Good Thought, Thank you. I plan to join the movement by deciding to wake up early and walk two miles a day.

Our ICU is emphasizing clinican well being, so that we can bring our best selves to our patients. We’re working to improve teamwork, and we also hold reflection rounds monthly, where we talk about the human part of healthcare. Combatting burnout by creating a healthy work environment may be one way to improve quality.

I`m teaching the quality of health care and medical statistics for medical students , and I focused every time on 6 sigma ( 6 standard deviation = 3.4 error / million trials) ... this can be applicable in all branches . I`m now studying Black Belt in 6 sigma related to IQF ( International Quality Federation ).

So I hope that all public health workers to think of 6 Sigma Black Belt. And there is higher degree which is Master Black Belt that focused on Optimization and non-parametric data .

steps :-

1- documentation

2- quality team with minitab software

3- applying target of 6 sigma

Khaled,

Thank you for your response. The concepts of Lean are quite valuable. The only criticism I have is that the process must take into account that the input into a healthcare system can not be controlled like in manufacturing. Therefore, outputs will not and cannot be the same. Retouching and throughput varies. Keep up the good work!

Cheers,

Christopher

I also agree that a formal approach to improvement is important. I do think that manufacturing concepts can be applied. Although each patient may be somewhat “different”, most patients who need a particular procedure, e.g., joint replacement, will benefit from processes that are somewhat analogous to a well-functioning assembly line. In contrast, patients who present with a diagnostic dilemma need an approach that is more like that found in a job shop. Certain principles lead to better individualized products in job shops and to better individualized health care.

Christopher A Smith , Thanks for relpying.

In Wikipedia ( not a scientific source for evidence based , but I mentioned the references below).

Healthcare field

This is a sector that has been highly matched with this doctrine for many years because of the nature of zero tolerance for mistakes and potential for reducing medical errors involved in healthcare.[26][27] The goal of Six Sigma in healthcare is broad and includes reducing the inventory of equipment that brings extra costs, altering the process of healthcare delivery in order to make more efficient and refining reimbursements. A study at the University of Texas MD Anderson Cancer Center, which recorded an increase in examinations with no additional machines of 45% and reduction in patients' preparation time of 40 minutes; from 45 minutes to 5 minutes in multiple cases.[24]

24 / Kwak, Young Hoon; Anbari, Frank T. "Benefits, obstacles, and future of six sigma approach". Technovation. 26 (5–6): 708–715. doi:10.1016/j.technovation.2004.10.003.

26 / Cascini, Egidio. Sei Sigma per Docenti in 14 Capitoli (PDF). RCE Multimedia.

27 / Celegato, Alessandro (2017). "IN MEMORY OF EGIDIO CASCINI" (PDF). Statistica Applicata - Italian Journal of Applied Statistics Vol. 29: 107–110.

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These is a table adapted from:“Factors critical to the success of Six-Sigma quality program in an Australian hospital”. Hilton, Roger and Balla, Margaret and Sohal, Amrik S.Total Quality Management. Vol. 19, No. 9, September 2008. 889

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There are many projects (about 20 overall) that a manager can perform using Six Sigma principals.

 Patient Satisfaction: In Healthcare most the time (if not all) people aren’t really happy to be in the hospital. It is a rough hoe to row to delight customers. A project example that might fall under this heading is room service. There is an increasing trend in hospitals to offer room service, and Six Sigma could be used by a company to verify the viability and importance of offering it in a hospital that currently doesn’t.

 Safety: Safety should be pretty self explanatory, it would be any and all projects preformed to enhance patient safety. The Committee on Quality of Health Care in America, suggests taking into account five principals for improving patient safety. 1. Provide leadership- Make patient safety a top priority and make it everyone’s responsibility. 2.Respect human limits in design processes- avoid reliance on vigilance and memory. 3. Promote effective team functioning- people who must work together should be trained together. 4. Anticipate the unexpected- be proactive and design for recovery from errors. 5. Create a learning environment- ensure no reprisals for reporting errors. (165-182) An example of this could be preventing medication errors, or patient falls.

 Efficiency: Doing more with less, eliminating waste, taking out unnecessary redundancy. One example could be improving turnover times in an ED.

 Outcomes: Projects that improve processes to allow for quicker healing, or decrease the percent of reoccurrences. Example: Testing a protocol to see if it improves clinical outcomes.

 Many Others: These were just some general ideas for projects but managers can find projects that incorporate all these project types or are more unique in nature.

Thank you dear Professor for allowing me about discussion.

In MSA ( Measurement System Analysis) chapter :-

Person , device in environment lead to readings. there are problems from these factors which are : person >> reproducibility , device >> repeatability , environment >> instability.. And the result can be alpha error or beta error which in meaning like alpha error and beta error of 2 * 2 table in Null & Alternative Hypothesis in Methodology ... These 3 factors is explained in screening test in public health department and the errors explained in research curriculum and screening test that are talking about accuracy problem and precision problem that for example in screening test , laboratory readings , pulmonary function test , weight , height , radiology by ultrasound when use parameters , other devices in Health care services..

So regarding these errors , researcher may accept the rejected or reject the accepted. In 6 sigma the target is 3.4 error / million reading that save cost , effort , time and improve meaning of efficiency , effectiveness.

Khaled,

In these applications: laboratory values, screening , etc. It makes sense. The point that I want to make is that even in the presence of perfect process fidelity, manufacturing outputs can easily acheive six sigma whereas in patient care, six sigma in not an achievable goal. Each patient brings a complex collection of pathophysiology and different levels of wellness. Outcome benchmarking must keep this in mind, for six sigma is not usually a realistic goal. (Even in an unlimited resource scenario)

Regards,

Christopher

Thanks professor sir , I will keep following for answers.

Article Optimizing Staffing, Quality, and Cost in Home Healthcare Nu...

I am doing a research to pinpoint Optimal Safe Staffing Levels Maximizing Quality-Cost in the Continuum of Changes, which serves as Evidence-based Informed Shared Decision-Making Rationales among partiesㅡpatients, nurses, and stakeholdersㅡ, leading to (a) mitigate global nursing shortage and (b) achieve the Patient-centered Value-driven Healthcare Delivery System.

Claire,

Thank you for your response. After reading your article, I wonder if there is a means to add a variable that takes into account different ”work ethics” . As we all know, not all Nurses are equally skilled, productive or caring. Highly skilled and productive staff can provide superior care with fewer numbers. Human capital is quite variable and this variability complicated staffing requirements.

Regards,

Christopher

Looking for quality in our work the answer is hiding in 3 C's of life:

Chance, Choice, Change!

Happy New Year!

My current area of investigation in organisational culture in community healthcare. While I agree that the application of business tools can be very insightful, the notion of controllable variables is not replicable in healthcare delivery. This suggestion also grates against the notion of person-centered care, and I say notion because our healthcare systems are not designed to be person-centered by their very nature.

Change is slow, changing culture is even slower , changing leadership is hardly the low hanging fruit but that's where is must start. @linkage.ie @TCPHI

Debra,

I agree.

Cheer,

Christopher