ASQ Healthcare Division - A Peer-Reviewed Publication of the …asqhcd.org/wp-content/uploads/2014/01/ASQQMFWinter2014... · 2014-01-17 · ASQ Health Care Division, and I coauthored

Articles published in The Quality Management Forum may not be reproduced without

consent of the author(s).

A P e e r - R e v i e w e d P u b l i c a t i o n o f t h e Q u a l i t y M a n a g e m e n t D i v i s i o n o f t h e A m e r i c a n S o c i e t y f o r Q u a l i t y

T h e Q u a l i t y M a n a g e m e n t

www.asq-qm.orgAS

®

Inside This Issue

Quality Management

Division

Special Edition Editor’s Comments: QMD/HCD Health Care Technical CommitteeBy Grace L. Duffy, co-chair QMD Health Care technical committee

It is an honor to serve as special editor of the Winter 2014 Quality Management Forum. Each year the QMD highlights the deliverables of one of the division’s technical committees. In previous special editions our readers have learned about the most current application of quality management tools related to the Baldrige Performance Excellence Program, Innovation, Cost of Quality, and Risk Management. This edition focuses on the advances made through collaboration between the Quality Management and Health Care Divisions of ASQ.

The mission of the joint QMD/HCD technical committee is to explore the overlap in customer segments and content between the divisions through joint study, research, writing, presentations, and other deliverables using a broad range of media and social channels.

The QMD and Health Care Divisions have a history of partnership in joint conferences, liaison activity, research, and publication. Four-and-a-half percent of QMD members are also members of the Health Care Division. Since 2012, QMD has partnered with the HCD through inter-divisional study and applications expanding the bounds of the Quality Management Body of Knowledge. Results of these activities are documented through papers, presentations, webcasts, and other deliverables using a broad range of media. The primary goal of this partnership is to expand knowledge and application of a culture of continuous improvement related to health. Efforts are targeted on the management of quality and organizational

excellence through systems of people and processes, with major focus on driving out waste and balancing benefit and cost for affordability of health care and the improved health of our communities.

This edition offers a number of leading-edge papers documenting the application of quality management tools in health care. The opening paper, “The ASQ Health Care Division Marshall Plan,” is a case study of seminal work done with a major Southern California hospital that resulted in over $500,000 of annual hard dollar savings. Only the abstract and the project A3 are printed in the hardcopy version of the Forum. Follow the links to the HCD or QMD websites to take advantage of the full 22-page case study. Also in this edition is “Seven Super Tools for the Breakthrough Improvement in health care Operations.” This paper documents current activity at Franciscan St. Francis Health to provide more, better, faster care, at lower cost and to make improvements faster at lower cost with less risk. “Affordability in Hospital Care Delivery” introduces a new model for managing hospital costs while effectively increasing the quality of care. The use of this model has already returned over $800,000 in tangible savings to a Northern Virginia hospital system. Readers who are following the risk management series already begun in the Forum will appreciate another contribution based on the authors’ application of techniques in a health care setting. Finally, this edition of QMF is not complete without the review of a health care related text. Enjoy this edition. I am grateful to all the contributing authors.

Special Edition Editor’s

Comments: QMD/HCD Health

Care Technical Committee . .1

Chair’s Message . . . . . . . . .2

Joint Message Title to be

deteremined . . . . . . . . . . . .3

The ASQ Healthcare Division

Marshall Plan: "Put Me In

The Game, Coach!" . . . . . . .4

Attacking the White Spaces:

Seven Super Tools for

Breakthrough Health

Care Improvement . . . . . . .7

Affordability in Hospital

Care Delivery . . . . . . . . . . 11

Quality Management

Journal Preview . . . . . . . . . 15

Book Review . . . . . . . . . . . 17

Book Review . . . . . . . . . . . 18

A New QMD Sub-Group

on Linkedin! . . . . . . . . . . . 20

QMF Book Summary . . . . . 21

Coach's Corner . . . . . . . . . 23

Winter 2014V o l u m e 3 9 , N u m b e r 4

T H E Q U A L I T Y M A N A G E M E N T F O R U M

2

Chair’s MessageBy Milt Krivokuca

Chair’s MessageBy Milt Krivokuca

I prepared this Chair's Message with both excitement and sadness. I am excited that the Quality Management Division (QMD) has met its goal of collaborating with other ASQ divisions, in this case the Health Care Division. This Winter 2014 issue of the Quality Management Forum (QMF) features health care topics of interest to quality professionals, as well to society in general. The articles “Affordability in Healthcare,” “Attacking the White Spaces,” and “Put me in the Game, Coach!” explain how fundamental quality concepts can be utilized to improve the delivery of health care services. I want to thank Grace Duffy, QMD Technical Committee chair and health care subject matter expert (SME), who served as guest editor for this issue of QMF. Grace’s participation assured the success of this collaborative effort between QMD and the ASQ Health Care Division. Joe Fortuna, MD, immediate past chair of the ASQ Health Care Division, and I coauthored a special introduction to these articles. Of the four issues QMF publishes each year, one was designated for articles written by global authors to develop a more inclusive perspective of quality, a goal we reached last summer. Another goal was to be a collaborative effort containing a series of articles of interest and concern designed specifically to reach a broader audience. That goal was accomplished in this issue.

