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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
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