Quality models: selecting the best model to deliver results.Total quality management Continuous Quality Improvement Malcolm Baldrige National Quality Award The Malcolm Baldrige National Quality Award is given by the United States National Institute of Standards and Technology. Through the actions of the National Productivity Advisory Committee chaired by Jack Grayson, it was established by the Malcolm Baldrige National Quality Plan, Do, Check, Act (PDCA PDCA Purebred Dexter Cattle Association PDCA Painting and Decorating Contractors of America PDCA Purebred Dairy Cattle Association (USA) PDCA Pile Driving Contractors Association PDCA Pug Dog Club of America ) Zero defects "Zero Defects" is a notional quality standard developed by Phil Crosby. Although applicable to any type of enterprise, it has been primarily adopted within industry supply chains wherever large volumes of components are being purchased (common items such as nuts and bolts are good Lean processes Six Sigma Not to be confused with Sigma 6. Six Sigma is a set of practices originally developed by Motorola to systematically improve processes by eliminating defects.[1] A defect is defined as nonconformity of a product or service to its specifications. Institute for Healthcare Improvement The list of quality improvement programs goes on and on. The challenge for physician executives is to decide which model is most appropriate for their organization. And as the ACPE ACPE Accreditation Council for Pharmacy Education ACPE American Council on Pharmaceutical Education ACPE American College of Physician Executives ACPE Association for Clinical Pastoral Education, Inc. Quality of Care Survey showed, physician leaders are going down many different paths in the quest for Verb 1. quest for - go in search of or hunt for; "pursue a hobby" quest after, go after, pursue look for, search, seek - try to locate or discover, or try to establish the existence of; "The police are searching for clues"; "They are searching for the achieving the highest levels of patient safety. Six Sigma was the most common approach utilized by nearly one in five (18.5 percent) of the respondents followed closely by Lean Processes (13.3 percent). Proprietary products provided by vendors represented more than one-tenth (12.2 percent) of the respondents' approach to improve quality. Surprisingly, almost one-third (29.2 percent) of the respondents reported that no program is primarily used to improve quality, which represents a more eclectic approach. Here's a look at each of the more common quality management models: Six Sigma Six Sigma has inspired the approach to quality management in many industries including health care since it began in the manufacturing sector at Motorola. Under the leadership of former CEO (1) (Chief Executive Officer) The highest individual in command of an organization. Typically the president of the company, the CEO reports to the Chairman of the Board. Bob Galvin Robert (Bob) W. Galvin (born on October 9, 1922 in Marshfield, Wisconsin) is the son of the founder of Motorola, Paul Galvin. He attended the University of Notre Dame and the University of Chicago. , Motorola not only diffused Six Sigma throughout the enterprise but also attributed Six Sigma to Motorola's winning the coveted cov·et v. cov·et·ed, cov·et·ing, cov·ets v.tr. 1. To feel blameworthy desire for (that which is another's). See Synonyms at envy. 2. To wish for longingly. See Synonyms at desire. Malcolm Baldrdige Award in 1988. Six Sigma was further developed by General Electric, which has a health care consulting division. Six Sigma is a data-driven, customer-centered approach and methodology applicable to health care products and services. Sigma is a letter in the Greek alphabet Greek alphabet Writing system developed in Greece c. 1000 BC, the direct or indirect ancestor of all modern European alphabets. Derived from the North Semitic alphabet via that of the Phoenicians, it modified an all-consonant alphabet to represent vowels. used to denote variability. It is assumed that every human activity has variability. Reducing variability is the essence of Six Sigma. A health care organization's performance is measured by the sigma level of its various clinical, operational and other business processes. The aim of Six Sigma is to eliminate defects to six standard deviations between the mean and the nearest customer specification limit. The Six Sigma standard is 3.4 problems per million opportunities. Kevin Linderman and others emphasized the need for a common definition of Six Sigma and proposed: "Six Sigma is an organized and systematic method for strategic process improvement and new product and service development that relies on statistical methods and the scientific method to make dramatic reductions in customer defined defect rates." (1) The step-by-step method of deploying Six Sigma is based upon DMAIC DMAIC Define, Measure, Analyze, Improve, Control DMAIC Design, Measure, Analyze, Improve, Control (5 stages of Six Sigma Quality Improvement and Assurance) which translates into: * Define * Measure * Analyze * Improve * Control These steps are not deployed until projects have been selected based upon the translation of organizational goals into operational goals. One of the intriguing aspects of Six Sigma is the reference to the martial arts This is a list of martial arts, broken down by region and style. African martial arts Eritrea
