Quality and Safety in Healthcare, Part XCIII: Design for Six Sigma and Lean Six Sigma.

ABSTRACT: Design for Six Sigma (DFSS) is used to design new outputs such as manufactured products or to design new processes. The steps in DFSS are define, measure, analyze, design, and verify. Many sophisticated statistical tools are often used. There are advantages and disadvantages of both Lean and Six Sigma, and often a blending of the 2 methodologies are used in the Lean Six Sigma methodology.

Quality and Safety in Healthcare, Part XCIV: Six Sigma and Lean Six Sigma in Health Care.

ABSTRACT: For existing goods or services, Six Sigma uses the steps of DMAIC and the statistical analysis of data to decrease variation and errors, improve the value of an organization's outputs to the customers, and increase the profitability of the organization. In health care, in view of the training required and other issues, Six Sigma is best used for large complex problems, although it has also been applied successfully to smaller issues. Many examples of the use of Six Sigma and Lean Six Sigma in health care are reviewed.

Quality and Safety in Healthcare, Part XCI: Lean Thinking in Healthcare.

ABSTRACT: Lean thinking refers to the thought processes utilizing the main characteristics of Lean to improve processes, reduce waste, and increase value to the customer. Lean thinking can be used to improve health care organizations using such tools as the A3 form, root-cause analysis, value stream maps, Gemba walks, kaizen events, and defining standard work. Examples are given about how Lean thinking improved scheduling and productivity, as well as better compliance regarding core measures and adherence to best practices. Lean thinking examples are also given which resulted in less need for space, inventory, and personnel, and a decrease in hospital-acquired infections.

Quality and Safety in Healthcare, Part LXXXIX: Principles of the Toyota Production System.

ABSTRACT: A major priority of the Toyota Production System is to satisfy the customers by providing high value. The use of continuous flow, pull systems, the Andon system, standard work, visual controls, the 5S system, and reliable technology are critically important. Optimizing one's workforce is also very important by developing leaders and teams, using consensus in decision making, and becoming a learning organization. To fully understand the problems, it is also important that leaders go to the workplace to talk to workers and see what is going on.

Quality and Safety in Healthcare, Part LXXXVII: Comparison of the Framework for Safe, Reliable, and Effective Care With TeamSTEPPS and CUSP.

ABSTRACT: The Framework for Safe, Reliable, and Effective Care (Framework) and the combined TeamSTEPPS and CUSP programs have many similarities to improve safety including the use of teams, excellent communication, safety culture, engaging patients, and leadership. However, the Framework has a focus on the Model for Improvement, and the TeamSTEPPS and CUSP programs emphasize other subjects including handoffs, the membership of teams, coaching, and spreading changes.

Quality and Safety in Healthcare, Part LXXXVIII: Introduction to the Toyota Production System.

ABSTRACT: The Toyota Production System (TPS) revolutionized automotive manufacturing and then spread more widely to other manufacturing and service industries, including healthcare. Many of the concepts in the TPS originated from ideas from the quality and production pioneers in the United States. Japanese experts built on these concepts and added many of their own to fashion them together into a comprehensive system. One of the key concepts in the TPS is to reduce waste without sacrificing quality.

Quality and Safety in Healthcare, Part XC: The A3 Approach and Lean in Healthcare.

ABSTRACT: The A3 form is a structured way of solving problems using a detailed step-by-step methodology using the principles of the Plan-Do-Check-Act cycle. The A3 form supports efforts to organize the thinking of workers about new ways to improve. The form is used as a guide for many project teams to find answers, and then the team arrives at decisions through consensus. Sometimes process mapping, driver diagrams, and gap analysis are included in A3 problem solving. The A3 form is just one of numerous healthcare applications for the Toyota Production System and Lean.

Quality and Safety in Healthcare, Part LXXXV: Introduction to Teamwork in High Reliability Organizations.

ABSTRACT: A high-reliability organization must have high-performing teams. Core teams in healthcare should include the patient and, where possible, the patient's family. Everyone on the team should understand what is expected of them in terms of expertise, leadership, communication, mutual support, and awareness of the situation. One test of the excellence of a clinical team is having high-quality handoffs of patients.

Quality and Safety in Healthcare, Part LXXXVI: Teamwork and the Comprehensive Unit-Based Safety Program.

ABSTRACT: The Comprehensive Unit-Based Safety Program or CUSP is a methodology to enhance teamwork and improve safety by building on the TeamSTEPPS program, the concepts of a safety culture, knowledge of safety science, engaging patients and their families, and standard change management techniques. It can be used with multiple other approaches to help healthcare organizations achieve high reliability.

Quality and Safety in Health Care, Part XCV: Sensemaking.

ABSTRACT: Many times in high reliability organizations, there is uncertainty about the meaning of various happenings or circumstances. Unfortunately, in an emergency, there is often no time to fully investigate events or what is going on in the environment before action must be taken to avoid unfortunate results or disaster. In groups, sensemaking refers to the process of interrelating with others so that a shared understanding may be reached, taking advantage of the differing observations, expertise, and opinions of the people involved, and then taking appropriate action.

Quality and Safety in Healthcare, Part XCII: Introduction to Six Sigma.

