The Quality Improvement Challenge A Practical Guide for Physicians

Efforts to improve the quality of healthcare have failed to achieve a meaningful and sustainable improvement. Patients continue to experience fragmented, inconvenient, and unsafe care while providers are increasingly becoming overburdened with administrative tasks. The need for change is clear. Healthcare professionals need to take on new leadership roles in quality improvement (QI) projects to effect real change. The Quality Improvement Challenge in Healthcare equips readers with the skills and knowledge required to develop and implement successful operational improvement initiatives.

Designed for healthcare providers seeking to apply QI in practice, this valuable resource delivers step-by-step guidance on improvement methodology, team dynamics, and organizational change management in the context of real-world healthcare environments. The text integrates the principles and practices of Lean Six Sigma, human-centered design, and neurosciences to present a field-tested framework. Detailed yet accessible chapters cover topics including identifying and prioritizing the problem, developing improvement ideas, defining the scope of the project, organizing the QI team, implementing and sustaining the improvement, and much more. Clearly explaining each step of the improvement process, this practical guide:

• Presents the material in a logical sequence, gradually introducing each step of the process with clearly defined workflow templates
• Features a wealth of examples demonstrating QI application, and case studies emphasizing key concepts to highlight successful and unsuccessful improvement initiatives
• Includes end-of-chapter exercises and review questions for assessing and reinforcing comprehension
• Offers practical tips and advice on communicating effectively, leading a team meeting, conducting a tollgate review, and motivating people to change

Leading QI projects requires a specific set of skills not taught in medical school. The Quality Improvement Challenge in Healthcare bridges this gap for experienced and trainee healthcare providers, and serves as an important reference for residency program directors, physician educators, healthcare leaders, and health-related professional organizations.

Richard J. Banchs, MD, is a board-certified pediatric anesthesiologist and the Associate Head for Quality and Safety for the Department of Anesthesiology at the University of Illinois Hospital, Chicago. Dr. Banchs is a Lean Six Sigma Black Belt and Change Management Experienced Practitioner and has served as the Senior Director of the Organizational Process Improvement office at UIC. He is the creator and director of the QI Project Bootcamp: an intensive three-day course that serves the learning needs of the UIC Hospital community of providers and staff.  

Michael R. Pop, LSSMBB, MBA is the Director of Business Process Improvement for the Omron Automation Americas group and a Senior Member of the American Society for Quality (ASQ). He has assisted multiple Hospitals and Clinics implement Lean Six Sigma Operations and coached and mentored numerous healthcare leaders in the use of Statistical Process Control techniques.  

Why This Book? x

About the Authors xi

List of Stories, Examples, Exercises, and Case Studies xiii

About the Companion Website xv

Part I The Basics 1

Chapter 1 The Problem with Healthcare 3

Chapter 2 We Need to Improve the Way We Improve 11

Part II The First “R”: The Right Project 21

Chapter 3 The Project Selection Process 23

Chapter 4 Frame Your Challenge: The Problem Statement and Charter 36

Part III The Second “R”: The Right People 45

Chapter 5 Don’t Go at It Alone: Find a Primary Sponsor 47

Chapter 6 Organize Your QI Team and Select the Team Leader 51

Part IV The Third “R”: The Right Problem 61

Chapter 7 What is the Scope of the Project? The SIPOC Diagram 63

Chapter 8 Who Are the “Customers,” and What Do They Need? 68

Chapter 9 Who Are the “Stakeholders,” and What Challenges Do They Have? 81

Part V The Fourth “R”: The Right Cause 87

Chapter 10 To Understand a Process, You Need to “Go See” and Create a Map 89

Chapter 11 Get a Quick Win: Identify and Eliminate “Waste” 109

Chapter 12 Measure What Matters: Choose the Right Project Metrics 124

Chapter 13 Practicalities for Planning and Collecting Baseline Data 137

Chapter 14 Define Baseline Performance: Is the Process “Stable”? 147

Chapter 15 Tools to Characterize the Type of Variation: The Run Chart 176

Chapter 16 Tools to Characterize the Type of Variation: The Control Chart 186

Chapter 17 Define Baseline Performance: Is the Process Capable? 207

Chapter 18 How to Identify and Prioritize the Most Likely Cause of the Problem 222

Chapter 19 Before Proceeding, Confirm the Cause-and-Effect Relationship 242

Part VI The Fifth “R”: The Right Solution 253

Chapter 20 Develop and Prioritize Your Improvement Ideas 255

Chapter 21 Test the Effectiveness of Your Ideas with a Pilot 280

Chapter 22 Improve “Flow” and Work Conditions 288

Chapter 23 Now Roll-Out Your Improvement Ideas and Make Them “Stick” 310

Part VII Additional Things You May Need to Know 331

Chapter 24 How to Prepare and Conduct a Tollgate Review 333

Chapter 25 How to Communicate Effectively to Engage the Frontline 339

Chapter 26 How to Lead an Effective Team Meeting 354

Chapter 27 How to Help Your QI Team Become a High-Performing Team 369

Chapter 28 Steps and Strategies to Effective Decision-Making 393

Chapter 29 What Neurosciences Can Teach Us to Motivate People to Change 403

Chapter 30 How Does it All Fit Together? The MRI Suite at St. Mary’s Hospital 421

Appendix 449

Appendix I Common Improvement Tools and Techniques 451

Appendix II Glossary of Improvement Terms 457

Appendix III Additional Resources 460

Index 463

The New copy of this book will include any supplemental materials advertised. Please check the title of the book to determine if it should include any access cards, study guides, lab manuals, CDs, etc.

The Used, Rental and eBook copies of this book are not guaranteed to include any supplemental materials. Typically, only the book itself is included. This is true even if the title states it includes any access cards, study guides, lab manuals, CDs, etc.