Six Sigma is built upon a strong infrastructure that is essential to driving results. The players in this infrastructure include the following: leadership, champions and sponsors, master black belts, black belts, and green belts. Leadership: Given the strategic nature of Six Sigma, leadership is essential. However, the initiative must not be exclusively top-down but accountability for results must report to the highest levels of the management structure and even the board. Champions and sponsors: It is almost a cliche that every successful change effort requires a champion. This is the case for Six Sigma. Typically, the champions sit in key executive roles including the chief medical officer and vice president of medical affairs. However, champions are also informal leaders who use Six Sigma as part of their day-to-day work in both clinical and operational settings. On the other hand, sponsors are those individuals who are willing to have their clinical and operational processes benefit from Six Sigma improvement activities. Sponsors could be clinical chairs, department heads, and service line leaders. Master black belt: As a leader, the master black belt provides technical leadership and mentorship of black belts and green belts. The master black belt must also possess great teaching competencies. This role is a full-time role within the organization. Black belt: As masters of the technical tools, black belts typically are quantitatively oriented or trained and receive one-on-one coaching from their master black belt or consultant. Many black belts are also proficient in information technology due to the integration between improvement activities and information technology. This role is a full-time role within the organization. Green belt: As facilitators of Six Sigma teams and managers of Six Sigma projects from concept to completion, green belts "get under the hood under the hood - [hot-rodder talk] 1. The underlying implementation of a product (hardware, software, or idea). Implies that the implementation is not intuitively obvious from the appearance, but the speaker is about to enable the listener to grok it. " and get "their hands dirty" with project management, quality management, quality control, problem solving problem solving Process involved in finding a solution to a problem. Many animals routinely solve problems of locomotion, food finding, and shelter through trial and error. , and descriptive data analysis. This is typically a balanced role within the organization. After the infrastructure is in place, the implementation process takes off. Similar to other strategic management efforts, the research is very clear that the successful deployment of Six Sigma depends upon selecting high leverage projects that are few in number and actively engage employees on the front-line workers who are trained and facilitated by green belts. Lean processes Lean processes can be traced back to the Japanese automobile industry Japan is the world's largest automobile manufacturer and exporter, and has six of the world's ten largest automobile manufacturers. In addition to its massive automobile industry, Japan also is the home to manufacturers of other types of vehicles, like powersports vehicle manufacturers in general and Toyota Production System The Toyota Production System (TPS) is the philosophy which organizes manufacturing and logistics at Toyota, including the interaction with suppliers and customers. The TPS is a major part of the more generic "Lean manufacturing". (TPS (1) (Transactions Per Second) The number of transactions processed within one second. TPS is a better rating for the performance of hardware and software than the common MHz and GHz rating of the computer. ) in particular. Later, Ford Motor Company began to embrace the way of lean thinking. The terms world class manufacturing, Kaizen This article is about a continual improvement philosophy. For Kaizen ($K), a fantasy currency invented by Kaizen Games, see Priston Tale. “Red tag” redirects here. For designation of damaged structures, see Red-tagged structure. , TPS, lean manufacturing Lean manufacturing is the production of goods using less of everything compared to mass production: less human effort, less manufacturing space, less investment in tools, and less engineering time to develop a new product. and just-in-time all refer to the same principles. Also, lean processes are associated with removing waste from any process. Lean processes distinguish between value-added and non-value-added activities. The dominant tool is the value-added stream map that seeks to prevent and correct suboptimization along the entire value chain. Quality is defined as "meeting or exceeding predefined standards." Lean processes deploy a portfolio of standardized tools for common organizational problems. In the book Lean Thinking, (2) there are five steps to this methodology: 1. Specify value from the standpoint of each customer. 2. Identify all steps in the value stream. 3. Make the value creating steps flow toward the customer. 4. Let customers pull value (toward them) from the next upstream activity. 