Lean Six Sigma for Healthcare Professionals 12MAY20.pdf -...

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1 © Kannan Ramanathan 2018 LEAN SIX SIGMA FOR HEALTHCARE PROFESSIONALS BY KANNAN RAMANATHAN, Ph.D. A Textbook for HMGT 6332 Naveen Jindal School of Management University of Texas at Dallas For HMGT 6332 Courses - 2018 & 2019 © Kannan Ramanathan 2020
© Kannan Ramanathan 2018 2 Contents PART I ........................................................................................................................................................ 21 Quality in Healthcare ............................................................................................................................ 21 PREFACE ............................................................................................................................................ 22 1. Structure of this book ...................................................................................................... 23 2. Levels of analysis in healthcare quality ........................................................................... 24 3. Tension between levels of analysis ................................................................................. 25 CHAPTER One .................................................................................................................................... 27 Three core problems in healthcare ............................................................................................... 27 Access ............................................................................................................................................ 27 1. Meaning of ‘Access’ ......................................................................................................... 27 1.A. Availability .................................................................................................................. 27 1.B. Accessibility ................................................................................................................ 27 1.C. Accommodation ......................................................................................................... 28 1.D. Affordability ................................................................................................................ 28 1.E. Acceptability ............................................................................................................... 28 2. Importance of Access to Healthcare ............................................................................... 29 3. Characteristics Associated with Insurance status ........................................................... 31 3.A. Aspects of Employment .............................................................................................. 31 3.B. Stage of a Person’s Life ............................................................................................... 32 3.C. Other Demographic Characteristics ........................................................................... 32 3.D. Location ...................................................................................................................... 33 Cost ............................................................................................................................................... 36 1. Reasons for growth in costs ............................................................................................ 38 1.A. Increasing Prevalence of Chronic Diseases ................................................................ 39 1.B. Changing Nature of Disease Management ................................................................ 40 1.C. Growth in Demand ..................................................................................................... 42 1.D. Structure of Healthcare Delivery ................................................................................ 44 1.E. Shortage of Healthcare Providers .............................................................................. 44 1.F. Administration and Payroll Costs ............................................................................... 46
3 © Kannan Ramanathan 2018 1.G. Uncompensated Care ................................................................................................. 49 1.H. Social Issues ................................................................................................................ 49 1.I. Defensive Medicine .................................................................................................... 54 Quality ........................................................................................................................................... 55 1. Need for Quality in Healthcare ....................................................................................... 57 1.A. Need for Quality in Healthcare – Errors ..................................................................... 57 1.B. Need for Quality in Healthcare – Variation ................................................................ 57 1.C. Need for Quality in Healthcare – Usage ..................................................................... 59 2. Factors Contributing to Poor Quality in Healthcare ........................................................ 62 2.A. Demand Factors Contributing to Poor Quality in Healthcare .................................... 62 2.B. Supply Factors ............................................................................................................ 63 Conclusion ..................................................................................................................................... 64 CHAPTER Two .................................................................................................................................... 65 How a quality framework can help ............................................................................................... 65 1. A Brief History of Quality ................................................................................................. 65 1.A. Interchangeable Parts ................................................................................................ 65 1.B. Division of Labor ......................................................................................................... 66 1.C. Mechanization ............................................................................................................ 66 1.D. The Scientific Method ................................................................................................ 66 1.E. Emergence of Quality as a Distinct Product Characteristic ........................................ 66 1.F. Increasing Sophistication of Consumers .................................................................... 67 1.G. Standardization and Benchmarking ........................................................................... 67 1.H. Emergence of the Marketing Concept ....................................................................... 67 1.I. Growing Competition among Manufacturers ............................................................ 67 1.J. Government and Other Agencies ............................................................................... 68 1.K. Internet ....................................................................................................................... 68 2. Future of quality .............................................................................................................. 68 CHAPTER Three ................................................................................................................................. 69 Definition of quality ...................................................................................................................... 69 1. Different Ways to Define Quality .................................................................................... 69 1.A. Subjective and Objective Definitions of Quality ........................................................ 69
© Kannan Ramanathan 2018 4 1.B. Manufacturer and User Definitions of Quality ........................................................... 69 1.C. Characteristics of Quality for Tangible Goods and Services ...................................... 69 What is Six Sigma? ........................................................................................................................ 70 1. Evolution of Six Sigma ..................................................................................................... 71 2. The DMAIC Framework ................................................................................................... 71 3. The DFSS Framework ...................................................................................................... 72 What is Lean? ................................................................................................................................ 73 1. Evolution of Lean ............................................................................................................. 73 2. The SIMPA Framework .................................................................................................... 74 CHAPTER Four ................................................................................................................................... 75 Quality in Healthcare .................................................................................................................... 75 1. Evolution of Quality in Healthcare .................................................................................. 75 1.A. Early Events in the Development of Medical Science ................................................ 75 1.B. More Recent Events . . . ............................................................................................. 77 1.C. Joint Commission on Accreditation of Hospitals ........................................................ 78 2. Definition of Quality in Healthcare ................................................................................. 79 2.A. Difficulties in Defining Healthcare quality .................................................................. 79 3. What is quality in healthcare? ........................................................................................ 80 3.A. Objective and Subjective Approaches to Quality ....................................................... 81 3.B. Individual and Societal Approaches to Quality .......................................................... 81 3.C. Outcome and Process Approaches to Quality ........................................................... 81 Traditional Approaches to Quality Assurance in Healthcare ........................................................ 83 1. Introduction ..................................................................................................................... 83 2.

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