Think about the problem you identified or one you read about in the previous section.
Throughout this module, you will learn how interventions are planned, implemented, and improved.
There are a number of process improvement methodologies that are used in health care. A few of the most common are described below. Many institutions will primarily use one of these models (e.g., lean) to structure their institution-wide initiatives in order to create a common language and structure for everybody in the health system. Others borrow concepts from each of the below to create a customized version that works for their local health care system.
In this section, we will look at three major improvement methodologies commonly seen in health care: Lean, the Institute for Healthcare Improvement Model, and Six Sigma.
Grown originally from the automobile production industry, Lean is an improvement methodology that focuses on improving quality through the consistent removal of waste from a system1. Recall from module 1 that approximately a third of health care is considered waste – that is, it does not make people healthier. Thus, in health care there is a lot of waste to tackle!
Services that add to expenses without improving health.
Inefficient care due to systems errors and failures of coordination.
Excessive costs of supplies, equipment, and services, which are then passed on to the patient.
Billing for services that were not rendered.
Failing to provide services to a patient that will prevent future medical need.
But even in a low-waste environment, Lean principles remain useful in that they aim to increase efficiency while maximizing value received for effort expended in a process.
There are dozens of books and articles you can read about Lean in a variety of settings, including health care. The Care Redesign Case at the end of this module will focus on how a health system, Virginia Mason Medical Center in Seattle, Washington, implemented Lean to transform their care processes. But before we get there, let’s take a brief fly-by of a few key Lean concepts.
‘Gemba’ is a Japanese term that means, “the actual place.” As a Lean concept, it refers to the place where value is created. It is always important to go to Gemba — to go to the place work is done — so as to understand the process. Oftentimes interventions or project plans are designed sitting around a conference table, but this nearly always lacks the context and insights from the work environment that are critical to actual success.
Read more about going to Gemba in health care here.
“In healthcare…waste is disrespectful to our patients because it asks them to endure a process with no value”
The Institute for Healthcare Improvement (IHI) is a worldwide leader in health care quality training and innovation. The IHI improvement model is a straightforward approach to improvement with the Plan-Do-Study-Act (PDSA) cycle at its heart.1 It focuses on developing a goal and quality measures, and includes three key questions that should be asked throughout iterative cycles of continuous improvement to guide strategy and develop ongoing action plans.
A key to this model is the concept of testing small-scale interventions and changes. The effect of these small changes should be measured and the action plan adjusted based on the results.
Three actions you might take based on the results are sometimes referred to the Three A’s:
We will cover the PDSA cycle in more detail in the following section.
Visit IHI’s Open School for more valuable information
Similar to the PDSA approach, Six Sigma uses the DMAIC (Define, Measure, Analyze, Improve, Control) Methodology as a roadmap for process improvement. This is a very data-driven method that first analyzes current processes and outcomes in order to develop a baseline to understand the current system and measure the impact of the improved process once implemented.
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