Lean Six Sigma for Hospitals: Improving Patient Safety, Patient Flow and the Bottom Line, Second Edition

Lean Six Sigma for Hospitals: Improving Patient Safety, Patient Flow and the Bottom Line, Second Edition

by Jay Arthur


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Lean Six Sigma for Hospitals: Improving Patient Safety, Patient Flow and the Bottom Line, Second Edition by Jay Arthur

Simple Steps to Improve Patient Safety, Patient Flow and the Bottom Line

A Doody's Core Title for 2017!

This thoroughly revised resource shows, step-by-step, how to simplify, streamline, analyze, and optimize healthcare performance using tested Lean Six Sigma and change management techniques. Lean Six Sigma for Hospitals, Second Edition, follows the patient from the front door of the hospital or emergency room all the way through discharge. The book fully explains how to improve operations and quality of care while dramatically reducing costs—often in just five days. Real-world case studies from major healthcare institutions illustrate successful implementations of Lean Six Sigma.

Coverage includes:

• Lean Six Sigma for hospitals, emergency departments, operating rooms, medical imaging facilities, nursing units, pharmacies, and ICUs
• Patient flow and quality
• Clinical staff
• Order and claims accuracy
• Billing and collection
• Defect and medical error reduction
• Excel power tools for Lean Six Sigma
• Data mining and analysis
• Process flow charts and control charts
• Laser-focused process innovation
• Statistical tools for Lean Six Sigma
• Planning and implementation

Product Details

ISBN-13: 9781259641084
Publisher: McGraw-Hill Professional Publishing
Publication date: 08/04/2016
Pages: 400
Sales rank: 1,238,370
Product dimensions: 5.90(w) x 8.90(h) x 0.90(d)

About the Author

Jay Arthur (Denver, CO), “The KnowWare Man,” works with companies that want to fire up their profits using Lean Six Sigma. He is the author of Lean Six Sigma Demystified (2nd) and QI Macros SPC software for Excel. Jay has worked with Tenet, Kindred, Centura, Sutter Health, and Christus Healthcare on projects to improve patient flow and to reduce clinical and operational errors.

