Healthcare Process Improvement Research Articles

Healthcare process analysis and improvement at Department of abdominal surgery-University Medical Centre Ljubljana

Background: Healthcare processes in hospitals, like processes in companies or governmental organizations, may accumulate problems and obstacles over time, which consequently cause the processes to become ineffective. BPM is an approach for process modeling, improvement and automating, which has been used with great success for process improvement.Methods: This work was to examine the possibility of carrying out healthcare process improvement using BPM. To implement BPM ideas, a revised TAD methodology was developed, representing an important contribution to the BPM. The first three phases of the TAD methodology were introduced in a step-by-step approach. The first phase deals with process identification, the second develops the "as-is" model, and the third phase discusses process improvement by developing the "to-be" model.Results: We found that (a) the Surgery process is efficient and well organized; (b) patient stay in the clinic could be shortened; however for humane and social reasons the leadership prefers to leave the residence time as it is; (c) the process is connected to some time-consuming activities which are perfrmed in other departments and represent the bottleneck of the process.Conclusions: The following were concluded (a) BPM proved to be a suitable approach for carrying out healthcare process improvement; (b) the revised TAD methodology showed to be consistent and efficient in performing BPM approach; (c) The Surgery process discussed was found to be an effective one and no changes or improvements are needed; (d) Concerning time-consuming activities, the leadership decided to discuss this problem with the management of the departments where the activities are executed.

Improvement in primary care: Integrating people and processes

Despite evidence that contextual factors can hinder process improvement in healthcare, ambiguity persists about which factors are both important and modifiable by implementation teams. Our study id...

COMUNICATION AND PATIENT SAFETY: PERCEPTION OF THE NURSING STAFF OF A TEACHING HOSPITAL

This is a quantitative study with descriptive exploratory design, which investigated perception among the nursing staff at a teaching hospital regarding the possibility of communication and non-punitive response to errors. It also sought to highlight communication as a relevant factor for patient safety. The study was conducted on a teaching hospital with a population of 95 nurses. Data was collected through a questionnaire based on the Agency Health Research Quality, considering communication openness and non-punitive response to errors. The results show that the staff will freely speak up when something does not seem right. We believe this study can contribute to the necessary interventions for the assessed dimensions and to provide subsidies for the improvement of healthcare processes and management with a focus on patient safety.

Stimulated recall methodology for assessing work system barriers and facilitators in family-centered rounds in a pediatric hospital

Human factors and ergonomics methods are needed to redesign healthcare processes and support patient-centered care, in particular for vulnerable patients such as hospitalized children. We implemented and evaluated a stimulated recall methodology for collective confrontation in the context of family-centered rounds. Five parents and five healthcare team members reviewed video records of their bedside rounds, and were then interviewed using the stimulated recall methodology to identify work system barriers and facilitators in family-centered rounds. The evaluation of the methodology was based on a survey of the participants, and a qualitative analysis of interview data in light of the work system model of Smith and Carayon (1989, 2001). Positive survey feedback from the participants was received. The stimulated recall methodology identified barriers and facilitators in all work system elements. Participatory ergonomics methods such as the stimulated recall methodology allow a range of participants, including parents and children, to participate in healthcare process improvement.

The need to improve health care in prisons.

OBJECTIVETo analyze physical structure, working conditions of health professionals and outline of the procedures established in prisons.METHODSWe analyzed 34 provisional detention centers and 69 male and six female prison units in the state of Sao Paulo, Southeastern Brazil, in 2009. A self-applied instrument was developed to collect quantitative data on the characteristics of health care structure, equipment and personnel in prisons. Analysis of variance (ANOVA) or equivalent non-parametric tests and Chi-square or Fisher’s tests were used to compare categorical and continuous variables, respectively, between the groups.RESULTSThe main problems were delays in the results of laboratory tests and imaging. With respect to the teams, it was observed that a large majority were in conditions close to those proposed by the Bipartite Commission 2013 but without improvement being reflected in the indicators. With respect to the process, more than 60.0% of prisons located in small towns do not have the structural conditions to ensure secondary or tertiary health care for the continuity of treatment.CONCLUSIONSThis profile of prisons in the country can be used for planning and monitoring future actions for the continuous improvement of healthcare processes.