5. Pursue perfection. One of the more well-known tools associated with lean thinking are The 5 Whys that seek to pursue the root causes of any non-valued-added activity and formulate recommendations for improvement. Another tool is 5S's that refer to sort, straighten, scrub, standardize, and sustain. Don Berwick, president and CEO of the Institute for Healthcare Improvement (IHI IHI Institute for Healthcare Improvement (Boston, MA, USA) IHI Ishikawajima-Harima Heavy Industries (Japan, ship building, aerospace & others) IHI Institute of History IHI I'd Hit It ), included no waste as one of the five goals for health care change in addition to no needless deaths, no needless pain, no helplessness, and no unwanted waiting. (3) Waste is non-value-added. It must be noted that lean thinking does not mean working harder but working smarter. In essence, the cliche' "lean and mean" is often associated with organizational restructuring and downsizing (1) Converting mainframe and mini-based systems to client/server LANs. (2) To reduce equipment and associated costs by switching to a less-expensive system. (jargon) downsizing and this definition should not be confused with lean processes. Lean processes are based upon embedding improvements in a different organizational cultural framework. The Institute for Healthcare Improvement recognizes the importance of culture in the implementation of lean management principles as stated, "In order for lean principles to take root, leaders must first work to create an organizational culture  This article or section is written like an .Please help [ rewrite this article] from a neutral point of view. Mark blatant advertising for , using . that is receptive to lean thinking." (4) Similar to Six Sigma, an infrastructure must be in place beyond focusing solely on a quality improvement project. Institute for Healthcare Improvement Berwick's IHI has developed a quality management model that's grounded in three questions and the Plan-Do-Study-Act cycle. 1. What are we trying to accomplish? 2. How will we know that a change is an improvement? 3. What changes can we make that will result in improvement? Another way of framing IHI's quality management model is to describe it as three sequenced steps: 1. Setting aims 2. Establishing measures 3. Testing changes According to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. IHI, there are several tips for setting aims: * State the aim clearly * Include numerical goals * Set stretch goals * Avoid aim drift * Be prepared to refocus the aim There are also key tips for effective measurement: * Plot data over time * Seek usefulness, not perfection * Use sampling * Integrate measurement into the daily routine * Use qualitative and quantitative data Finally, there are tips for testing changes based upon the PDSA cycle PDSA cycle - Plan, Do, See, Approve (from Japan). : * Stay a cycle ahead * Scale down the scope of tests * Pick willing volunteers * Avoid the need for consensus, buy-in, or political solutions * Don't reinvent the wheel * Pick easy changes to try * Avoid technical slowdowns * Reflect on the results of every change * Be prepared to end the test of a change What is the decision-making process to choose a specific model of quality management? After physician executives have familiarized themselves with the different quality approaches, a decision must be made in selecting the best method for their organization. Although the three models were presented separately, they are by no means mutually exclusive Adj. 1. mutually exclusive - unable to be both true at the same time contradictory incompatible - not compatible; "incompatible personalities"; "incompatible colors" . In fact, some recommend that the models be combined: "Lean provides a total system approach but is short on details, organizational structures and analytic tools for diagnosis. Six Sigma, on the other hand, offers fewer standard solutions but provides a general framework for problem solving and an organizational infrastructure. The ideal solution is to combine the two approaches." (5) Another decision to be made is if you began with one quality management approach how do you integrate another approach. Ronald Snee offers advice on this challenge: "If you started from a Six Sigma perspective, you can add lean tools, with their power to reduce waste. If you began with lean, you can add the DMAIC framework and Six Sigma tools designed to reduce process variation and find the operating sweet spot." (4) In the ACPE survey, the respondents seemed to make the decision to select a specific quality approach based upon a number of different factors: * Opinion of a board member * Opinion of a member of the C-suite (CEO, CFO See Chief Financial Officer. , COO, CMO CMO See: Collateralized mortgage obligation CMO See collateralized mortgage obligation (CMO). , etc.) * Bundling of quality management model with other products or services supplied by vendors such as Premier, Novations, and University Health Consortium * Honoring the existing tradition of the organization Physician executives should be advised to engage in optimal decision making rather than satisficing Satisficing is a decision-making strategy which attempts to meet criteria for adequacy, rather than identify an optimal solution. A satisficing strategy may often, in fact, be (near) optimal if the costs of the decision-making process itself, such as the cost of obtaining complete . Satisficing is defined as "searching for and choosing an acceptable response or solution, not necessarily the best possible one." (6) There are numerous individual and group decision-making models that can be used by physician executives to select the most appropriate quality management model for their organizations. In the end, physician executives should remember that any single quality management model is only a means to an end. The end is enhancing the total quality experience of physicians, nurses, other staff, patients, payers and other stakeholders. William Martin William Martin can refer to:
