an Era of Reform 243
Trends in Healthcare Reform 243
New Financial and Quality Realities 250
Financial Models 252
Quality Reporting and Improvement 257
Health Information Technology (HIT) 260
Role of DMAIC as a Quality Improvement Strategy 261
Discussion Questions 262
References 263
Appendix: Quality Measures for Accountable Care Organizations 265
Glossary: DMAIC Terms and Definitions 283
Index 317