Scientifically based process improvement in health care with statistical process control.

Background : For better performance, it is crucial to continuously improve quality and patient safety based on the science of quality and patient safety and the usage of appropriate tools such as statistical process control. The aim of this article is to describe statistical process control in the continuous improvement of healthcare processes. Methods : Patient falls and surgical site infections were studied using a run chart, u-chart, and g-chart. Results : In the case of patient falls special causes of variation were depicted. However, these are only statistical conclusions, whereas the content of the causes can be found only by those who work in the process of fall prevention. In the case of surgical site infection, the use of a new wound covering material was abandoned because the g-chart showed failure to improve the process. The g-chart showed that a different type of preparation of the surgical site with hair cutting instead of shaving showed a decrease in infection rates. Conclusion : Statistical process control can differentiate between common and special causes of process variability. The importance of this distinction is in the employment of different strategies for process improvement.

Cloud based metalearning system for predictive modeling of biomedical data.

Rapid growth and storage of biomedical data enabled many opportunities for predictive modeling and improvement of healthcare processes. On the other side analysis of such large amounts of data is a difficult and computationally intensive task for most existing data mining algorithms. This problem is addressed by proposing a cloud based system that integrates metalearning framework for ranking and selection of best predictive algorithms for data at hand and open source big data technologies for analysis of biomedical data.

Evaluating healthcare process improvement for patient callbacks

Given the rising cost of healthcare, improving the service quality provided in the healthcare field is critical to the continued success of healthcare providers. This study analyses the service quality and standards of the healthcare industry, specifically the communication or callbacks made to the patients regarding medical information in an independent healthcare facility in the USA. Communication with patients regarding medical information is essential in providing the high level of quality expected in a provider–patient healthcare relationship. Timeliness in relaying information and responding to a patient’s request is often the most important concern to the patient and integral in maintaining the expectation of service quality in the patient–provider relationship. The PDSA (Plan-Do-Study-Act) method provides structure within the analysis of the nurse callback process. This case study illustrates the viability of process improvement within a highly regulated service-orientated industry.

Driving Change from the Middle: An Exploration of the Complementary Roles and Leadership Behaviors of Clinical Nurse Leaders and Engineers in Healthcare Process Improvement

:The healthcare system presents challenges and opportunities for those looking to drive process improvement. Engineering managers can improve the probability of successfully implementing initiatives by partnering with a clinical nurse leader (CNL), since a key CNL role is designing and implementing changes to improve patient outcomes. Similar to project managers and engineers, CNLs drive change from the middle of the organization by successfully balancing the needs of upper management with frontline demands. Case studies of change efforts in healthcare are used to illustrate behaviors required of successful middle leaders to both lead and serve as “courageous followers” when improving healthcare outcomes.

Healthcare Process Improvement: The Consumer's Role

Healthcare Process Improvement: The Consumer's Role

Abstract P5-14-04: Alleviate the pain in the system: Using process improvement and systems design tools to strive for a high quality breast healthcare system in the District of Columbia metro area.

