health care improvement by management tools
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Dr. A. K. KHANDELWAL
CONSULTANT HOSPITAL MANAGEMENTAND HEALTH CARE SEVICES
ASSESOR OF NATIONAL ACCREDITATION BOARD FOR HOSPITAL AND HEALTH SERVICE PROVIDER
MEDICAL SUPERINTENDENTPARAMOUNT HOSPITALSILIGURI
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.
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.
Increased Customer/Patient Satisfaction And Care
Higher satisfaction. Fewer complaints. Improved billing. Increased prescription accuracy. Reduced waiting time. Safer and more efficient emergency services. Fewer medical errors and defects. Increased service orientation. Eliminate the 'I don't know' factor.
Increased Physician Satisfaction
Reduced scheduling delays.
Fewer physician complaints.
Improved working condition of clinician and staff .
Reduced Cost & Savings
Better financial and higher annual savings.
Optimised materials management chain.
Less rework and waste.
Better recruiting and retention power. Stronger growth.
The PDCA Cycle
Six Sigma
Balance score card
Lean method
Business process re engineering/redesigning
Bench marking
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.
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
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.
LEAN SYSTEMThe 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..
BUSINESS PROCESS REENGINEERINGIt is the critical analysis and radical redesign of existing business processes to achieve breakthrough improvements in performance measures.
BENCH MARKINGBenchmarking 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.
Step 1: Identify The ProblemSelect 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
Step 2: Analyze The ProblemIdentify the processes that impact the problem and select oneList the steps in the process as it currently existsMap the ProcessValidate the map of the processIdentify potential cause of the problemCollect and analyze data related to the problemVerify or revise the original problem statementIdentify root causes of the problem Collect additional data if needed to verify root causes
Step 3: Develop Solutions
Establish criteria for selecting a solutionGenerate potential solutions that will address the root causes of the problemSelect a solutionGain approval and support for the chosen solution Plan the solution
Step 4: Implement a SolutionImplement 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
Step 5: Evaluate The ResultsGather data on the solutionAnalyze the data on the solutionAchieved the Desired Goal?
What went wrong? What we learned?
If YES, go to Step 6. If NO, go back to Step 1.
Step 6: Standardize The Solution.Identify systemic changes and training needs for full implementationAdopt the solutionPlan ongoing monitoring of the solutionContinue to look for incremental improvements to refine the solutionLook for another improvement opportunityThis can be the beginning of the ramp of improvement.
Case studies
1.PROLONGED POST OPERATIVE STAY
PLAN:
IDENTIFY THE PROBLEM
Comparison of the hospital's length-of-stay data to "best practice" hospitals revealed that 53 percent of the hospital's patients were discharged on or after the seventh post-op day compared to 18 percent for benchmark hospitals
ANALSE THE PROBLEM
ANALYSIS revealed that patients with atrial fibrillation stayed more than two days longer than those without . 6.9 days with atrial fibrillation, 4.6 days without.
That those who did not ambulate also had a two-day difference in length of stay – 6.8 days with no consistent ambulation, 4.8 days with consistent ambulation.
DO:
DEVELOP THE SOLUTION
A standard operating procedure related to ambulation of patients was developed and accountability clearly identified.
A protocol for treating atrial fibrillation was developed .
IMPLEMENT THE SOLUTION
Protocols were implemented on pilot basis.
Evaluate The ResultsGather data on the solutionAnalyze the data on the solution
Achieved the Desired Goal. The protocol was very effective at reducing post operative stay from 53 to 22 percent at more than 6 days.
WENT to Step 6.
ACT :
Standardize The Solution
The team will continue to monitor performance indicators on post-op length of stay, adherence to the atrial fibrillation protocol and ambulation to make sure that procedures are followed and improvements are sustained.
Case studies-2
DELAY IN REPORTING OF LAB REPORT
PLAN:
Identify The Problem
In 200 hundred beded hospital, providing both acute care and emergency services,Physician were complaining that reports from lab are not available in morning round
Analyze The Problem
The two biggest drags on the process were the actual delivery of the test ubes to the lab and their analysis.
The phlebotomist would collect10 to 15 patient samples and return to the lab with a basketof tubes all at once.
DO:Develop Solutions
simple solution: Designate a “runner” tobring test tubes from the floor to the lab every 15 minutes .
Implement a Solution
Implement the chosen solution on a trial or pilot basis.
CHECKEvaluate The Results
Sampleof 920 blood results delivered before the redesign, 68% reached theappropriate doctors by required time. Sample of 1,020 results using thenew process, the percentage delivered by the required time increased to 98%.
ACTStandardize The Solution.
Plan ongoing monitoring of the solution.Continue to look for incremental improvements to refine the solution.
CASE STUDIES:3
PLAN
IDENTIFY PROBLEM:
Delay in reporting of USG Report.
ANALYSE THE PROBLEM:
•Bladder not full. •Patient not informed of the prior preparation. •Number of people waiting are more. • Doctors not available •No proper scheduling of In Patient and Out Patient •No allocation of work load
DO:
DEVELOP SOLUTION:Developing a leaflet which would explain the prerequisite of the procedure.
Scheduling all the In Patient cases requiring fasting in the morning before 9.30 am and the other In Patient cases along with Out Patient cases in the afternoon to avoid waiting time.
Scheduling the doctors to ensure at least two doctors are made available at any point of time.
Reorganizing of the reporting procedure to make available the reports within 45 minutes of completion of the procedure.
IMPLEMENT THE SOLUTION
CHECKEvaluate The Results
Result depicts the reduction of the waiting time and reporting time and with increase in the efficiency levels to 98%
IMPLEMENTATION
OF PDCA
Waiting
Time(minutes)
Procedure Time(minutes)
Reporting
Time(minutes
Before 49.7 14.8 NA
After 34.2 12.9 35.6
Problem: Post-operative surgical infection is a major cause of patient injury, mortality and healthcare cost.
USE OF PDCA
Procedure Before AfterAntibiotic Given Within 60 Minutes
14% 88%
Right Antibiotic Administered
32% 94%
Redose After 240
Minutes 50% 93%
Case studies-4
