DDHA 8450 Week 3 Process Improvement & Productivity Enhancement
DDHA 8450 Week 3 Process Improvement & Productivity Enhancement
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You must use the references provided 3-4
APA 7TH EDITION-Only experience with PHD level writing.
Must be able to attach plagiarism report and must use Grammarly checker. No passive voice writing.
The Assignment (3–5 pages):
- Complete the case questions presented.
- Create a fish bone diagram and a flow diagram that represent an analysis of the processes for improvement and implementation approaches to support your answers to the case questions.
- Be sure to support your answers with support from the literature.
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Week 3 Case Questions
Applying Methods of Process Improvement to Improve Productivity
Chapter 8, Case 2: “Noninvasive Cardiovascular Laboratory”
Questions:
- Is Findley overworked? Why or why not? Should another technician be hired?
- Assume that there is no budget to add a new technician. How should the current NCVL process be changed to improve quality and productivity? DDHA 8450 Week 3 Process Improvement & Productivity Enhancement
- Draw a cause-and-effect (fishbone) diagram of the reasons Findley’s work is inefficient.
- Draw a flow diagram showing the steps in the process(es) for Findley’s work.
Assignment: Applying Methods of Process Improvement to Improve Productivity
Consider the following scenario:
Terry is a senior histology lab technician at a large urban hospital. He is responsible for overseeing a team of six junior technicians to process samples for testing. Recently, the hospital has introduced a new process whereby the senior histology lab technician must visually accept and approve the findings of the junior technicians in order for samples to be cleared and entered into the electronic health record for disease diagnosis. Terry has been able to meet this new need for the past few months. However, as more cases are entering the histology lab, cases have started to become backlogged. Additionally, the histology lab hours are restricted to business hours; this has severely impacted the processing of histology samples. Terry is worried that the approval process is not efficient and that perhaps a second senior histology lab technician should be hired to meet around-the-clock demand.
As a current or future health care administrator, how might you address the productivity lag in the histology lab in the scenario?
For this Assignment, review Case 2, “Noninvasive Cardiovascular Laboratory” in Chapter 8 of the text, Managing Health Services Organizations and Systems. Reflect on how you, as a current or future health care administrator, might be required to identify opportunities to improve productivity in an HSO. What types of information might you need to gather? How might you identify whether a process improvement opportunity exists? Then, review the Week 3 Case Questions document in this week’s Learning Resources to complete the Assignment.
The Assignment (3–5 pages): DDHA 8450 Week 3 Process Improvement & Productivity Enhancement
- Complete the case questions presented.
- Create a fish bone diagram and a flow diagram that represent an analysis of the processes for improvement and implementation approaches to support your answers to the case questions.
- Be sure to support your answers with support from the literature.
Resources
Longest, B. B., Jr., & Darr, K. J. (2014). Managing health services organizations and systems (6th ed.). Baltimore, MD: Health Professions Press.
- Chapter 8, “The Quality Imperative: Implementation” (pp. 367–420)
Required Media
Week 3 Case Questions – DDHA 8450 Week 3 Process Improvement & Productivity Enhancement
Applying Methods of Process Improvement to Improve Productivity Chapter 8, Case 2: “Noninvasive Cardiovascular Laboratory” Questions: 1. Is Findley overworked? Why or why not? Should another technician be hired? 2. Assume that there is no budget to add a new technician. How should the current NCVL process be changed to improve quality and productivity? 3. Draw a cause-and-effect (fishbone) diagram of the reasons Findley’s work is inefficient. 4. Draw a flow diagram showing the steps in the process(es) for Findley’s work. © 2016 Laureate Education, Inc. Page 1 of 1
DDHA 8450-Week 3 Assignment Assignment: Applying Methods of Process Improvement to Improve Productivity
Consider the following scenario: Terry is a senior histology lab technician at a large urban hospital. He is responsible for overseeing a team of six junior technicians to process samples for testing. Recently, the hospital has introduced a new process whereby the senior histology lab technician must visually accept and approve the findings of the junior technicians in order for samples to be cleared and entered into the electronic health record for disease diagnosis. Terry has been able to meet this new need for the past few months. However, as more cases are entering the histology lab, cases have started to become backlogged. Additionally, the histology lab hours are restricted to business hours; this has severely impacted the processing of histology samples. Terry is worried that the approval process is not efficient and that perhaps a second senior histology lab technician should be hired to meet around-the-clock demand. As a current or future health care administrator, how might you address the productivity lag in the histology lab in the scenario?
