The document discusses various management techniques that can be used to improve healthcare delivery and lower costs. These include PDCA (Plan-Do-Check-Act) cycle, Six Sigma, balanced scorecard, Lean methodology, business process reengineering, and benchmarking. Case studies are provided that demonstrate how these techniques were used to reduce prolonged hospital stays, delays in lab and ultrasound reports, and surgical infections.

1. HEALTH CARE IMPROVEMENT BY MANAGEMENT TECHNIQUES

2. Dr. A. K. KHANDELWAL CONSULTANT HOSPITAL MANAGEMENT AND HEALTH CARE SEVICES ASSESOR OF NATIONAL ACCREDITATION BOARD FOR HOSPITAL AND HEALTH SERVICE PROVIDER MEDICAL SUPERINTENDENT PARAMOUNT HOSPITAL SILIGURI

3. Health care has significantly changed in last decade. Health care provider are facing competition,consumerism, TPA and Insurance . Healthcare is no longer the prerogative and dictate of the health care professionals. Hospitals are competeting neck to neck to attract customers. Consumers demand quality care at optimum price.

4. Corporatisation and competition in healthcare sector are forcing healthcare organisations to look for new ways and means for improving their processes. This is for improving quality of the hospital's products and services and reducing patient dissatisfaction . . Several business-management techniques like PDCA , Six Sigma, Balance score card, Lean method, Business process re engineering, Benchmarking are being used to provide quality health care at low cost.

9. The PDCA Cycle This technique provides a framework for the improvement of a process or system. It can be used to guide the entire improvement project, or to develop specific projects once target improvement areas have been identified .

10. SIX SIGMA Six Sigma is a management technique that seeks to drive defects to less than 3.4 defects per million. or 99.9997% perfect. Defects are defined as any non-conformance to customer specifications. Once the causes of defects are identified, processes are modified to avoid the causes. Six Sigma projects normally follow a five-phase improvement

11. BALANCED SCORE CARD The balanced scorecard is a management system that enables organizations to clarify their vision and strategy and translate them into action. It provides feedback around both the internal business processes and external outcomes in order to continuously improve strategic performance and results.

13. LEAN SYSTEM The concept called “lean management” or “lean thinking” is most commonly associated with Japanese manufacturing, particularly the Toyota Production System (TPS). Lean means using less to do more. Health care organizations — are composed of a series of processes, intended to create value for those who use or depend on them (customers/patients). The core idea of lean involves determining the value of any given process by distinguishing valueadded steps from non-value-added steps, and eliminating waste (or muda in Japanese) so that ultimately every step adds value to the process..

14. BUSINESS PROCESS REENGINEERING It is the critical analysis and radical redesign of existing business processes to achieve breakthrough improvements in performance measures.

15. BENCH MARKING Benchmarking is the the process of identifying, understanding, and, wherever possible, adapting the best practices or techniques used by other organizations that may help your own organization to improve its performance .

17. Step 1: Identify The Problem Select the problem to be analyzed. Set a measurable goal for the problem solving effort. Clearly define the problem and establish a precise problem statement. Establish a process for coordinating with and gaining approval of leadership PLAN

18. Step 2: Analyze The Problem Identify the processes that impact the problem and select one List the steps in the process as it currently exists Map the Process Validate the map of the process Identify potential cause of the problem Collect and analyze data related to the problem Verify or revise the original problem statement Identify root causes of the problem Collect additional data if needed to verify root causes

19. Step 3: Develop Solutions Establish criteria for selecting a solution Generate potential solutions that will address the root causes of the problem Select a solution Gain approval and support for the chosen solution Plan the solution DO

20. Step 4: Implement a Solution Implement the chosen solution on a trial or pilot basis. If the Problem Solving Process is being used in conjunction with the Continuous Improvement Process, return to Step 6 of the Continuous Improvement Process If the Problem Solving Process is being used as a standalone, continue to Step 5

21. Step 5: Evaluate The Results Gather data on the solution Analyze the data on the solution Achieved the Desired Goal? What went wrong? What we learned? If YES, go to Step 6. If NO, go back to Step 1. CHECK

22. Step 6: Standardize The Solution. Identify systemic changes and training needs for full implementation Adopt the solution Plan ongoing monitoring of the solution Continue to look for incremental improvements to refine the solution Look for another improvement opportunity This can be the beginning of the ramp of improvement. ACT

32. CHECK Evaluate The Results Result depicts the reduction of the waiting time and reporting time and with increase in the efficiency levels to 98% 35.6 12.9 34.2 After NA 14.8 49.7 Before Reporting Time(minutes Procedure Time(minutes) Waiting Time(minutes) IMPLEMENTATION OF PDCA

33. Problem: Post-operative surgical infection is a major cause of patient injury, mortality and healthcare cost. USE OF PDCA Case studies-4 93% 50% Redose After 240 Minutes 94% 32% Right Antibiotic Administered 88% 14% Antibiotic Given Within 60 Minutes After Before Procedure

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