ABSTRACT: Six Sigma is a methodology to diminish variation and errors and improve efficiency, quality, value, and profit, using certain defined steps and statistical analysis. For existing products and services, the DMAIC (Define, Measure, Analyze, Improve, and Control) acronym is used to stand for its steps. For new products and services, the Design for Six Sigma methodology is used. The goal of Six Sigma is to reduce the number of defects to no more than 3.4 for every million opportunities.

Quality and Safety in Health Care, Part LXXXII: Introduction to High Reliability Organizations.

ABSTRACT: Reports from the Institute of Medicine regarding the number of errors in medicine leading to fatalities prompted a major review of medical practices and a move to make medical systems high reliability organizations. Many of the concepts used today to improve performance in health care are borrowed from what has been learned from successes and accidents in other industries, especially in the aviation, space, and nuclear power programs. An emphasis on excellent leadership and communication, the knowledge that there needs to be an emphasis on system failures rather than human failures, and having a safety culture that encourages everyone to be mindful of potential errors and report errors are critical to achieve high reliability.

Quality and Safety in Healthcare, Part LXXIV: Combating Disruptive Behavior in Healthcare Workers.

ABSTRACT: Disruptive behavior has major adverse consequences for patient care, morale of the staff, and institutional reputation. Disruptive actions must be confronted as soon as is feasible. Usually, such behavior will not recur following 1 more firm conversations by officials of the healthcare institution, but if necessary disciplinary measures and/or remediation may be necessary. Rarely, because of egregious or repeated offenses, it may be obligatory to suspend the privileges of the individual permanently or until there is further evaluation, such as by a subcommittee of the medical executive committee or perhaps by a fitness-for-duty assessment by an outside organization.

Quality and Safety in Healthcare, Part LXXXIII: The Culture of Safety in High Reliability Organizations.

ABSTRACT: A safety culture encourages the reporting of mistakes so that all can learn from them and remedy underlying system problems. However, errors will only be reported in a culture in which most types of common human errors are not punished because all humans make errors, and usually there are underlying system problems contributing to this. All healthcare errors must be viewed partly as opportunities to improve. A safety culture includes good leadership, communication, learning, collaboration, mindfulness, medicine that is based on evidence and best practice, and care that is centered on the patient.

Quality and Safety in Health Care, Part LXXX: The National Database for Nursing Quality Indicators and the Practice Environment Scale of the Nursing Work Index.

ABSTRACT: The National Database for Nursing Quality Indicators is an important source of information used to benchmark nursing by unit category in multiple areas related to not only structure and process but also outcome. It also provides some information regarding best practices and the cost to achieve certain results. The Practice Environment Scale of the Nursing Work Index is a frequently used way to measure the professional practice environment of nurses and the relationship of the latter to quality, safety, and other outcomes.

Quality and Safety in Healthcare, Part LXXXI: Critical Care Nursing and the Beacon Award for Excellence.

ABSTRACT: When the "Standards for Establishing and Sustaining Healthy Work Environments" set forth by the American Association of Critical-Care Nurses are met in a health care system, there is enhanced safety and quality care for the patient, better job satisfaction, and less turnover by the staff. The American Association of Critical-Care Nurses started the Beacon Award for Excellence not only to recognize those who have such high standards but also to encourage units who already have achieved this distinction or are applying for it to do better.

Quality and Safety in Healthcare, Part LXXIX: Chief Nursing Officer Development, Assessment, and Turnover: An Example for Many Other Healthcare Executives.

ABSTRACT: Most executives new to a health care organization should have introductory and development programs during their first year, which should include networking opportunities, special projects to improve skills, independent or assigned course work, multiple types of assessments, and periodic discussions regarding expectations about their work and their progress in achieving them. It is preferable for the organization and the new executive to have information from outside sources about how a person in that position can achieve success and the reasons for turnover in the position. This is discussed in this article, using the chief nursing officer as the example.

Quality and Safety in Healthcare, Part LXXVII: Major Roles of the Chief Nursing Officer.

ABSTRACT: The chief nursing officer serves in multiple roles, but among the most important are being the chief administrator for the division of nursing, the chief voice in the organization to engage and empower nurses as professionals, and a major leader for increasing patient satisfaction, quality, and safety. Each of these roles has overlapping responsibilities, and failure in any one of could result in failure in all of them. If all of these roles are done well, the value of the care rendered by the healthcare organization will be substantially increased.

Quality and Safety in Healthcare, Part LXXVIII: Expected Competencies of the Chief Nursing Officer and Most Other Healthcare Executives.

ABSTRACT: Numerous expected competencies of a chief nursing officer are outlined in this article including communication, ability to build relationships, expertise about the environment of healthcare and its future directions, leadership, expertise in business matters, combating bullying, encouraging shared decision making, and optimizing interdisciplinary teams and the use of advanced practice providers. These skills are also expected of most other healthcare executives, whether or not they are nurses, because using these competencies increases quality, safety, and value for the patients and improves conditions for the healthcare organization and those who work there.

Quality and Safety in Healthcare, Part LXXVI: The Value of Magnet® Hospital Recognition.

ABSTRACT: Magnet recognition has value that benefits patients; nurses, physicians, and other providers; the healthcare organization; and the community. This includes not only better job satisfaction, more empowerment, and less turnover for nurses, but also better outcomes for patients, more research and evidence-based practice, a superior reputation for the organization, and an easier time recruiting for the organization.