[ILLUSTRATION OMITTED] References 1. Linderman K, Schroeder R., Zaheer S, and Choo A. "Six sigma: A goal theoretic perspective." Journal of Operations Management Operations management is an area of business that is concerned with the production of goods and services, and involves the responsibility of ensuring that business operations are efficient and effective. , 21(2):193-203, March 2003. 2. Womack JP and Jones DT. Lean thinking: Banish waste and create wealth in your corporation. New York New York, state, United States New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of : Simon and Schuster, 1996. 3. Berwick DM. "Improving Patient Care: My right knee." Annals of Internal Medicine Annals of Internal Medicine (Ann Intern Med) is an academic medical journal published by the American College of Physicians (ACP). It publishes research articles and reviews in the area of internal medicine. Its current editor is Harold C. Sox. , 142 (2):1215, Jan. 18, 2005. 4. Institute for Healthcare Improvement. Innovation series: Going lean in health care. Institute for Healthcare Improvement; Cambridge, Massachusetts This article is about the city of Cambridge in Massachusetts. For the English university town, see Cambridge, England. For other places, see Cambridge (disambiguation). Cambridge, Massachusetts is a city in the Greater Boston area of Massachusetts, United States. , 2005. 5. Koning H, Verver JPS JPS Jewish Publication Society JPS John Peter Smith (Hospital; Texas) JPS Justice & Public Safety JPS Jean Piaget Society JPS Juvenile Polyposis Syndrome JPS Joint Planning Staff , Van den Heuvel J, Bisgaard S and Does RJ. "Lean Six Sigma Lean Six Sigma is a business improvement methodology which combines (as the name implies) tools from both Lean Manufacturing and Six Sigma. Lean manufacturing focuses on speed and traditional Six Sigma focuses on quality. By combining the two, the result is better quality faster. in healthcare." Journal of Healthcare Quality, 28(2):4-11, Mar-Apr. 2006. 6. George JM and Jones GR. Understanding and managing organizational behavior. 4th edition. Upper Saddle River Saddle River may refer to:
By William F. Martin MPH, PsyD RELATED ARTICLE: 2007 Quality of Care Survey There are several well-known quality programs being promoted nationally. Which of the programs listed below is your organization primarily using to improve quality?
Response % Response Total
Six Sigma (DMAIC) 18.5% 192
Lean processes 13.3% 138
Proprietary products provided by vendors 12.2% 126
None 29.2% 303
Other, including homegrown measures 26.7% 277
(please specify)
Total Respondents 1036
(skipped this question) 119
RELATED ARTICLE: DMAIC Steps * Define: Define the problem, clarify and relate it to the customer. * Measure: Measure your target metric and know your measure is reliable and valid. * Analyze: Identify root causes and prioritize root causes. * Improve: Determine and confirm the optimal solution using statistical tools. * Control: Drive for sustainability in the quality solution.
Traditional Culture vs. Lean Culture
Traditional Culture Lean Culture
Function Silos Interdisciplinary Teams
Manages direct Managers teach/enable
Benchmark to justify not Seek the ultimate performance, the
improving: "just as good." absence of waste
Blame people Root cause analysis
Rewards: individual Rewards: group sharing
Supplier is enemy Supplier is ally
Guard information Share information
Volume lowers cost Removing waste lowers cost
Internal focus Customer focus
Expert driven Process driven
Source: IHI. Innovation Series: Going Lean in Health Care, citing the
work of A.P. Byrne & O.J. Fiume, 2005.
Comparing and Contrasting Three Quality Management Models
Factor Six Sigma Lean Processes IHI
Focus To reduce process To improve To set aims, establish
variation. process flow measures, and test
and eliminate changes.
waste.
Methodology DMAIC (define, Value Stream PDSA (Plan-Do-Study-
measure, analyze, Map. 5 Whys. Act).
improve, control).
Role of Champion Sponsor Champion Establish the Mission,
Physician Sponsor Vision, and Strategy.
Executives Build the foundation
for an effective
leadership system.
Build will. Generate
ideas. Execute change.
Role of Master Black Belt Member of
Physicians Black Belt Green project team.
Belt Member of SME (Subject
project team. SME Matter Expert)
(Subject Matter
Expert)
Source: Institute for Healthcare Improvement. A framework for leadership
of improvement, February 2006.
|
|
||||||||||||||||||||
Printer friendly
Cite/link
Email
Feedback
Reader Opinion