For a healthcare process to achieve Six Sigma, what level of quality is expected
The Center for Disease Control and Prevention defines quality improvement as“…a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality in services or processes which achieve equity and improve the health of the community.” 13
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The U. S. Department of Health and Human Services defines quality improvement as“…systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups.” 15 The Agency for Healthcare Research and Quality defines quality improvement as“…the framework we use to systematically improve the ways care is delivered to patients.” 1 HistoryThe most commonly used QI models - Model for Improvement, Lean, and Six Sigma - were initially developed for use in the manufacturing industry.
ModelsWhen starting a QI project, it is important to use a model to help guide your project and provide feedback on your progress. As previously mentioned, the three most commonly used models are the Model for Improvement, Lean, and Six Sigma. Let’s dive a little bit deeper into each of these models. Model for ImprovementThe Model for Improvement is split into two phases. The first phase involves setting aims, establishing measures, and selecting an intervention. The second phase involves testing the intervention in real world settings using the PDSA cycle. Phase OneDuring phase one, ask yourself three fundamental questions:
Answering these questions will help you set your aims, establish your measures, and select an intervention.
Set AimsWhen setting your aims, use the SMART goal format: specific, measurable, achievable, relevant, and time-bound 6, 8 . SMART goals provide the clarity, focus and motivation needed to achieve your goals. SpecificGoals should be straightforward and state what you want to happen. Be specific and define what you are going to do. Ask: Who needs to be involved? Where is the project going to occur? What actions will you take? MeasurableIf you can't measure it, you can't manage it. Choose goals with measurable progress, and establish concrete criteria for measuring the success of your goal. Ask: What metrics will determine if you meet your goal? AchievableGoals must be within your capacity to reach. If goals are set too far out of your reach, you will not be successful. Accomplishing goals keeps you motivated. Ask: Is the goal doable? Do you have the necessary skills and resources? RelevantGoals should be relevant. Make sure your goal is consistent with your other goals and aligned with the goals of your company, manager, or department. Ask: Why is the project important? Does the project align with other efforts? Time-boundSet a time frame for the goal. Putting an end point on your goal gives you a clear target to work toward. Without a time limit, there's no urgency to start taking action now. Ask: What is the start date? What is the end date? What can be accomplished within that time frame? Source: Goal Setting A good way to make sure your goal is SMART is to use this formula: Verb (Measure) from X to Y by When 8 . For example, your SMART goal could be improve staff hand hygiene compliance on the medical/surgical unit from 80% to 100% within 3 months. Establish MeasuresMeasurement is a critical part of testing and implementing changes. Measures inform the team if the change is effective and leading to improvement. There are four types of QI metrics: structure, process, outcome, and balance.
Your team can choose to look at just one key metric, say handwashing compliance rates, or your team can choose to look at a couple metrics, say handwashing compliance rates and CLABSI rates. Select InterventionBefore you select an intervention, you need to discover the cause of your problem. It is more effective to treat the underlying problem than the symptoms. To put it simply, if you have group A strep with a fever and sore throat, you could either stay at home or, you could visit your provider to find the root cause of your illness. Over-the-counter medications, such as acetaminophen and cough drops, will only treat the symptoms; antibiotics will treat the underlying problem. We need to do the same thing for QI projects. To do so, you will conduct a root cause analysis (RCA). You can perform an RCA using a variety of tools. Some of the more common tools are cause and effect diagrams (also known as the Fishbone diagram or Ishikawa diagram), driver diagrams, Failure Modes and Effects Analysis (FMEA), and Pareto charts. Phase TwoDuring phase two, you will test your intervention using the PDSA cycle. Source: The Improvement Guide PlanBefore you implement your intervention, you need a plan. Start by identifying your stakeholders. A stakeholder is any person or group that has an interest in, or concern about your project 2. This includes management, patients and families, clinical staff, etc. Stakeholders are key to the success of your project. Once you have your list of stakeholders, you need to determine how often to engage in each person. Some stakeholders have the power to hinder or advance your project, while others do not; some stakeholders are interested in your project, while others are not. It may be helpful to map out your stakeholders by level of power and interest 5. Source: The Influence Agenda Next, build your project team. Consider including some of the stakeholders you previously identified as part of your project team. In addition, the Institute for Healthcare Improvement (IHI) recommends every team include members that represent three different kinds of expertise: system leadership, technical expertise, and day-to-day leadership 7.
Once you have your team in place, decide how you are going to implement the intervention. Who is going to do what? When are they going to do it? What resources do you need? Answering these questions will help you organize your plan. DoOnce your plan is in place, set it in motion. Implement your intervention on a small scale. Be sure to collect and document data. StudyAfter implementation, study the results. Look at your data, analyze the results and compare them to your predictions. Displaying your data in a graph or chart may help you visualize patterns not seen using summary statistics alone. Some of the more common graphs and charts are control charts, histograms, run charts, and scatter diagrams. ActFinally, you will act on what you learned. Take a look at your results:
LeanWaste, or Muda in Japanese, is any step or action in which the user does not gain any value 16. Although some waste is unavoidable, the main emphasis of Lean is to minimize waste as much as possible. Lean defines 8 types of waste, or Muda: transportation, inventory, motion, waiting, overproduction, over processing, defects, and skills 16.
There are a dozens of Lean tools to help you identify and eliminate waste in processes and procedures. Some of the more common tools are A3 Report, 5S, Bottleneck Analysis, Value Stream Mappin (VSM), Jidoka, Kaizen, Kanban, and Poka-Yoke. Six SigmaThe Six Sigma model is sometimes referred to as Zero Defects because it aims to eliminate defects and errors in processes and procedures. A six sigma process is one in which 99.99966% of all products are expected to be free of errors 11. Six sigma has 2 major methodologies: define-measure-analyze-design-verify (DMADV) and define-measure-analyze-improve-control (DMAIC). The DMADV methodology is used when creating a new product or service from scratch. It is not used in health care. The DMAIC methodology is used to improve existing processes and procedures. DefineDefine the project goals. Ask: What are you trying to accomplish? Who needs to be involved? What resources and support do you need? MeasureMeasure the performance of the current, unaltered process. Ask: How does the current process perform? AnalyzeAnalyze the process and determine the root causes of defects. Ask: What is the cause of the problem? ImproveAddress the problem. Ask: What changes can you implement to solve the problem? ControlContinue to monitor the process and make regular adjustments as needed. Ask: Did your change result in an improvement? Source: Six Sigma Black Belt Handbook Any of the tools previously discussed can be used not only for the Model for Improvement and Lean, but also with Six Sigma.
Note: Lean and Six Sigma are often used in tandem in healthcare, which is known as Lean Six Sigma or Lean Sigma. Though there are differences between the two models, the underlying philosophies behind Lean and Six Sigma complement each other well. Lean Six Sigma can be used to target both waste and defects in any component of health care delivery. What is a basic responsibility of the quality department in a healthcare organization?Review patient requirements and make sure they are met. Set standards for quality as well as health and safety. Make sure that services meet international and national standards. Look at ways to reduce waste and increase efficiency.
What are the 5 steps of the Six Sigma improvement model quizlet?A six-sigma process: define, measure, analyze, improve, and control.
What is a step common to all performance improvement model?What is a step common to all performance improvement models? Identify customer expectations. What improvement model involves small process changes and careful measurement of the effect of the changes? Rapid cycle improvement.
What tactic is a way to improve the reliability of a healthcare process quizlet?What tactic is a way to improve the reliability of a healthcare process? Create redundancies. When an IT system alerts the physician to a potential incompatibility when a new drug is prescribed for a patient, how is the system helping to prevent mistakes?
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