I am sad that this is my last Chair’s Message, as my term as QMD chair concludes on December 31, 2013. These have been two very challenging and exciting years for QMD and ASQ. A major transition is occurring within the entire ASQ organization. QMD is one of the leading divisions redirecting its efforts to provide activities and events that enhance member value. Our efforts seem to be working, as QMD has the highest member retention and growth figures in all of ASQ. These results directly reflect the many hours and dedicated efforts of the volunteer leadership team members.

I want to reflect back on several of the major QMD accomplishments during my two-year term. First, the QMD planned move from a single annual conference to several small regional events where the leadership team can engage more members to obtain voice-of-the customer information was very successful. Second, we developed a QMD-Global team to engage members and to open dialogue with quality professionals from emerging nations, as well as from highly developed nations. Third, the Certified Quality Manager/Organizational Excellence (CMQ/OE) was recently revised. Jerry Rice, vice-chair operations, assembled several teams of SMEs to participate in the exam preparation. Finally, Russ Westcott was called upon

again to revise the CMQ/OE Handbook. The critical aspect of Jerry's and Russ’s effort was the amount of work they accomplished in a very condensed timeframe in order to have the study materials and exam available for the next generation of CMQ/OEs.

The newly elected leadership team will assume their responsibilities on January 1, 2014. Each elected officer has been serving in leadership positions for several years, so the transition should be seamless. Ken Sadler, chair-elect for 2012–2013 and previously the QMD treasurer, will be the 2014–2015 chair. He will announce other members of his leadership team very shortly. Jan Tucker, vice-chair of membership, will be the chair-elect. Jan has been very active in administering the VOC surveys and engaging new division members. Sandy Low continues as treasurer for a second term, and Peggy Milz continues as secretary for a second term. I become the immediate past-chair and chair of the nominations committee.

ASQ is in the process of changing its operating model for the purpose of better engaging member leaders. A new program awards and recognition (PAR) process begins in 2014. This program requires member units, both divisions and sections, to plan activities and events that will enhance the value of an ASQ membership. PAR especially recognizes creative and innovative approaches to developing actions that enhance member value. Program success metrics include member growth and retention. I am excited about PAR for several reasons. First, QMD has already moved our operations model in this area, but awards are not retroactive, so we continue to be challenged to develop new and innovative activities to engage our members. Second, ASQ has invited me to participate on the PAR committee. I am eager to learn how ASQ member units create innovative member activities.

As my term closes, I want again to thank all the volunteer members of the QMD leadership team for their contributions to making my term a success.

Please enjoy this issue of the QMF. We did not forget to include our regular features such as J.R. McGee’s “Coach’s Corner” and the current book reviews.

Happy Holidays!

Milt Krivokuca DBA ASQ-QMD Chair 2012–2013

Winter 2014


3

Joint Chair's Message— Healthcare Special EditionBy Joseph Fortuna, MD and Milton Krivokuca, DBA

The Health Care Division of ASQ (HCD) and the Quality Management Division of ASQ-QMD recognize that the science of quality and process improvement, its proven tools and methodologies, and its skilled and experienced practitioners, can provide the resources necessary for solving many of the problems now plaguing the US health care system.

These problems include the rampant waste of all eight types identified by Lean processes, reduced quality of patient care, and the failure to establish cultures of continuous quality and process improvement in health care. Possible solutions to these critical aspects of the health care process are discussed in this issue of the QMD Special Winter Forum on health care.

For several years the QMD and the HCD have been collaborating on methods to effectively and efficiently address the weaknesses of the health care processes in the US. The fulcrum of

this collaboration has been the QMD-HCD Joint Technical Committee on Health Care, chaired by Grace Duffy (QMD) and Pierce Story (HCD).

The prevailing wisdom and practice in the health care industry is that all of those involved in the important work of improving quality in health care must have clinical degrees (RN, MD) and clinical training. Judging from the overwhelming percentage of help-wanted ads for health care quality managers that list such credentials as required, there seems to be little appreciation of the potential contributions of non-clinical quality professionals.

Our QMD-HCD collaborative analysis suggests that at least three changes must take place if the record on quality and efficiency improvement in health care is ever going to approximate that which has occurred in other industries, such as the automotive industry, the airline industry, and others.

