Lean six sigma for hospitals : simple steps to fast, affordable, and flawless healthcare

"The main purpose is to present simple steps to help hospitals start getting faster, better, and cheaper in five days or less while achieving the goal of fast, affordable, and flawless healthcare. Healthcare has many opportunities for improvement and the use of Lean Six Sigma concepts can make a dramatic impact. This book provides the basic information to do that."-- Doody's Review Service

Lean Six Sigma for Hospitals: Simple Steps to Fast, Affordable, Flawless Healthcare explains how to use tested Lean Six Sigma methods and tools to rapidly improve hospital operations and quality of care and reduce costs. These proven strategies follow the patient from the front door of the hospital or emergency room all the way through discharge, examining key aspects of patient flow and quality. The trail of billing and collections is also followed to discover and eliminate cash flow leaks. This practical guide emphasizes both the clinical and operational sides to reduce the "three demons of quality"--delay, defects, and deviation. Real-world case studies from major hospitals illustrate successful implementations of Lean Six Sigma.

Coverage Includes:

Achieving a faster, better hospital in five days--emergency department, door-to-balloon time, operating room, medical imaging, lab, nursing unit, clinical staff, pharmacy, order accuracy, diagnosis, ICU Lean for accelerated patient flow Reducing medical errors with Six Sigma Creating a more profitable hospital in five days by reducing denied, rejected, and appealed claims Six Sigma for hospitals Excel power tools for Lean Six Sigma Identifying improvement projects through data mining and analysis Sustaining improvement using control charts Laser-focused process innovation Statistical tools for Lean Six Sigma Implementing Lean Six Sigma

Author Notes

Jay Arthur , The KnowWare Man, works with companies that want to fire up their profits using Lean Six Sigma. He is the author of Lean Six Sigma Demystified and the QI Macros SPC software for Excel. The QI Macros is used by over 3,000 hospitals to meet the accreditation needs of the Joint Commission. Jay has worked with Tenet Healthcare, Kindred Healthcare, Centura Healthcare, and Christus Healthcare on projects to improve patient flow and to reduce clinical and operational errors. Besides consulting with healthcare companies, Jay has been researching what works and what doesn't work in healthcare for over a decade. He will backup his writing with examples and case studies from all aspects of healthcare.