Abstract Background: Throughout the District of Columbia Metro Area, breast cancer mortality rates are higher than the national average due in part to limited service coordination and lack of access to breast health services along the continuum. The Primary Care Coalition of Montgomery County (PCC) and the Regional Primary Care Coalition (RPCC) are collaborating to improve the efficiency and effectiveness of breast cancer screening, referral, and follow-up so that jurisdictions and clinics in the DC metro area are better positioned to provide 100% low-income women residents with access to breast healthcare. The Regional Initiative builds upon the successes of the PCC Breast Healthcare Process Improvement Project. Objectives: 1) Adopt the Primary Care-Based Model in three clinics in three other jurisdictions and implement process improvement approaches to show improvements in breast cancer screening, referral, and follow-up; and 2) Develop a cross-jurisdiction learning community to enhance spread throughout the Region. Methods: The Regional Initiative employs a multi-tiered learning community framework to share data, address systems level barriers, and design new systems for the provision of high-quality care regardless of insurance status. Partners use the Model for Improvement to improve processes at the micro-system level and system design theory drives larger systems changes. Results: Objective 1: The three adaptation sites represent Prince Georges County, Maryland, Washington, DC, and Fairfax Virginia. After a year of focused process improvement, partnership development, and data collection, initial analysis demonstrates: – All three clinics show increased screening rates approaching 65%, representing the 90th percentile performance in the Healthcare Effectiveness Data and Information Set (HEDIS) for Medicaid breast cancer screening.– At Greater Baden Medical Services in Prince Georges County, Maryland, cycle time between referral and mammography screening decreased from 48 to 27 days.– The Community Health Care Network, Fairfax County, Virginia, worked closely with one mammography provider to decrease the no-show rate for mammography appointments from 26% to 6%.– The Project Team developed a change package to share recommended interventions and successful strategies that have been tested and documented, and can be used by clinics certified as primary care medical homes or in the process of adopting those standards. Objective 2: The Cross-Jurisdiction Learning Collaborative brings representatives from each jurisdiction together to share breast health measures, success stories, and plan/discuss process improvement activities from a regional perspective. Participants include over 50 breast health providers from around the region: – 17 safety-net clinics– 11 hospital and/or mammography providers– All County and/or State National Breast and Cervical Cancer Early Detection Programs in the Region Next Steps: Spread learnings regionally and nationally to foster collaboration, replicate the PCC Primary Care-Based Model using the change package, and further improve breast health outcomes for the safety-net population. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-14-04.

Simulation-based framework to improve patient experience in an emergency department

The global economic crisis has a significant impact on healthcare resource provision worldwide. The management of limited healthcare resources is further challenged by the high level of uncertainty in demand, which can lead to unbalanced utilization of the available resources and a potential deterioration of patient satisfaction in terms of longer waiting times and perceived reduced quality of services. Therefore, healthcare managers require timely and accurate tools to optimize resource utility in a complex and ever-changing patient care process. An interactive simulation-based decision support framework is presented in this paper for healthcare process improvement. Complexity and different levels of variability within the process are incorporated into the process modeling phase, followed by developing a simulation model to examine the impact of potential alternatives. As a performance management tool, balanced scorecard (BSC) is incorporated within the framework to support continual and sustainable improvement by using strategic-linked performance measures and actions. These actions are evaluated by the simulation model developed, whilst the trade-off between objectives, though somewhat conflicting, is analysed by a preference model. The preference model is designed in an interactive and iterative process considering decision makers preferences regarding the selected key performance indicators (KPIs). A detailed implementation of the framework is demonstrated on an emergency department (ED) of an adult teaching hospital in north Dublin, Ireland. The results show that the unblocking of ED outflows by in-patient bed management is more effective than increasing only the ED physical capacity or the ED workforce.

A3 Process: A Pragmatic Problem-Solving Technique for Process Improvement in Health Care

Short-term approaches or patch working are the predominant modes of solving process-related problems in organizations. As a result, problems recur at regular intervals and inhibit their smooth functioning. Organizational leaders have adopted various quality initiatives to produce sustainable change, but the existing literature suggests that many of them have met with limited success. The ‘A3 Process’, adapted from Toyota Motor Corporation, has been proposed as a pragmatic problem-solving technique for creating sustainable organizational change. Observing, drawing iconic sketches, discussing with other stakeholders, and experimenting has helped each stakeholder gain a deeper, contextualized understanding of the problem. These activities influenced knowledge validation and/or knowledge creation, both instrumental in transforming the stakeholder’s passive mindset to a collaborative and active mindset. This article presents one of the many applications of the A3 Process that produced enduring change in a health care environment.

