Chapter 5 Clinical Workflow Analysis, Process Redesign, and Quality Improvement Flashcards
Workflow
collection of processes designed to accomplish a specific goal
Processes
made up of tasks which are performed by different people
4 basic steps to workflow analysis
1) determine organization’s goals and objectives from senior management
2) delineate the roles of each employee and what sort of tasks he/she does for the business
3) calculate the time, energy, resources, and cost for each task
4) make recommendations for improvement
Process maps
flowcharts that document the way a process works
Process mining
specific method of workflow analysis which involves reviewing the event log of an information system to see how various tasks are carried out
Business Process Reengineering
-workflow re-engineering
-only by analyzing workflows and reorganizing them from ground up can useful gains be had
-common threads: many current workflows are based on assumptions that are no longer valid; many controls systems, some with minimal value; handoffs are problematic; unfortunate habit of patching problems instead of fixing them
7 Principles of Reengineering (by Hammer)
1) organize around outcomes, not tasks
2) have those that use the output of the process perform the profess (e.g., ultrasound)
3) subsume information-processing work into the real work that produces the information
4) treat geographically dispersed resources as though they were centralized
5) link parallel activities instead of integrating their results
6) put the decision point where the work is performed, and build control into the process
7) capture information once and at the source
Quality Health care (US AHRQ definition)
“doing the right thing, at the right time, in the right way, for the right person–and having the best possible result”
hi lights both process (way that the activity is done), and outcome (result)
Total Quality Management
-Quality improvement philosophy
-Transformed from business and manufacturing world
-3 focal points:
1) Continuous Quality Improvement
2) Customer Service
3) Teamwork
Plan, Do, Study, Act (PDSA)
-Most common QI paradigm in healthcare
-Plan: decide what kinds of interventions are most likely to be effective
-Do: implement, variations from initial plan are called defects
-Study: analyze interventions to see if they had expected outcome
-Act: group determines what was success and what was not and how intervention should be modified
This goes back to planning phase and the cycle repeats
Six-Sigma
-QI paradigm
-Developed by Motorola to decrease process variation and prevent defects
-Goal is to have defects occur at a rate that is six standard deviations (sigma) from the mean, or approximately 3.4 defects per million
Steps are abbreviated: DMAIC
-Define: define problem, create project charter, select team members, pick success criteria, agree on deadline
-Measure: choose a method of data collection, incorporated into control chart
-Analyze: data reviewed and defects identified
-Improve: corrective actions are debated and selected
-Control: create policies and procedures to crystal the new methods into routine habits
LEAN methodology
-Developed by Toyota in 1950s process improvement technique
-Taiichi Ohno (Engineer in 1950s)
-Primarily to remove non-value-added activities (or muda, Japanese for waste); Mura “irregularity, unevenness”, Muri “unreasonable, burdensome work”
-7 categories of waste:
1) overproduction
2) waiting
3) transporting
4) inappropriate processing
5) unnecessary inventory
6) excess motion
7) defects
-Key to identifying waste is to create value stream map (also called end-to-end system map) which shows all the inputs, throughputs and outputs of a process
-Tests of change implemented as “kaizen” or “change for the better”: small improvements, rapid adaptation to results, continuous quality improvement