Preface	p. xi
Chapter 1 Simple Steps to a Faster Hospital	p. 1
Goal: Accelerate the Patient's Experience of Healthcare	p. 1
A Faster Emergency Department in Five Days	p. 3
Faster Door-to-Balloon (D2B or DTB) Time in Five Days	p. 6
A Faster Operating Room in Five Days	p. 7
Faster Medical Imaging in Five Days	p. 8
A Faster Lab in Five Days	p. 9
A Faster Nursing Unit in Five Days	p. 13
The Problem Isn't Where You Think It Is	p. 13
Take the Domino's Challenge	p. 15
How to Get a Faster Hospital in Five Days	p. 15
Chapter 2 Lean for Accelerated Patient Flow	p. 19
Mind the Gap	p. 20
Value-Stream Mapping	p. 20
If They Can Do It in Botswana	p. 21
The Fast Eat the Slow	p. 23
Core Score	p. 24
Speed Saves Lives	p. 25
You Already Understand Lean	p. 28
The Power Laws of Speed	p. 29
Economies of Speed	p. 30
The Toyota Production System	p. 30
Core Ideas of Lean	p. 30
The Lean Mindset	p. 33
The Seven Speed Bumps of Lean	p. 34
The Five S's	p. 36
Value-Stream Mapping	p. 37
Pull versus Push	p. 38
Redesign for One-Piece Flow	p. 38
Lean Tools	p. 41
Walking Is Waste	p. 45
Lean Principle-Load Leveling	p. 48
Lean Principle-Minimize Inventory	p. 48
Theory of Constraints (TOC)	p. 49
Get the Idea?	p. 52
Chapter 3 Simple Steps to a Better Hospital	p. 53
A Better Emergency Department (ED) in Five Days	p. 54
A Better Clinical Staff in Five Days	p. 54
A Better Operating Room (OR) in Five Days	p. 55
A Better Pharmacy	p. 63
Better Order Accuracy in Five Days	p. 64
Better Medical Imaging in Five Days	p. 68
A Better Lab in Five Days	p. 68
A Better Nursing Unit in Five Days	p. 70
Better Diagnoses	p. 72
A Better Intensive-Care Unit (ICU) in Five Days	p. 72
Misuse of Antibiotics	p. 74
Bar Codes Bust Medication Errors	p. 75
The Problem Isn't Where You Think It Is	p. 75
I Pledge Allegiance to Science and Evidence	p. 77
Simple Steps to a Better Hospital in Five Days	p. 79
Chapter 4 Reducing Defects with Six Sigma	p. 81
Invisible Low-Hanging Fruit	p. 82
Six Sigma's Problem-Solving Process	p. 83
Getting to Lean Six Sigma	p. 84
Key Tools for Defect Reduction	p. 84
Problem-Solving Process	p. 85
The 4-50 Rule	p. 104
Six Sigma Tar Pits	p. 104
Become a Lean Six Sigma Detective	p. 108
Mistakes, Defects, and Errors	p. 111
Measurement Simplicity	p. 113
Accidents Don't Just Happen	p. 115
Analysis Is Easy ... If You Know What to Look For	p. 115
Chapter 5 Simple Steps to a Cheaper (More Profitable) Hospital	p. 117
Faster + Better = Cheaper and More Profitable!	p. 117
Reducing Denied Claims in Five Days	p. 120
Reducing Rejected Claims in Five Days	p. 122
Reducing Appealed Claims in Five Days	p. 127
How to Get a Cheaper (More Profitable) Hospital in Five Days	p. 131
Insights	p. 132
Conclusion	p. 133
Chapter 6 Six Sigma for Hospitals	p. 135
Double Your Profits	p. 135
Manufacturing and Service	p. 137
Tricks of the Trade	p. 138
The Faster, Better, Cheaper Toolkit	p. 140
Every Business Has Two Sources of Cash Row	p. 141
Every Business Process Has Three Big Leaks	p. 142
Every Business Has Two Improvement Focuses	p. 143
The Universal Improvement Method	p. 148
Lean Six Sigma	p. 152
Chapter 7 Excel Power Tools for Lean Six Sigma	p. 155
The QI Macros for Excel	p. 156
The QI Macros Are Easy to Use	p. 156
QI Macros Introduction	p. 157
Power Tools for Lean Six Sigma	p. 168
Analyzing Customer Service Data Hidden in Trouble-Reporting Systems	p. 169
Setting Up Your Data in Excel	p. 172
Data Collection and Measurement for Six Sigma	p. 175
Mistake-Proof Data Collection	p. 178
Troubleshooting Problems	p. 185
Technical Support	p. 186
Chartjunk	p. 186
Get the Idea?	p. 188
Chapter 8 Is There an Improvement Project in My Data?	p. 189
Data Mining with Excel and the QI Macros PivotTable Wizard	p. 189
Word Count	p. 195
PivotTable Wizard	p. 196
Get the Idea?	p. 202
Chapter 9 Sustaining Improvement	p. 205
Process Flowchart	p. 206
Control Charts for Sustaining the Improvement	p. 208
Control Plan	p. 219
Chapter 10 Laser-Focused Process Innovation	p. 221
Focusing the Improvement Effort	p. 221
Critical-to-Quality Indicators (CTQs)	p. 228
SIPOC	p. 228
Balanced Scorecard	p. 230
Quality Management Systems	p. 232
Chapter 11 Statistical Tools for Lean Six Sigma	p. 235
Hypothesis Testing	p. 235
Hypothesis Testing for Variation	p. 236
Hypothesis Testing for Means	p. 239
Analysis of Variance	p. 249
Are Your Data Normal?	p. 251
Tests of Proportion	p. 256
Chi-Square Tests in Excel	p. 257
Determining Sample Sizes	p. 261
Conclusion	p. 267
Chapter 12 Implementing Lean Six Sigma in Hospitals	p. 269
Excuses, Excuses, Excuses	p. 270
Decisive Force	p. 271
Crisis Junkies	p. 273
Minor in Major Things	p. 274
Getting the Right People Involved with Lean Six Sigma	p. 275
The Improvement Mindset	p. 275
Talent versus Process	p. 279
New CEOs Can Kill Lean Six sigma	p. 280
Be a Money Belt	p. 281
Our Reward Systems Are Broken	p. 282
Barriers to Lean Six Sigma	p. 283
Here's My Point	p. 284
Management by Quality (MBQ)	p. 285
Why Do Six Sigma Teams Fail?	p. 288
ôBridezillaö Meets Lean Six Sigma	p. 292
Here's My Point	p. 293
Making Lean Six Sigma Successful	p. 293
What's Wrong with Most Lean Sue Sigma Training?	p. 300
Are You a Lean Six Sigma Salmon?	p. 304
Risk-Free Way to Implement Lean Six Sigma	p. 310
Can Lean Six Sigma Kill Your Hospital?	p. 319
Assets and Liabilities	p. 320
Innovation Rules	p. 323
Religion of Reuse	p. 325
Conflicting Goals	p. 326
Honor Your Progress	p. 328
The Hard Work Is Soft	p. 329
Lean Six Sigma Roles	p. 329
Get a Faster, Better, Cheaper Hospital	p. 330
Bibliography	p. 333
Index	p. 337

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