Choose a process improvement model from Chapter 5 in the Spath textbook, and apply this model to your practice problem.
Post a Discussion entry describing the model that you selected and how each step of the model will be used to develop the plan for the Practice Experience Project. Continue to collaborate with the selected individuals in your practice environment as needed in the development of the Practice Experience Project, and share this information with your group.
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Practicum: Applying Process Improvement Models
Choose a process improvement model from Chapter 5 in the Spath textbook, and apply this model to your practice problem.
By Day 4
Post a Discussion entry describing the model that you selected and how each step of the model will be used to develop the plan for the Practicum Project. Continue to collaborate with the selected individuals in your practice environment as needed in the development of the Practicum Project, and share this information with your group.
By Day 7
Read and respond to two or more of your colleagues’ postings from the Discussion question. Provide feedback on the selected model, and offer other models if appropriate for their project. As a member of a community of practice, help each other refine and clarify the patient-centered Practicum Project.
The process improvement model chosen is the plan-do-study-act (PDSA) cycle. The PDSA cycle is the most widely recognized process improvement model (Spath, 2013). The design of the model is to ensure continuous improvement, as the steps cycle and repeat (Spath, 2013). I feel that this model is best for fall prevention in long-term care because there are always constant changes and using a model like the PDSA will help to incorporate and address the changes as they come.
Plan- Patient falls will be reduced as a result of implementing a fall prevention plan in the facility. A fall prevention committee will be formed consisting of stakeholders who represent the broad range of organizational members. Providing the weekly fall information discussed in the risk meetings to all facility employees and families to keep them informed. Ensuring that fall risk assessments scores are provided to frontline staff and that they are educated on patient-centered fall prevention measures. Lastly, implementing interdisciplinary hourly rounding throughout the facility.
Do- Form the fall prevention committee that will consist of staff nurses, certified nursing assistants (CNA), physical therapists, occupational therapist, physicians, nurse practitioners, dieticians, environmental services managers, pharmacist, and risk managers. Weekly risk meetings will continue in the facility, but members of the fall prevention committee will also be present.
A fall report will be provided to all facility staff weekly, families of affected residents will be provided the outcome that week as well, and monthly reports provided to department heads to disperse to their staff. Fall risk scores will be made available to frontline nursing staff by placing it in the resident’s medication administration record and the care tracker for certified nursing assistants.
Lastly, create and enforce hourly rounding protocols that are facility-wide and conducted by all staff to help address resident’s needs to help prevent falls.
Study- Analyze the fall rates from the facility incident reports to determine if the changes made have been effective in reducing falls. Collect information from the fall prevention committee, facility staff, including frontline nurses and CNAs, families, and residents to determine if the changes have been effective in preventing falls. Also get feedback on the hourly rounding to help determine what was found as resident’s needs that could have led to falls. Summarize the lessons learned after implementing the fall prevention plan in the facility.
Act- Evaluate if the fall prevention plan in the facility was successful, if not make changes where appropriate. If the changes were successful, fine-tune them to make the changes even better.
Reference
Spath, P. (2013). Continuous improvement. In Introduction to healthcare quality
management (2nd ed.). (pp. 117-119). Chicago, IL: Health Administration Press.
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t for sale.
Introduction to Healthcare
Quality Management
Continuous Improvement
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College of Healthcare Executives. Not for sale.
Continuous
Improvement
• Analyzing performance of various processes and
improving them repeatedly to achieve quality
objectives
– Some performance problems can be resolved quickly,
but in other situations an in-depth evaluation may be
required.
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The Improvement Step
• Find and fix the cause of
unfavorable performance.
• Two factors influence the
decision to initiate improvement:
– Results of performance assessment
– Improvement priorities
Measurement
How are we
doing?
Assessment
Are we meeting
expectations?
Improvement
How can we improve
performance?
Yes
No
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Common Steps of Performance
Improvement
1. Define the improvement goal
2. Analyze current practices
3. Design and implement improvements
4. Measure success
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Improvement
Models
• Walter A. Shewhart
• W. Edwards Deming
Act Plan
Check Do
See Exhibit 5.4 PDSA Improvement Project on page 119
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Improvement Models
Rapid Cycle Improvement
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Improvement Models
FOCUS-PDCA FADE
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Improvement Models: Lean
• Lean: Eliminate inefficiencies adversely
affecting performance.
• Lean’s project goal is to minimize waste.
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Five Lean Principles
1. Specify
Value
2. Identify
value
stream
3. Flow4. Pull
5.