A Practical Guide to Applying Lean Tools and Management Principles to Health Care Improvement Projects

Manufacturing organizations have used Lean management principles for years to help eliminate waste, streamline processes, and cut costs. This pragmatic approach to structured problem solving can be applied to health care process improvement projects. Health care leaders can use a step-by-step approach to document processes and then identify problems and opportunities for improvement using a value stream process map. Leaders can help a team identify problems and root causes and consider additional problems associated with methods, materials, manpower, machinery, and the environment by using a cause-and-effect diagram. The team then can organize the problems identified into logical groups and prioritize the groups by impact and difficulty. Leaders must manage action items carefully to instill a sense of accountability in those tasked to complete the work. Finally, the team leaders must ensure that a plan is in place to hold the gains.

Process improvement in healthcare: overall resource efficiency

AbstractThis paper aims to develop a unifying and quantitative conceptual framework for healthcare processes from the viewpoint of process improvement. The work adapts standard models from operation management to the specifics of healthcare processes. We propose concepts for organizational modeling of healthcare processes, breaking down work into micro processes, tasks, and resources. In addition, we propose an axiological model which breaks down general performance goals into process metrics. The connexion between both types of models is made explicit as a system of metrics for process flow and resource efficiency. The conceptual models offer exemplars for practical support in process improvement efforts, suggesting to project leaders how to make a diagrammatic representation of a process, which data to gather, and how to analyze and diagnose a process's flow and resource utilization. The proposed methodology links on to process improvement methodologies such as business process reengineering, six sigma, lean thinking, theory of constraints, and total quality management. In these approaches, opportunities for process improvement are identified from a diagnosis of the process under study. By providing conceptual models and practical templates for process diagnosis, the framework relates many disconnected strands of research and application in process improvement in healthcare to the unifying pursuit of process improvement. Copyright © 2011 John Wiley & Sons, Ltd.

Practitioner Perceptions of the A3 Method for Process Improvement in Health Care

The focus of this article is to present students' perceptions of the recently developed A3 method, a structured problem-solving approach based on lean concepts and tools that have been adapted to the health care environment. The students were all employees of a large health care provider and were enrolled in a customized health care executive MBA Program. Each student was required to complete an individual A3 Project in order to improve a process at the department for which they worked. At the end of the semester the students presented their A3 projects to their peers who voted on the best projects. A survey measuring perceptions of the A3 method for problem solving in health care was administered and from it we present propositions for A3 implementation. These propositions are applicable both to health care practitioners and to academic researchers.

Cleanliness Is Next to Godliness

This paper discusses the role of litigation in reducing the spread of hospital-acquired infections. Given the prophylactic nature of litigation, it is suggested that legal action serve as part of a multifaceted approach to improving American medical care and that there be a balance between the burden of an environment occasioned by the specter of potential lawsuits with the benefit of improved care through pecuniary responsibility for failing to meet the standard of care. This paper concludes that while we should not over-employ litigation in the health care environment, we should also not abandon it. It is one treatment modality for the illnesses that compromise the American health care system. Robert Steinbuch is an associate professor of law at the University of Arkansas at Little Rock [Arkansas], William H. Bowen School of Law. Steinbuch received a bachelors in political science and a masters in political theory from the University of Pennsylvania in Philadelphia. Thereafter, he earned his juris doctor at the Columbia University School of Law in New York City. Steinbuch has testified before the US Senate, Committee on the Judiciary and the US House of Representatives, Committee on the Judiciary on issues including public safety. Currently, Steinbuch serves on the board of trustees of the Society of Chest Pain Centers, an international accrediting health care organization. The society is a nonprofit international society that bridges cardiology, emergency medicine, and other professions focused upon improving care for patients with acute coronary syndromes and other acute heart conditions. The society promotes protocol-based medicine, often through a chest pain center model, to address the timely diagnosis and treatment of acute coronary syndromes and acute heart failure. It is focused on promoting the adoption of process improvement science by health care providers. Additionally, Steinbuch serves as a commissioner on the Arkansas Commission for the Newborn Umbilical Cord Blood Initiative. The 11-member commission will establish and oversee a statewide network that will contribute to a central bank of blood donated from umbilical cords otherwise discarded after childbirth. Once the network has been established, Arkansas will be connected to a national and international network of cord blood banks that supply potentially life-saving cells for transplants to children and adults with cancer all over the world. The University of Arkansas School of Medical Sciences, which has one of the largest adult blood cell transplant centers in the country, will serve as the statewide network”s main storage site. Steinbuch currently teaches business associations, law and economics, legal profession and evidence. He has published numerous papers on topics such as health law, commercial law, criminal procedure, and election law, in both medical and legal journals. He often focuses his research on the intersection of law and process improvement in health care and other public services.

