Winner of a 2013 Shingo Research and Professional Publication Award
This practical guide for healthcare executives, managers, and frontline workers, provides the means to transform your enterprise into a High-Quality Patient Care Business Delivery System. Designed for continuous reference, its self-contained chapters are divided into three primary sections:
This book will help to take you out of your comfort zone and provide you with new ways to extend value to your customers. It drives home the importance of the Lean Six Sigma journey. The pursuit of continuous improvement is a journey with no end. Consequently, the opportunities are endless as to what you and your organization can accomplish.
Forty percent of the authors’ profits from this book will be donated to help the homeless through two Baltimore charities.
Praise for the book:
… well-timed and highly informative for those committed to creating deep levels of sustainable change in healthcare.
— Peter B. Angood, MD, FACS, FCCM, Senior Advisor – Patient Safety, in National Quality Forum
… the most practical and healthcare applicable book I have ever read on LEAN thinking and concepts.
— Gary Shorb, CEO, Methodist Le Bonheur Healthcare
... well written ... an essential reference in the library of all healthcare leaders interested in performance improvement.
— Lee M. Adler, DO, VP, Quality and Safety Innovation & Research, Florida Hospital, Orlando; Associate Professor, University of Central Florida College of Medicine
… a must read for all Leadership involved in healthcare. … I can see reading this book over and over.
— Brigit Zamora, BSN, RN, CPAN, CAPA, Administrative Nurse Manager, Florida Hospital, Orlando
The Four Critical Issues in Healthcare
Occurrence of Errors or Mistakes in the Delivery of Treatment
The Recognition of the Uninsured
Cost of Delivery of Healthcare
Medication (Prescription Drugs)
Directions of Improvement in Healthcare
The Mechanics of Change
Typical Participants in a Healthcare Team
Sample Roles and Responsibilities of Team Members
Implementation of the Team
When to Use D
Measuring Effectiveness of a Team
Relationships between Internal and External Teams
The Transition of Groups to Teams
Internal Development of the Team
Stage 1: Forming
Stage 2: Storming
Stage 3: Norming
Stage 4: Performing
Stage 5: Ending
Logistical Issues of Teams
To Meet or Not to Meet
Creating an Agenda
Establishing Meeting Roles and Ground Rules
The Meeting Leader
Starting a Meeting
Establishing Team Strategies and Objectives
Involving all Team Members and Building Team Consensus
Applying Active Listening Skills
Leading a Brainstorming Session
Handling Difficult Situations
Keeping the Meeting on Track
The Effects of Change in Healthcare
What Are We Trying to Accomplish?
How Do We Know Whether the Change Is Indeed an Improvement?
What Are the Changes That Will Result in Expected Improvement?
The Customer Service Attributes
Approach for Healthcare Service Quality Improvement
Develop Feedback Systems for Customer Service Quality
The Six Ps and S Model
Considerations in Defining the Customer (Patient) for Healthcare
Developing a Patient Satisfaction Instrument
Preliminary Steps to an Effective Survey
Healthcare Concerns about Customer Satisfaction (CSat)
Understanding the Process
Failure Mode and Effect Analysis (FMEA)
Poka-yoke (Mistake Proofing/Error Proofing)
Advance Practice Quality Planning (APQP)
The Process of Project Management
Key Integrative Processes
Project Management and Quality
A Generic Seven-Step Approach to Project Management
Phase 1. Define the Project
Phase 2. Plan the Project
Phase 3. Implement the Plan
Phase 4. Track Progress and Complete the Project
Value Process Mapping
Using Six Sigma Methodology for Improvement
Design for Six Sigma
Synthesis of Lean Thinking and Six Sigma
Lean Six Sigma Healthcare
Using Lean Methodology for Improvement
Lean Enterprise versus Lean Organization
Applying the Hoshin Method
Lean Is Not a Toolbox It Is a Way of Thinking about Work
Tools Used in Lean
Value Stream Mapping
Construction of a VSM
The Seven VSM Tools
Quick Changeover—SMED Setup Reduction
Theory of Constraints
Some Additional Items Concerning Lean
Push versus Pull
A Final Note for the Lean Discussion
Level I (System or Hospital)
Level II (Departments)
Level III (Operational Issues)
Understanding the Process
Step 1: Select a Registry
Step 2: Identify a Template
Step 3: Protocols (Standardize the System of Care)
Step 4: Self-Management Support (Using Diabetes as a Model)
Patient-Centered Medical Home (PCMH)
Lean Strategy for Primary Care
Facilitate the Project Using Leadership Skills
"Lean" the Practice
Using Lean Six Sigma
Special Note on Measurement
Note 1: Understanding the Customer and the Process
Note 2: Chronic Model
Note 3: Medical Home
Primary Care Example
Concerns and Comments
Immediate Applications for Computer Technology (IT) in Healthcare
Billing and Administration
Health IT Focused on Improving Patient Care
Population (Proactive) Care
Whole-Patient (Planned) Care
Use of Models, Including Models of the Desired Care System and Models of Improvement
Focus on a Practical, Patient-Oriented View of Functionality
and What It Should Be Able to Accomplish
Use of Learning Strategies to Accelerate Progress in Testing and Applying Change Ideas
Specific Change Ideas
Implications for Spread
Data Structures to Support Improvement
Dense Display of Data
Transferability of Data
Optimal Design of Alerts and Reminders
Designs That Are Patient-Centric (Patient-Controlled)
Personal Health Records (PHRs), Communications,
Home as Hub
The Link between Quality Function Needs and Overall
The Link between Strategic Plan and Quality Plan
The Theory of Variation (Common and Special Causes)
The Quality Function Mission Is Very Important in Strategic Planning
Metrics and Goals that Drive Organizational Performance
Resource Requirements to Manage the Quality Function
How Is Robustness Incorporated into Six Sigma and Lean Methodologies?