Table of Contents

Preface xi

Chapter 1 A Faster Hospital in Five Days 1

Goal: Accelerate the Patient's Experience of Healthcare 1

A Faster Emergency Department in Five Days 2

Faster Door-to-Balloon (D2B or DTB) Time in Five Days 6

A Faster Operating Room in Five Days 6

Faster Medical Imaging in Five Days 7

A Faster Lab in Five Days 8

A Faster Nursing Unit in Five Days 9

Case Study: Virginia Mason Medical Center (VMMC) 12

Simple Steps to Better, Faster, Cheaper Healthcare 20

The Problem Isn't Where You Think It Is 20

Take the Dominos Challenge 21

How to Get a Faster Hospital in Five Days 22

Chapter 2 Lean for Accelerated Patient Flow 25

Mind the Gap 25

Value-Stream Mapping and Spaghetti Diagramming 26

If They Can Do It in Botswana 27

The Fast Eat the Slow 28

Core Score 29

Speed Saves Lives 30

You Already Understand Lean 32

The Power Laws of Speed 33

Economies of Speed 34

The Toyota Production System 34

Core Ideas of Lean 35

Toyota's Five Rules 36

The Lean Mindset 37

The Seven Speed Bumps of Lean 38

The Five S's 39

Value-Stream Mapping 40

Pull Versus Push 41

Redesign for One-Piece Flow 41

Lean Tools 44

Walking Is Waste 47

Lean Principle-Load Leveling 50

Lean Principle-Minimize Inventory 51

Cleveland Clinic Case Study 51

Chapter 3 Simple Steps to a Better Hospital 53

Memorial Hermann Case Study 54

A Better Emergency Department (ED) in Five Days 54

A Better Clinical Staff in Five Days 55

A Better Operating Room (OR) in Five Days 55

A Better Pharmacy 65

Better Order Accuracy in Five Days 69

Better Medical Imaging in Five Days 70

A Better Lab in Five Days 70

A Better Nursing Unit in Five Days 71

Better Diagnoses 74

A Better ICU in Five Days 74

Misuse of Antibiotics 75

Bar Codes Bust Medication Errors 75

The Problem Isn't Where You Think It Is 76

I Pledge Allegiance to Science and Evidence 76

Simple Steps to a Better Hospital in Five Days 79

Chapter 4 Reducing Defects with Six Sigma 81

Invisible Low-Hanging Fruit 82

Six Sigma's Problem-Solving Process 83

Getting to Lean Six Sigma 83

Key Tools for Defect Reduction 84

The 4-50 Rule 107

Reducing Patient Falls: A Case Study 108

Mistake-Proofing Forms to Improve Quality 114

Six Sigma Tar Pits 116

Become a Lean Six Sigma Detective 120

Mistakes, Defects, and Errors 122

Measurement Simplicity 123

Accidents Don't Just Happen 125

Analysis Is Easy …If You Know What to Look For 125

Chapter 5 Simple Steps to a Cheaper (More Profitable) Hospital 127

Faster + Better = Cheaper and More Profitable! 127

Reducing Denied Claims in Five Days 130

Reducing Rejected Claims in Five Days 132

Reducing Appealed Claims in Five Days 137

How to Get a Cheaper Hospital in Five Days 141

Insights 142

Conclusion 142

Chapter 6 Six Sigma for Hospitals 143

Double Your Profits 143

Manufacturing and Service 144

Tricks of the Trade 145

The Faster, Better, Cheaper Toolkit 148

Every Business Has Two Sources of Cash Flow 148

Every Business Process Has Three Big Leaks 150

Every Business Has Two Improvement Focuses 150

The Universal Improvement Method 154

Lean Six Sigma 158

Chapter 7 Excel Power Tools for Lean Six Sigma 161

Trend Lines Can Tell Lies 161

What Is a Pareto Chart? 169

What Is a Histogram? 170

What Is a Fishbone Diagram? 170

What Is a Countermeasures Matrix? 172

Why Get SPC Software? 172

The QI Macros for Excel 174

The QI Macros Are Easy to Use 175

QI Macros Introduction 175

Power Tools for Lean Six Sigma 185

Analyzing Customer-Service Data Hidden in Trouble-Reporting Systems 185

Setting Up Your Data in Excel 188

Data Collection and Measurement for Six Sigma 191

Mistake-Proof Data Collection 193

Troubleshooting Problems 200

Technical Support 201

Chartjunk 201

Get the Idea? 202

Chapter 8 Is There an Improvement Project in My Data? 203

Data Mining with Excel and the QI Macros PivotTable Wizard 203

Word Count 209

PivotTable Wizard 211

Get the Idea? 216

Chapter 9 Sustaining Improvement 219

Performance Drift 219

Process Control System 220

Process Flowchart 220

Standard Work 222

Control Charts for Sustaining the Improvement 223

What Chart Do I Choose? 229

Control Plan 237

Chapter 10 Laser-Focused Process Innovation 241

Focusing the Improvement Effort 241

Critical-to-Quality Indicators (CTQs) 247


Balanced Scorecard 250

Mayo Clinic Case Study in Innovation 253

Quality Management Systems 254

Chapter 11 Statistical Tools for Lean Six Sigma 257

Hypothesis Testing 257

Hypothesis Testing for Variation 258

Hypothesis Testing for Means 260

Analysis of Variance 269

Are Your Data Normal? 272

Tests of Proportion 276

Chi-Square Tests in Excel 277

Determining Sample Sizes 280

QI Macros Statistics Wizard 285

Conclusion 286

Chapter 12 Change Management 287

Three Stages of Change 287

Key Components of Managing Change 288

Plan 288

Inspire the Team 290

The Power of Diffusion 291

Change Management Transition Planning 293

Physician Engagement to Lead Cultural Transformation 297

The Best Work Anywhere Should Be the Standard of Work Everywhere 298

Chapter 13 Theory of Constraints 301

Hospitals Are Complex, but Problems Are Simple 301

Theory of Constraints 302

The TOC Process 303

Chapter 14 Implementing Lean Six Sigma in Hospitals 307


Excuses, Excuses, Excuses 308

CONI-Cost of No Improvement 310

Decisive Force 311

Crisis Junkies 312

Minor in Major Things 313

Getting the Right People Involved with Lean Six Sigma 315

The Improvement Mindset 315

Talent Versus Process 318

New CEOs Can Kill Lean Six Sigma 319

Be a Money Belt 320

Our Reward Systems Are Broken 321

Barriers to Lean Six Sigma 322

Here's My Point 323

Management by Quality (MBQ) 323

Why Do Six Sigma Teams Fail? 326

"Bridezilla" Meets Lean Six Sigma 329

Here's My Point 330

Making Lean Six Sigma Successful 330

What's Wrong with Most Lean Six Sigma Training? 335

Are You a Lean Six Sigma Salmon? 338

Here's My Point 340

Risk-Free Way to Implement Lean Six Sigma 342

Can Lean Six Sigma Kill Your Hospital? 348

Assets and Liabilities 349

Innovation Rules 351

Conflicting Goals 354

Honor Your Progress 355

The Hard Work Is Soft 356

Lean Six Sigma Roles 356

Get a Faster, Better, Cheaper Hospital 357

Epilogue 359

Bibliography 363

Index 369

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