Statistical process control part 1: a primer for using statistical process control in health care process improvement

QUALITY IMPROVEMENT is increasingly important for health care organisations both nation-wide and internationally. There is greater recognition of both the variances in patient care and the gaps between evidence-based research and current practice. At the same time, demand, not only for the quantity of services, but for higher quality services, continues to grow. Realising this, most major hospitals across Australia are initiating the redesign of hospital processes in order to maximise the timeliness and quality of patient care. But changing a process does not always result in an improvement.1,2 For this reason, a key component of any quality improvement effort is the robust measurement, analysis, and interpretation of appropriate clinical outcomes and processes, to ensure beneficial changes occur.

Statistical process control part 2: using statistical process control to measure process improvement in patient flow

THE FIRST ARTICLE in this series, ?Statistical process control part 1: a primer for using statistical process control in health care process improvement? 1 (in this issue of the Journal), introduced the basic concepts of statistical process control (SPC) and its main tool, the control chart. While this set of techniques was originally developed in the manufacturing sector, there is growing realisation in recent years that SPC (and also other quality improvement techniques, such as Six Sigma and lean thinking) can be successfully applied to health care quality improvement.2 The reason for this is that SPC is a potent and powerful, yet simple tool for tracking, and detecting any variation in, process performance over time; which creates the opportunity for health professionals to promptly respond to any improvement or deterioration in the process. Perhaps the most valuable feature of SPC techniques however, is the ability to place a change in the outcome of a process in close temporal proximity to the redesign and improvement of the process. This means SPC can reliably evaluate the effectiveness of quality improvement initiatives implemented at the front line of health service delivery, despite the complexities of the hospital system and the challenges this often poses for health services research (for example, the inability to use robust research designs). The purpose of this companion article is to therefore demonstrate the practical application of SPC in a health care organisation. Specifically, the technique of control charting was used to track the impact of patient flow process improvement interventions in a public hospital, in the hope that this will exemplify to health care professionals the value and simplicity in applying SPC as part of their daily work.

EHR Safety: The Way Forward to Safe and Effective Systems

Diverse stakeholders—clinicians, researchers, business leaders, policy makers, and the public—have good reason to believe that the effective use of electronic health care records (EHRs) is essential to meaningful advances in health care quality and patient safety. However, several reports have documented the potential of EHRs to contribute to health care system flaws and patient harm. As organizations (including small hospitals and physician practices) with limited resources for care-process transformation, human-factors engineering, software safety, and project management begin to use EHRs, the chance of EHR-associated harm may increase. The authors propose a coordinated set of steps to advance the practice and theory of safe EHR design, implementation, and continuous improvement. These include setting EHR implementation in the context of health care process improvement, building safety into the specification and design of EHRs, safety testing and reporting, and rapid communication of EHR-related safety flaws and incidents.