What Is the Significance of the Project?
What Is the Cost of Poor Quality?
What Is Customer and CTQ Identification?
What Is the Significance of a Data Collection Plan?
Measurement for Projects
What Are Some of the Common Formulas Used in Six Sigma?
Specific Project Expectations of the DMAIC Model for Each Phase
Understanding and Utilizing ISO Standards
Third Accreditation Option for Hospitals: National Integrated
Accreditation for Healthcare Organizations (NIAHO)
The Certification Process
Understanding and Utilizing the Malcolm Baldrige National Quality Program
Each chapter begins with an Introduction and concludes with a Summary, References, & Selected Bibliography
I never knew that four letters – L E A N – could be so powerful! Of particular interest to me were the productive principles and techniques of selected Lean applications in a healthcare setting. I’ll never walk onto a hospital floor again without assessing for waste! Thank you for a thought provoking read that has caused me to assess my effectiveness in the healthcare environment.
—Mary Jo Kirkpatrick, MSN, RN, Chairman of the Quality Committee of the Board of Directors, Methodist/LeBonheur Healthcare System
Lean methodologies, as profiled so succinctly in Protzman’s book, offer an avenue towards improved patient safety and marked increases in efficiency for healthcare. The science and technology of healthcare, along with recent legislative and payment reforms, continue forcing the industry through a period of profound and unsettling change. This instructive book is well-timed and highly informative for those committed to creating deep levels of sustainable change in healthcare.
—Peter B. Angood, MD, FACS, FCCM, Senior Advisor – Patient Safety, National Quality Forum (NQF)
Having derived tremendous value through the application of PDSA/PDCA rapid cycle process improvement methods over the past decade to support discrete improvement initiatives, I now look forward to using Leveraging Lean in Healthcare as an essential reference as we pursue larger scale efforts to reduce waste and improve clinical effectiveness and safety across our organization.
—David J. Ballard, MD, PhD, FACP, Chief Quality Officer, Baylor Health Care System; Recipient of the 2007 Leapfrog Patient-Centered Care Award; 2008 National Quality Healthcare Award of the National Quality Form; 2010 Preeminence Award of the American Medical Group Association
In today’s healthcare environment we must work to improve outcomes and reduce cost. It is a matter of survival. Leveraging Lean in Healthcare: Transforming Your Enterprise into a High Quality Patient Care Delivery System is the most practical and healthcare applicable book I have ever read on LEAN thinking and concepts. A must read for CEOs, managers and supervisors as it has all the tools needed to get the results we must achieve.
—Gary Shorb, CEO, Methodist Le Bonheur Healthcare
The insights provided in this book will be invaluable to anyone trying to get a clearer understanding of what that Lean journey entails. To those wondering what Lean can do for them, Charlie and his colleagues provide case studies gleaned from many years of experience to illustrate Lean at work in the real world. We believe Charlie has succeeded in his goal to have this book play a role in the "quest to provide high quality, affordable healthcare to everyone in the years to come.
—Rick Malik, Worldwide Director, ValuMetrix® Services
From the C-Suite to the frontline supervisor who desire to decrease waste, focus on patient-centered care and improve quality Leveraging Lean in Healthcare is a fundamental read. The authors’ skillfully point out that successful outcomes depend on organizational will and an integrated, systematic approach using Lean methodology. In this book, Lean manufacturing principles were aptly translated into useful healthcare examples and tools based upon the authors’ extensive clinical experiences. I can recommend this well written book as an essential reference in the library of all healthcare leaders interested in performance improvement.
—Lee M. Adler, DO, Vice President, Quality and Safety Innovation & Research Florida Hospital Associate Professor of Internal Medicine University of Central Florida College of Medicine
... a must read for all Leadership involved in healthcare. ... I can see reading this book over and over.
—Brigit Zamora, BSN, RN, CPAN, CAPA; Administrative Nurse Manager Surigical RIO, Peds RIO, PTEC, Florida Hospital, Orlando