Change #1: Recognition and support for the potential value of first-career, non-clinical quality professionals and scientists as valued members of the health care team. As we write these articles, we can anticipate the eager cry to health care decision makers coming from such professionals who have effectively been sidelined so far to “Put Me In The Game, Coach!”

Change #2: Establishment in health care organizations of “cultures of continuous improvement” that are stimulated and supported by the adoption of formal Quality Management Systems, such as Baldrige, ISO 9001, and Lean.

Change #3: Implementation of effective, sustainable, and proven quality improvement tools, such as Lean and Six Sigma to improve quality in all of the domains of health care.

Were these changes to occur in health care organizations, we believe that we would experience a sea-change in our ability to effectively address many of the problems plaguing health care in the US.

Officials at Illinois State University have informed the Quality Management Division that articles appearing in recent editions of the Quality Management Forum have been determined to violate academic plagiarism guidelines. These articles involved the topic of Hospital Acquired Infections. The ISU officials have requested and QMD agrees that the articles be deleted from the QMF and that the affected editions be re-published in electronic format on the QMD website. No changes or replacements will be possible for paper copies of the QMF already distributed.

Robert Spencer, Editor of the Quality Management Forum

IMDS DATAWe can create your data

and submit within 72 hours!

We do the work and invoice youReferences found on our website

Based in US

Call (734) 205-8874 or visit imdsdata.org

IMDS DATAMember of the American Society for Quality


4

The ASQ Healthcare Division Marshall Plan: "Put Me In The Game, Coach! "By Dr. Joe Fortuna, Kathy Merrill, Mary Hones-Burr, Carol Elm, Dr. Roderick Munro, Heather Shay, and Bud Sherman

AbstractThe Health Care Division of ASQ (HCD) believes that the science of quality and process improvement—its proven tools and methodologies, and its skilled and experienced practitioners—hold an important key to solving many of the problems now plaguing the US health care system. These problems include

waste of all eight types, reduced quality, and the failure to reliably establish cultures of continuous quality in health care. They are discussed in some detail in the article. Accordingly, in the mid-2000s the division launched the HCD Marshall Plan (MP) to place volunteer, skilled and experienced process improvement professionals in medical practices and hospitals.

Problem Statement (Gap)

87% of percent of Medicare IP admissions (discharge dates 2011 through 2012) coded as DRG 313 (Chest

Pain) with admissions less than 48 hours are denied by MAC resulting in an estimated $530K lost revenue

Current State/Problem Breakdown

1. SEE Annotated Swim Lane Value Stream

2. Pareto of Reasons for Denials for DRG 313 1-Day Stays (2010–2012 Discharges)

ACC Algo Not Followed

OVS1 Override

Error in Use of Interqual

Billed Wrong Provider

Coding Opp

Discharge Override

Documentation Error

Other 2

Other 3

0 5 10 15 20 25 30

Targets (SMART)

Denials for 1-day stays for DRG 313 less than 20% by Dec 2013

Denials for 1-day stays for DRG 313 less than 5% by July 2014

Project Name: Reduce DRG 313 1-Day Stay Denials Date: Jan 2013–May 2013

Project Lead: Kathy Schumm/Janette Dawson Executive Sponsor(s): Heather Shay Facilitator(s): Bud Sherman (ASQ)

Project Team: Kathy Schumm, Ken Kuhn, Janette Dawson, Sheridan Ghaby, Grace Turk, Ike Verano, Dr. Ernest Lee, Dr. Curtis Wong, Palmetto: Dr. Feliciano, ASQ: Bud Sherman

Root Cause Analysis

Issue #1:ACC Algorithm Not consistency followed for status determination

Analysis/Why:1.1 TMMC Tri-Level Troponin ranges do not correlate w/ACC Guidelines1.2 TMMC has different, non-standardized definitions of a diagnostic EKG1.3 ACC CP Guideline not fully integrated into TMMC processes and operations1.4 Status and clinical decisions based on conversations are not always documented therefore not able to be considered by payers

Issue #2:OVS1 overrides TMMC determination of status

Analysis/Why:2.1 Different Interpretation of Data2.2 OVS1 documentation/decision making process does not match TMMC2.3 OVS1 determinations often made based on limited documentation in absence of conversation with admitting/attending MD

Issue #3:Error in us of InterQual

Analysis/Why:3.1 Decision made before all relevant data available3.2 Final diagnosis different than presentation3.3 InterQual not applied/interpreted correctly

Issue #4:Billed wrong provider

Analysis/Why:4.1 Insurance information not always know at time of admission— a) Sometimes insurance information available. b) Sometimes information trickles in during stay and/or after prolonged investigation

Issue #5:Coding opportunities

Analysis/Why:5.1 DRG 313 coded as primary when the "2 or more dx that equally meet the definition of PDx" rule applies5.2 No CDI evaluation on one day stays due to resource allocation and limitation of information available on short stays for thorough review

