Aravind Paper

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LEAN AND SIX SIGMA

IN HEALTH CARE(QUALITY INITIATIVE TO ACHIVE WORLD CLASS

EXCELLENCE)

By

R.Gayathri. M.B.A., PGDHRM.,

M.Priya. B.Sc., M.B.A

Vadamalayan Institute of Paramedical

Sciences


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INTRODUCTION

Quality, though recognizable to one and all, is one of the most imperative

issues that all sectors have focused on in the last 20-30 years.

As markets become much more competitive, quality has become a key

ingredient for victory in todays business.

With Lean and Six Sigma, hospitals embark on with the accent of the client to

capture the anticipation of patients, family members, physicians, and otherstake holders.


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LEAN AND SIX SIGMA

LEAN ZERO

WASTE

SIX SIGMA ZERO

ERROR

ELIMINATING NONVALUE ADDED THINGS DOING THINGS RIGHTAT FIRST TIME


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SOME QUALITY PROBLEMS

More waiting time

Unnecessary lab investigations and treatments

Hospital acquired infections

Ambiguity in process flow

Lack of inspection and supervision

Reluctance of staff to work in ICUs

Poor ICU service


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QUALITY TOOLS USED TO ACHIEVE SIX

SIGMA AND LEAN

Triaging patient - Reducing waiting time

Eliminating non value added procedures cost-cutting

Check sheet, Histogram and Pareto chart decreasing

nosocomial infection

Standardizing the process process flow diagrams for each

department

Quality assurance Professional Review

Why- Why diagrams Reluctance of staff nurse to work in ICU

Cause and effect diagram Poor ICU Services


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TRIAGING PATIENT IN EMERGENCY

Using Lean Principle

Triaging Patients By Triage team

Yellow BlackGreenRed

Requires

Immediate

Medical

Attention

Not

Emergency

Not Life

Threatening

but requires

Treatment

No Use in

giving

treatment


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ELIMINATING NON VALUE ADDED

ACTIVITIES

In some hospitals where they want to train their

CRRIs to collect history, do physical assessment,

ask for laboratory diagnosis, and make preliminary

diagnosis.

They almost get complete history, wasting patient

time, go for all-embracing physical assessment,

solicit for all related laboratory diagnosis.

We can make these CRRIs to practice with the

senior doctors


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NOSOCOMIAL INFECTIONS

QUALITY TOOLS - CHECK SHEET, HISTOGRAMAND PARETO CHARTS

SLNO

TYPE OF INFECION TALLY TOTAL NO. OFINFECTIONS PER

MONTH

1. A //// // 7

2. B /// 3

3. C //// //// // 12

4. D //// //// //// // 17

5. E //// 5

GRAND TOTAL 44


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SLNO

TYPE OF INFECTION TOTAL NO. OF INFECTIONS PERMONTH

1. D 17

2. C 12

3. A 7

4. E 5

5. B 3


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`


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TYPE OFINFECTION

SUB

TOTAL

n

PERCENTAGE OFINFECTIONS

PERCENT OFINFECTION PER

PATIENT

D 17 3.4 38.64C 12 2.4 27.27

A 7 1.4 15.91

E 5 1 11.36

B 3 0.6 6.82

44 8.8 100


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20

40

60

80

100

5

10

15

20

25

20% 80%


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PROCESS FLOWDIAGRAMS


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Emergency OperationTheater

IP Wards

Admission to ICU

Stability

Emergency

protocol

No

YesFollow same

medical prescription

Prognosis

Further Investigation

And Treatment

Service Center

Protocols

No

Recovery

Yes

Exit


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QUALITY ASSURANCE

PROFESSIONAL REVIEW

Quality assurance is achieving through an ongoing valuation of patient

care which would declare the hospital that all that was done for the

patient was done to validate diagnosis, treatment, and outcome and to

pinpoint the inadequacies in medical care for renovation for the futurecases.

Retrospective Professional Review:

We have to form a team comprising heads of clinical departments, pathologist,

radiologist and hospital administrators. The main objective of the team is to

scrutinize all fatal case medical records.


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SL

NO

TYPE OF REVIEW DESCRIPTION

1. Radiological Review To justify the radiological assessment

done

2. Tissue Review To Justify the surgeries done

3. Chart Review To assess the completeness of the

medical record

4. Death Review To validate the untoward outcome


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The professional review helps to assess

professional competence of health care

providers and to make

recommendations for future policyplanning


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Reluctance

to work in ICU

Heavy

work load

High rate

of infection

Inadequate

staff

Unpredictable

requirements

Lack of

Training

Poor

Isolation

Recruiting adequate

staff

On Call nurses

Training programs

Proper Isolation

for patient with

Infective diseases

Why

Why

Why

Why

Why

Why


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CAUSE AND EFFECT DIAGRAM

Human Resource Supplies and Equipment

Absence of treatment

protocolsPoor

Communication

Poor ICU

Services

Inadequacy No team workRepair

Inadequate

supplies

Absence of

antibiotic

protocolsNo organizedDaily rounds

Delayed lab

report

Delay in

Patienttransfers


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THANK YOU FOR THE

OPPORTUNITY

Aravind Paper

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