The document discusses key concepts related to improving clinical practice, including efficiency, effectiveness, utility, benefit, and health quality. It also discusses techniques from lean manufacturing and Six Sigma that aim to reduce waste and process variation. These concepts can be applied to clinical practice by considering time, only requesting necessary tests, and reducing risks for patients. The document then discusses initiatives like Choosing Wisely and NICE that also aim to improve the diagnostic process.

1. Some Basic Concepts
EFFICIENCY: Cost for each outcome unit
OUTCOME MEASURES: .
EFFECTIVE: Outcomes in an experimental situation
EFFECTIVENESS: Outcome under real conditions
UTILITY:Outcomes expresed considering time and Quality of Life.
BENEFIT: Outcome evaluated in terms of money.
HEALTH QUALITY: How much efectiveness is closer to effective
EVALUATION OF CLINICAL PRACTICE:
SAFETY: reducing the risk
EFICACY
EFECTIVITY
UTILITY
BENEFIT
EFICIENCY
EQUITY
24/11/12 Alberto Ruiz Cantero
Málaga

2. II Workshop Foro Osler.
November 2012
• Conference Dr.Alberto Ruiz Cantero, Head of Internal
Medicine, Hospital de la Serranía, Ronda, Málaga, titled:
General actions heading to Diagnostic Process
Improvement
• SUMMARY: Some general concepts about improving
techniques from the Industry (Lean and Six Sigma) and
more medical initiatives such as “Chossing Wisely” and
NICE

3. lean
manufacturing
• Lean is a production practice that considers the expenditure of resources for
any goal other than the creation of value for the customer to be wasteful,
and thus a target for elimination.
• Value: any action or process that a customer would be willing to pay for.
• Lean basically is everything around to do the proper thing, at the proper
place and moment, with the amount correct, trying to eliminate waste and,at
the same time, being flexible and open to changes.
• Do you find a meaning for that in clinical practice? I,M sure yes: considering
time, asking for the proper test, reducing waste and in Medicine also
reducing risk for the patient.
24/11/12 Alberto Ruiz Cantero
Málaga

4. Six Sigma: concept
• Continuous efforts to achieve stable and
predictable process results (reduce process
variation)
• Process have characteristics that can be
measured, analyzed, improved and controlled.
• Commitment from the entire organization

5. Six Sigma procedures
• Define the problem
• Measure key aspects
• Analyze data
• Improve or optimize the current process
• Control the future state process to ensure
that any deviations from target are
corrected before they result in defects.

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7. American Board of Internal Medicine
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20. Less is more
24/11/12 Alberto Ruiz Cantero
Málaga