Perfection
& eliminating
waste
Define and
understand the
process that
creates value for
the customer
Create smooth and
continuous development
of value though out the
process
Produce only what
the customer is
demanding, when
they demand it
Relentlessly
eliminate waste
from the value
stream
Define value from the customers
perspective
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House of Lean
Process management
Stable & capable processes
Standardised methods
Eliminate Waste
Just In
Time
Jidoka
Quality Cost Delivery & Agility
Deliver
exactly what
the customer
wants, when
they want it
with minimal
waste
Detect &
resolve
abnormalities
that threaten
quality and
delivery
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Types of Waste (Muda)
• Movement
• Waiting
• Overprocessing
• Defects
• Inventories
• Transportation
• Design
• Overproduction
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Exercise Process Thinking and Waste
Purpose This exercise focuses on process thinking and the types of
waste in a process
Silent reflect on
your own
(4 minutes)
Individually, respond to the following question:
What are the most prevalent types of waste (Muda) in a
process (or activity) that you are very familiar with?
Group
discussion
In group, select one of these processes, list the steps of this
process and identify1-3 types of waste for every step in the
process (20-25).
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1. Performance problem identified
2. Evaluate current work processes
3. Identify areas of opportunity
4. Find root causes of problems
5. Design better way of working
6. Create implementation plan
7. Identify expected improvements
8. Make process changes and measure results
Lean Project Steps
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Lean Improvement Techniques
• 5S
Methodology
• Kanban
• Mistake-proofing
• Value stream map
• Visual control
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The 5S Methodology
Reduce waste
Maintain and
continually
improve the
workplace
1
2
3
4
5
Sort
Straighten
Sanitize
Standardize
Sustain
Separate unnecessary from
necessary items
Designate a place for all
necessary items
Create written and visual
standards to help
maintain 5S
Implement systems to monitor
standards
Make 5S part of the company culture
Clean the work area
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Improvement Models: Six Sigma
• Six Sigma: Reduce performance variability
– Goal: Create processes that operate within Six
Sigma
quality.
– The higher the sigma level, the lower the defect
rate.
• 1 sigma = 32% defect rate
• 2 sigma = 5% defect rate
• 6 sigma = 99.999% defect free (near perfect)
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What is Sigma?
The term sigma used in statistics to represent standard
deviation from mean value, an indicator of the degree of
variation in a set of a process.
Sigma measures how far a given process deviates from
perfection. For example, the following 2 sets of data have
same mean but different sigma:
First set: 15, 15, 15, 14, 16. Mean = 15, Sigma = 0.707
Second set: 2, 7, 14, 22, 30. Mean = 15, Sigma = 11.27
Which set of data is more spread out?
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What is Six Sigma?
• A highly disciplined (or structured) improvement methodology
that enables organizations to deliver better or nearly perfect
products and services.
• It is a Quality Philosophy and the way of improving performance
by knowing where you are and where you could be.
• A methodology to measure and improve company’s performance,
practices and systems
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DMAIC – Six Sigma Project
Methodology
1.
Define
2.
Measure
3.
Analyze
4.
Improve
5. Control
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Define
• Describe the problem in operational terms
• Drill down to a specific problem statement
(project scoping)
• Identify customers and CTQs, performance
metrics, and cost/revenue implications
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Measure
• Understand causal relationships between
process performance and customer value.
Y = f(X)
where Y = customer CTQs and X represents critical
input variables that influence Y
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Data Collection Issues
• What questions are we trying to answer?
• What type of data will we need to answer
the question?
• Where can we find the data?
• Who can provide the data?
• How can we collect the data with minimum
effort and with minimum chance of error?
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Analyze
• Focus on why defects, errors, or excessive
variation occur
– Experimentation and verification to verify
Y = f(X) relationships
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Improve
• Improve the X variables so as to improve Y
– Idea generation
– Brainstorming
– Evaluation and selection
– Implementation planning
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Control
• Maintain improvements
–Standard operating procedures
–Training
–Checklist or reviews
–Statistical process control charts
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Improvement Models:
Lean Six Sigma
Lean Six Sigma: Eliminate waste and reduce
process variation
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College of Healthcare Executives. Not for sale.
Performance Improvement
Models
• Organizations don’t choose one approach
to the exclusion of the others.
• The approach most likely to achieve
improvement goals for a particular project
is used.
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Continuous Improvement
• Various improvement models
are used to improve healthcare
quality.
• The different models share a
common thread of analysis,
implementation, and review.
Measurement
How are we
doing?
Assessment
Are we meeting
expectations?
Improvement
How can we improve
performance?
Yes
No