For this Assignment, review Case 2, “Noninvasive Cardiovascular Laboratory” in Chapter 8 of the text, Managing Health Services Organizations and Systems. Reflect on how you, as a current or future health care administrator, might be required to identify opportunities to improve productivity in an HSO. What types of information might you need to gather? How might you identify whether a process improvement opportunity exists? Then, review the Week 3 Case Questions document in this week’s Learning Resources to complete the Assignment. The Assignment (3–5 pages): • Complete the case questions presented. • Create a fish bone diagram and a flow diagram that represent an analysis of the processes for improvement and implementation approaches to support your answers to the case questions. • Be sure to support your answers with support from the literature. DDHA 8450-Week 3 Assignment Resources Longest, B. B., Jr., & Darr, K. J. (2014). Managing health services organizations and systems (6th ed.). Baltimore, MD: Health Professions Press. • Chapter 8, “The Quality Imperative: Implementation” (pp. 367–420) D’Andreamatteo, A., Ianni, L., Lega, F., & Sargiacomo, M. (2015). Lean in healthcare: A comprehensive review. Health Policy. Damschroder, L.J., Aron, D.C., Keith, R.E., Kirsh, S.R., Alexander, J.A., & Lowery, J.C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science 4, 1-15. DDHA 8450 Week 3 Process Improvement & Productivity Enhancement
McAlearney, A.S., Robbins, J., Garman, A.N., & Song, P.H. (2013). Implementing highperformance work practices in healthcare organizations: Qualitative and conceptual evidence. Journal of Healthcare Management, 58(6), 446-462. Robbins, J., Garman, A. N., Song, P. H., & McAlearney, A. S. (2012). How high-performance work systems drive health care value: An examination of leading process improvement strategies. Quality Management in Healthcare, 21(3), 188-202. Required Media Institute for Healthcare Improvement (Producer). (2015a). Cause & effect diagrams [Video file]. Retrieved from http://www.ihi.org/education/IHIOpenSchool/resources/Pages/AudioandVideo/Whitebo ard16.aspx Institute for Healthcare Improvement (Producer). (2015b). Flowcharts (Part 1) [Video file]. Retrieved from http://www.ihi.org/education/IHIOpenSchool/resources/Pages/AudioandVideo/Whitebo ard11.aspx Reengineering Reengineering
Program Transcript
[MUSIC PLAYING] NARRATOR: Hospitals, nursing homes, and other health care entities often need to restructure their operations for greater efficiency or effectiveness. RONALD MCDADE: It’s a concerted look at the entire department and saying, how can we do this radically better? NARRATOR: Ronald McDade, Neil MacDonald, and Jan Bahner discuss the process of reengineering and explain how it can revitalize a health care organization.
[MUSIC PLAYING] RONALD
MCDADE: Reengineering is when an organization takes a wholesale look at how it does business, either organization-wide or in a particular department, and really goes in and makes radical, quantum change in how that department operates. It’s a concerted look at the entire department, its organizational structure, its staffing levels, its supply utilization, its skill mixes, the entire thing and saying, how can we do this radically better? There are three ways to identify whether an organization or a department really needs to be reengineered. The first of those, of course, is benchmarking, looking at external organizations, looking at how well other organizations provide their service, how inexpensively they provide the service and saying, hey, if that organization can do that, why can’t I? And we can do the same thing just internally looking at within our nine hospitals, who has the more effective, efficient radiology department, for instance? The second one is as you look at the metrics of how your department operates, are your metrics declining?
Are your quality and service levels going down? Are your costs going up per unit of service? And the third one, of course, is when the customers come to you and tell you, you’re not providing me the quality of service I need, or you’re costing me too much money to undertake your service. There are a couple tools that are standard to almost any engagement we undertake within MedStar Health. The first of them is flow charting, value stream analysis, whatever type of flow charting you want to do. But we need to display graphically what’s really going on in the department. Who hands off the process to whom, when, and how? What decisions need to be made? Who makes those decisions? And from our experience, that’s best communicated in a flow chart. © 2016 Laureate Education, Inc. 1 Reengineering The other tool that has almost universal applicability are control charts and run charts, where we’re taking the key metrics from the department and monitoring them over time and looking for variation and looking for improvement or declining performance and to let us know how we’re really doing. The flow chart gives us our baseline for starting the improvement process. And later on, it tells us what we’re doing to that process. Are we really making it better? Or have we gotten in the way of good operations, and we’re seeing declining performance? This type of flow chart is called a swim lane diagram. It takes the flow, and it arranges it in stripes. Each stripe represents someone, a person or an entity, involved in the process. And as that flow chart flows between those swim lanes, each time it switches somebody’s handing off to someone else.
