Organizational Quality Improvement

Various methodologies exist for the integration of quality improvement strategies into performance improvement measures. With concepts of total quality management (TQM) and quality improvement (QI) being introduced to health care organizations; administrators have had to decide which methodology is right for the organization. There are numerous methodologies: Six Sigma, Lean, and Customer Inspired Quality. Each has its own pros and cons. A key component of quality improvement is the technology that gathers and compares the data that the quality improvement measure produces.

All of the information that is gathered from the technology can be benchmarked against other health care organizations. Numerous methods exist for the integration of quality improvement into the health care setting. The Six Sigma model was pioneered by Motorola. This method focuses on reducing variance through a problem solving approach that will improve the quality of the output. The fundamental objective of the Six Sigma methodology is the implementation of a measurement based strategy that focuses on process improvement and the reduction of variance.

The Six Sigma method does through the DMAIC process (define, measure, analyze, improve, and control). The DMAIC process is an improvement system for existing quality processes that fall below specifications and need to be improved in increments. Lean Thinking was used by Toyota as a key in its success. The Lean method strives to reduce waste and to improve performance through workflow. The Lean method is concerned with driving out waste so that all work adds value to the product and serves the customers’ needs.

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Lean thinking identifies all steps in a process and identifies them as value-added or non-value-added steps. All non-value-added steps are then removed to prevent waste in the process. Customer Inspired Quality was patented by Shaw Resources in 1992 and this methodology focuses on work processes that have direct impact on the care and services that are provided in a hospital. This method identifies, defines, analyzes, and improves the quality and effectiveness of processes in the health care arena. This method uses techniques from the other methodologies.

Pros and cons of QI methods. Pros and cons exist in all of the methods for quality improvement. Some of the pros of the Six Sigma method are: Six Sigma places a heavy importance on leadership and its support for the success of the project, Six Sigma integrates the human elements (culture change, customer focus). The Six Sigma method uses the concept of statistical thinking and encourages the application of proven statistical tools and techniques for reducing variability. The cons of Six Sigma methods are having quality data available. In a new process where there is no data available to begin with can be discouraging.

The solutions that Six Sigma proposes are often expensive and only small parts of the solution can be implemented. In Six Sigma methodology the selection of the right project is critical to success. Lean thinking has pros and cons also. Organizations that have adopted Lean double their productivity, cut their production and reduce their inventory that is normally kept on hand. Employees that work in a Lean environment have a clear objective of what is expected of them and are interrupted less. The Customer Inspired quality model deals with the service industries, primarily the Health care industry.

The pros of this model are that the process improvement efforts are prioritized from the customers’ perspective. The methodology is service friendly and all of the hospital staff is encouraged to provide their input. This methods con is that the method is structured primarily for health care organizations. Florida Hospital uses the Six Sigma method for quality improvement because it provides the best opportunity to implement best practices that have been identified. Information Technologies for Quality Improvement Information technology is a large part of the quality improvement methods that a health care organization uses.

Florida Hospital uses Business Objects which is a software company that specializes in business intelligence. Business Objects has components that provide performance management, planning, reporting, query and analysis, and enterprise information management. The Business Objects Enterprise can track report instances that will trigger alerts. These reports are created by Crystal Reports and have parameters that can be modified to perform analysis on the data. The customer can set alerts that trigger when certain conditions are met or not met by the data.

The data can be customized to show in charts. Further customization allows the customer the chance to drill down into the data. Other information can be obtained from technology. Information technology allows data to be displayed in a dashboard or a scorecard. Dashboards are tool that monitor the ongoing performance of a process. A dashboard tracks data in real time. Scorecards report on past performances and generally focus on outcomes rather than processes. All of these applications can be used by administrators to track the quality improvement processes of the organization.

Administrators can design the scorecards or dashboards to display the information that is important. Benchmarks and Milestones Benchmarking is the process of comparing one’s business processes and performance metrics to industry bests or to best practices from other industries. Benchmarking involves management identifying the best in their industry and comparing the results and processes of those studied to their own results and processes. Benchmarking compares the organization to its competitors and defines how the competition performs better.

By better understanding how the competition is meeting their standards, the healthcare organization can then set goals for themselves. Benchmarking can be used to improve patient satisfaction. Using the website hospitalcompare. hhs. gov an organization can see how satisfied their competitors’ patients are. Benchmarking can also be used to improve the core measures that the Joint Commission measures. The outcomes of acute MI, pneumonia, heart failure and surgery can be compared to their own. If the competition is performing better on one of the core measures, the organization can then set their own goal based on the competition.

Potential benchmarks that Florida Hospital will strive for are improved core measures at 90% for pneumonia, Acute MI, heart failure and surgical care. Another benchmark that Florida Hospital will strive for is to improve patient safety. The hospital will continue to implement the processes that support the Joint Commission’s National Patient Safety Goals. The hospital will implement CPOE (computerized provider order entry) and the hospital will begin to extend the goals to the ambulatory services. The third benchmark is to enhance the patient experience.

The hospital will use the DMAIC model to understand and support the emotional, spiritual, and clinical needs of the patients. Florida Hospital will use different methods for their performance improvement plans. The hospital will use combinations of Six Sigma and Lean thinking. The hospital will use data from Crystal reports to display balanced scorecards and dashboards. The dashboards will be divided into the Extending Excellence Elements (Team, Clinical, Service, Market, and Finance). The hospital will use this information in conjunction with information from benchmarking data to monitor their quality improvement plan.

References

Dlugacz, Y. D. (2006). Measuring Health Care Using Data for Operational, Financial, and  Clinical Improvement. San Francisco, CA: Josey-Bass.

Florida Hospital. (2010). Florida Hospital Orlando's Most Preferred Hospital. Retrieved from  http://www.floridahospital.com/default.aspx

Insititute for Healthcare Improvement. (2010). A resource from the Institute for Healthcare Improvement. Retrieved from http://www.ihi.org/ihi Ransom, E. R., Joshi, M. S.,Nash, D. B., ; Ransom, S. (2008). The Healthcare Quality Book

Vision Strategy and Tools (2nd ed.). Chicago, IL: Health Administration Press. U.S. Department of Health ; Human Services. (2010). Hospital Compare. Retrieved from http://www.hospitalcompare.hhs.gov/

United States Department of Veterans Affairs. (2010). Quality Enhancement Research Initiative. Retrieved from http://www.queri.research.va.gov/default.cfm

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