HEALTHCARE SYSTEMS MANAGEMENT
Managing Quality to Promote Cost Effectiveness and Value-added Practices (graded)
Nursing leaders understand that to determine the level of success of an activity there must be opportunities to measure, analyze, and evaluate activity-based data. Consider a current National Patient Safety Goal or Institute for Healthcare Improvement care bundle.
Investigate how a systems-approach is utilized in providing patient-centered and value-added care. (PO 4, 6, 7)
Describe a patient-centered model that uses clinical pathways, nursing care plans, and multidisciplinary action plans to assist in planning quality-driven and cost-effective care. (PO 8, 9)
Identify various team strategies for problem-solving that enhance patient-centeredness and value-added care. (PO 8, 9)
What professional and organizational standards are met by these initiatives? How is the performance of staff related to these initiatives measured? Who analyzes them? Explain how the nursing staff is enabled and encouraged to maintain these standards that improve quality care.
Quality Control and Cost-Effective Care
No doubt, most workers in healthcare have heard of Six Sigma, LEAN, or the newer combination process called LEAN Six Sigma. Six Sigma is a specific process developed in manufacturing with a focus on improving quality and sustainability of products to improve customer satisfaction. As applied to healthcare, the use of Six Sigma strives to improve patient-care quality, ensure consistency, and improve patient satisfaction. LEAN is a set of methods or strategies to decrease the time frame to provide products and services (Van Leeuwen & Does, 2011). In healthcare, these methods or strategies decrease the time of consensus decision making and implementation and swiftly leads to positive results. The advantages of healthcare organizations using these combined methods is to improve the overall quality of patient care quickly, sustain the quality, and increase patient satisfaction, thereby improving the organization’s business performance.
In the combination, LEAN Six Sigma, there are eight categories of organizational waste that are addressed. These categories are (a) defects, (b) overproduction, (c) waiting, (d) unutilized talent, (e) transportation, (f) inventory, (g) motion, and (h) extra-processing (Van Leeuwen & Does, 2011). Like Six Sigma, LEAN Six Sigma uses the DMAIC phases of change, where D is for define, M is for measure, A is for analyze, I is for improve, and C is for control. Ultimately, through careful and purposeful use of LEAN Six Sigma, improved quality is assured.
Lean Six Sigma: Phases
To begin applying the Lean Six Sigma to an organization, there needs to be a comparison of its current performance in any number of areas with expected or desired performance. The first phase is to define the problem or issue (Van Leeuwen & Does, 2011). For example, one challenge in the emergency department is the length of stay and time to transfer of those patients who have admission orders. The issue for the department is that there is a backup of patients, new patients do not have exam rooms, and currently admitted patients do not have inpatient beds. Quality of care is diminished, patient satisfaction is decreased, and organizational revenue is compromised.
The second phase is to measure. This is accomplished in our example by looking at data. The data that are gathered include (a) length of time from patient time of arrival to time first being seen by a provider, (b) length of time from writing of patient admission or discharge order to actual time of transfer or leaving, and (c) identified factors that are barriers or challenges (such as readiness of inpatient bed, available staff to care for the patient, etc.). A flowchart or matrix diagram is constructed that identifies all of the parts or variables (Van Leeuwen & Does, 2011).
The third phase is analysis. Data collection continues for a period of time, which may be ex post facto or to sometime in the future. Once it is determined that the amount and quality of the data are adequate, the analysis of the data occurs. The issues addressed in the definition of the problem are those that are considered in the analysis. Evaluation of the data for causality is considered and noted. Statistical applications occur to determine if what seems to be intuitively important is really significant. Once completed, a cause-and-effect diagram or matrix is constructed that clarifies the data in a manner that everyone can appreciate (Van Leeuwen & Does, 2011).
The fourth phase is improve. It is at this point that the various solution options are generated, concerns are addressed, and consensus is reached. Some of the discussion may surround the availability of housekeeping to clean inpatient beds, lack of adequate nursing staff to accept the patient to the inpatient bed, delays in processing the admission orders, and so on. Each of the identified causal concerns would be addressed with a solution that supports the goal of the process, which is to decrease length of stay in the emergency department. The implementation of the improvement plan occurs (Van Leeuwen & Does, 2011).
The last phase is control. The processes that were changed during the improve phase are now monitored. The monitoring is done to ensure that the processes are hardwired into the workflow and to evaluate if additional changes are required. Data collection continues, and as the results come in, there is an expected decrease in the patient length of stay in the emergency department. This change-based data is the deliverable from the LEAN Six Sigma process (Van Leeuwen & Does, 2011).
The follow-through that monitors this change once the LEAN Six Sigma process is completed is generally taken over by the quality department of the organization. This process, sometimes called Kaizen after the original Toyota production process, identifies who and how the change will be monitored. The quality department will (a) define the responsibilities related to the process outcome, (b) develop control mechanisms at the unit level, and (c) ensure that processes are performed in a standard manner (Roussel, 2013).
One way that this is determined is through the control pyramid of Juran (Van Leeuwen & Does, 2011). The pyramid, with its defined areas of interest, will be adjusted to the original problem or issue, and those responsible will be identified. In the emergency department, beginning at the bottom of the pyramid, the processes, policies, and defined actions will be carried out by the staff when specific criteria are met. The frontline leaders will address any minor issues related to the policies and actions. The next section up on the pyramid will be the next level of leader, who will address any chronic or repetitive problems and develop a mechanism of quality control in conjunction with the quality department. The top of the pyramid is senior leadership, who are responsible for the coordination of the process improvement projects (Van Leeuwen & Does, 2011).