And any time you’re handing off a piece of work to someone else, there’s always a heightened opportunity for error. And when you’re trying to error-proof the health care system, those hand-offs are very important. You want to minimize the number of those. Any good process improvement initiative starts with preplanning. We’ve got to figure out what the project is, how we’re going to go about doing it, what data we’re going to need, who we need to have involved. So it starts with preplanning. The second step in there is to bring that group, that multi-disciplinary group, together and go through what we call the as-is process– what happens today? That’s where flow charting and our swim lane diagrams and our value stream mapping really come into play. Getting it on one piece of paper and reaching agreement on how it works is a very important step to bringing people together around what’s broken.
The third step in the process we use is benchmarking. We look anywhere we can for a better way to do business. We don’t just take it and just try to clone it into our businesses. We take the idea, the concept, and then try to meld it into our culture, our values, our physical plant, our processes. Armed with how it happens today and what other people are doing, we then go and develop what we call a to-be process– what we really want that future state to look like. And here’s where the value stream mapping and flow charting come back again. Bringing the group together and saying, block by block, decision by decision, how we want our world to be in the future is critical. Once we all agree about the ideal world, then we look at the gap between what we want it to be and what it is today. And we come up with our recommendations for improvement. Once we have those recommendations and they’re approved, © 2016 Laureate Education, Inc. 2 Reengineering then we undertake a very detailed implementation planning process. We implement it, and we monitor the success of that implementation. DDHA 8450 Week 3 Process Improvement & Productivity Enhancement
[MUSIC PLAYING]
NEIL MACDONALD: Lean and Six Sigma obviously are concepts or techniques that have been used in industry for years, something relatively new to the health care profession. Our lab was really not functioning as efficiently and as effectively as we felt it could. There was certainly opportunity for improvement. So we utilized the resources of an outside consultant. They provided three people for us. We partnered them with three of our own employees from day, evening, and night shift. And they conducted a thorough Lean analysis over a period of weeks within the hospital.
THOMAS KOCH: When we reengineered the laboratory at Union Memorial, which consisted of integrating all of the core functions into one space, one of the goals is to provide the staff with tools so that they can measure their performance continuously throughout the day. One of the key measures of performance in this laboratory is turnaround time, how quickly we get results back to the doctor. And this monitor tells the staff at all times how their turnaround time is performing against the goal. Each one of these lines represents a different patient sample that’s in the lab. And if the color is green, it means that the turnaround time is within goal. If that were yellow, it would mean that they’re getting close to the end of their allowable time to perform the test. And if it’s red, they failed to turn the specimen around in the appropriate time. So this is a nice little management tool for the staff to be able to tell at any one time how they’re performing with the specimens that they have in the lab. Prior to reengineering, we had a chemistry department, a hematology department, a coagulation department, each of those with their own little staff isolated from the others. When we reengineered, we made all of those people-trained all of those people to perform all of the functions in those areas so that they can continuously move throughout their work cell and service the patients better and much more effectively.
NEIL MACDONALD: What we found was we were, in fact, able to do the work more efficiently with fewer employees. At the end of the exercise, we were actually able to perform the same amount of work with four fewer employees. And we’re able to accomplish that not by laying people off, but through attrition and then relocating people to other areas of the hospital where we were short resources. © 2016 Laureate Education, Inc. 3 Reengineering One of the goals of the Lean Six Sigma initiative down in the laboratory was to improve our discharge times of patients on the back end by having results available sooner in the morning for our physicians. We now have documentation that shows that for the most part, 98%, 99% of our results are ready by 8:00 AM every morning. There are some late draws that take place a little bit later. But for the most part, we were able to get those draws done before 7 o’clock in the morning, process the specimens through the equipment, have printed results to the floors or on our computer system by 8 o’clock in the morning. So when those physicians round, the results are right there. They can look at them, and it allows them to make a better decision whether their patient is able to be discharged that day or not. So certainly there were benefits directly within the laboratory department. But down the road, the benefit was earlier discharge times for our patients from the hospital. DDHA 8450 Week 3 Process Improvement & Productivity Enhancement
JAN BAHNER: The challenges for system-wide performance improvement start in the culture of the organization. Any time you’re going to make a change that impacts that culture, you’re going to get some resistance to that. The first thing people think of when you go to reengineer or redesign a process is, what’s going to happen to me? What about me in this? If you make us more efficient, am I still going to have a job? And so taking care of people’s fears, as they were, when you embark on these kinds of system-wide projects is incredibly important, especially if you have a more decentralized organization where decision-making is at each business level. I think there is one thing that’s unique in health care performance improvement. The decisions we make, the processes we create, the systems we design ultimately all have an impact on human life. I think if you organize all your performance improvement activities with one common aim, that you do them to improve patient care, and then back staff into how their project links to that, then, in fact, it’s a motivator for people to be doing performance improvement in health care.
[MUSIC PLAYING] © 2016 Laureate Education, Inc. 4