Downloaded 14 times
Uploaded byUniversity of Utah
University of Utah Health Value Improvement Leaders: Methodology
The document discusses various methodologies for process improvement in healthcare, specifically Lean, Six Sigma, and PDSA. It emphasizes eliminating waste and creating value by improving quality and flow, while also detailing how to apply these principles to healthcare value streams. Key concepts include mapping value streams, identifying non-value-added activities, and utilizing data to drive process improvements.
More Related Content
Similar to University of Utah Health Value Improvement Leaders: Methodology
More from University of Utah
University of Utah Health Value Improvement Leaders: Methodology
- 1.
- 2. Methodologies: Lean /Six Sigma / PDSA Create Flow Improve Quality* Eliminate Waste Lean 6s D M A I C PDSA PLAN DO ACT STUDY
- 3. Lean: The ToyotaProduction System Decoded Each of these can be achieved alone or in conjunction with the other two. *poor quality is a form of waste. Create Flow Improve Quality Eliminate Waste “It’s not the big that eat the small. It’s the fast that eats the slow.” – Jennings and Haughton
- 4. • Map yourValue Streams • Identify Value vs. Waste • Value is defined by our patient Lean Value Principles Value = Quality + Service Cost
- 5. Healthcare Quality CostCurve As HC Quality Increases Costs Decrease Cost Quality A B • Spending too much on healthcare doesn’t just waste money. It lowers quality. • GOOD NEWS: When we focus on quality, costs come down. Optimal Value US Healthcare Today Focus on Value
- 6. Value Stream: Everyactivity required to deliver your product or service, from very first to very last. DIRT $$ FIRST CONTACT $$
- 7. Value Stream: Applying Leanto healthcare value streams means making it easier for patients and their information to move between our silos.
- 8. Patients come tous for two reasons: 1. Information about their health 2. Care provision Identify Value & Eliminate Waste Manufacturing Value-Added: An activity which changes the form, fit, or function of the product. Everything else is non-value added (NVA). Healthcare Value-Added: An activity that builds on a patient's information or is directly involved in care provision. Everything else is non-value added (NVA). “Okay, but where is all this waste? I don’t see it.”
- 9. Non Value Added:The 7 Wastes NVA ≠ “UNNECESSARY” A taxonomy for seeing NVA 1.Defects / Mistakes 2.Waiting 3.Over-processing 4.Over-production 5.Transportation 6.Inventory 7.Motion -Taiichi Ohno “Eliminating waste is easy. Seeing waste is hard.”
- 10. How much wasteis in our system?
- 11. Old Adage Lean Adage Create Flow Improve Quality Eliminate wasteBefore Lean: • You can have it fast. • You can have it high quality. • You can have it low cost. Pick 2. Lean says, “Pick 3.”
- 12. • Map yourValue Streams • Identify Value vs. Waste • Value is defined by our patient • Eliminate delays • Create Standard Work • Design Error-Proof Systems • Use pull to avoid over-production • Design Out the Complexity you can… • Use Visual Controls to manage the remaining complexity • Track process performance Lean Principles
- 13.
- 14.
- 15. • Variation isthe Enemy • The answers are in your data • Listen to the Voice of the Process • For consistent output, control your inputs • Listen to the Voice of the Customer • Your problems are in your processes, NOT your people Six Sigma Principles
- 16. Mean Process Improvement withSix Sigma Step 1: Control Step 2: Shift Before TargetLower Spec Upper Spec Target,Lower Spec Upper Spec TargetMeanLower Spec Upper Spec Mean
- 17. Six Sigma followsa methodology called DMAIC (“duh-MAY-ick”). Define • Define the project with a chartering document. • Map the process in low-detail, maybe with SIPOC. • Gather VOC (Voice Of the Customer) data. Measure • Quantitatively describe the current situation. • Identify the appropriate process metrics and establish a baseline. You will compare these against post-implementation metrics. • Map the process in greater detail. Analyze • Determine the root causes with a variety of methods. • Most of your statistical analysis happens here. • Tie the root causes to the problems you are solving. Improve • Design improvements • Model improvements • Pilot improvements • Estimate post-implementation process metrics Control • Design control systems to ensure gains are sustained. • Establish metrics collection systems. • Design elements that reduce the cognitive load while ensuring the new process is followed: visual cues, electronic cues, etc. • Transfer ownership back to original process owner.
- 18. DMAIC is sometimesshown as a cycle, sometimes as a linear project progression. Improve Control Define Measure Analyze Six Sigma Project Plan (aka “best intentions”) Define Measure Analyze Improve Control X weeks What actually happens. Defi Meas Analy Imp Control Define Measure Analysis Re-Define Improve X + 50% weeks
- 19. Plan-Do-Study-Act When a changeis deemed worthy of implementing: • The team turns toward spreading and adapting the change to all appropriate places in the organization. • Continued monitoring. • The scientific method applied to process improvement • What are we trying to improve? • What are the baseline measures? • What are the goals? • Who are the right people to evaluate the improvement? PLAN DO ACT STUDY
- 20. •Orderly •Controlled •Time-consuming •Expensive • Rapidimplementation, multiple iteration • In this sense, you are experimenting, but… • If you shortchange the methodology, you’re NOT engaged in continuous quality improvement; you’re chasing hunches. • Throw things against the wall to see what sticks • Go with your gut • Rely on common sense (a myth) PDSA: Clinical Research Shotgun Approach P D A S
- 21. • Needs tobe tolerance for not getting it perfect on the first try • This is how innovation works • But remember that “change fatigue” is a threat. • This image does not mean constant tinkering. Potential Issues with PDSA PLAN DO ACT STUDY PLAN DO ACT STUDY PLAN DO ACT STUDY PLAN DO ACT STUDY
- 22. Value improvement methodologyat UUHC 1. Project Definition 2. Baseline Analysis 3. Investigation 4. Improvement Design 5. Improvement Implementation 6. Monitoring Lean 6s PDSA
- 23. Project Life Cycles ProjectProgress ResourcesRequired& BusinessDisruption Project Def. Baseline Analysis Investigation Improvement Design Improvement Implementation Monitoring Define Measure Analyze Improve Control 6s PDSA MonitoringPLAN DO STUDY ACT
- 24. • A processof incremental resource allocation. • At the end of every phase progress is reviewed. • A stop/redirect/continue business decision is made. Project Gating: Incremental Project Approval ResourcesRequired& BusinessDisruption Project Def. Baseline Analysis Investigation Improvement Design Improvement Implementation Monitoring
- 25. Bottom Line Benefit EffortandComplexity ProjectSelection: Align with strategic priorities and go for the green.