Issue #6:Discharge override

Analysis/Why:6.1 Discharge summary trumps prior documentation and overrides initial diagnosis

Issue #7:Documentation error

Analysis/Why:7.1 MD ordered IP Status accidentally after agreed on Observation Status7.2 Order accidentally entered as IP instead of Observation

Table 1: A3 Summary Status Report on Project to Reduce DRG 313 1-Day Stay Denials


5

The MP has undergone several phases of development and operation. These are also discussed. During the most recent of the MP phases, a volunteer process improvement coach with extensive experience in industry was deployed in a major hospital in Southern California to improve the quality, efficiency, and yield of the hospital’s claims submissions to Medicare for one particular diagnosis-related group (DRG) having to do with short hospital stays for chest pain. Working closely with the hospital’s staff associated with the Health Information Supply Chain for that DRG, the MP coach was able within six months to stimulate real, annual hard-dollar savings in excess

of $500,000 in their use of outside validating vendors. It is also expected that the high Medicare claim denial rate for this DRG that the hospital was experiencing will diminish as well. The steps that the MP coach and the hospital team took are all carefully and graphically outlined. The “proof of the pudding” for his volunteer engagement was that the hospital has contracted for him to work with them on many other similar projects in their finance area. They are believers in the use of first-career process and quality professionals in the healthcare environment.

Do

Action Items Who When Status

A. SOP

A.1. Page visual tool/algorithm integrating admission criteria w/ACC guidelines Ernest/Curtis 6/20/13 Complete

A.2. Education Packet (A3, visual tool, SOP) Ernest/Curtis 6/20/13 Complete

A.3. Education ED, CM, Cardiology, OBs Unit, Hospitalist Ernest/Curtis June Open

B. Eliminate OVS1

B.1. Written plan to exit OSV1 for 1-day stay for chest pain Janette May Complete

B.2. Educate CM, CDI and MD Advisors (pending) Janette May Complete

C. Internal Physician Advisor

C.1. Scope of responsibility Heather May 2013 Complete

C.2. Determined resource needs to meet scope Heather May 2013 Complete

C.3. Operations approval and funding Heather May 2013 Complete

C.4. Implement Heather Aug 2013 Open

D. Troponins:

D.1. Meet w/Lab to determine what level o cTn-I represents the 99th percentile upper reference limit (i.e. value defining AMI) and detection limit of assay

Dr. Wong 6/7/13 Complete

D.2. Meet w/Cardiology to discuss #1 and develop plan or change Heather/Ernest 6/14/13 Complete

D.3 Implement plan for change based on #2 above UM Committee 6/25/13 Open

Plan Countermeasures

Strategy Countermeasure Who

A. Standard Operating Procedure to integrate Milliman/Interqual Criteria and ACC Guidelines for status Determination for CP patients admitted via ED

Dr. Wong, Dr. Lee, Janette

B. Eliminate use of OVS1 for Chest Pain Admissions Janette

C. Internal Physician Advisor Program Heather

D. Change troponin reference ranges to align w/current ACC Guidelines and industry standards of practice ??

Reflections

What went well? What can be improved?

Quote: "We've been working really hard to get it right. Now we know what "it" is and what to work on.

Underestimated amount of time and resources needed to complete project.

Involvement of physicians was very powerful

Check

Dashboard Measures Baseline Target 30D 60D 90D

DRG 313 1-day stay Denial Rate 87% 20%

Decrease OVS1 Expense by 50% 100K/mo 50k/mo

Act

Sustain the Results and Next Steps:

Expand to Syncope and TIA once MD Advisor and Milliman in place

Develope Countermeasures for remaining Issues/Root Causes

(The ASQ heAlThcAre DiviSion MArShAll PlAn: "PuT Me in The GAMe coAch!", continued on page 6)


6

This article in its entirety is presented on the ASQ Quality Management Division website (www.asq-qm.org/‎) and on the ASQ Healthcare Division website (asq.org/health/).

Dr. Joe Fortuna, the CEO of PRISM, a non-profit corporation providing sustainable transformative services to medical practices and facilities, is the current Chair of the Health Care Division of the ASQ. Dr. Fortuna was a Divisional Medical Director for the DELPHI Corporation, where he supervised the medical and occupational health activities in 73+ facilities worldwide, and where—using process improvement tools—he directed the design, development and implementation of Delphi’s Corporate Medical-Safety-Workers Comp Health Information System and its Absence Management System.

Kathy Merrill is professional change agent dedicated to driving substantive and sustainable performance improvement. In addition to an MBA from Eastern Michigan University, Kathy has completed executive programs at Wharton Business School, UCLA and Michigan State University. She is credentialed in Lean/6 Sigma by the Deming Institute and the Toyota Production System, certified in Balanced Scorecard methodology and proficient as a Lean Leadership instructor. Kathy is a member of ASQ.

Mary Hones-Burr has 30 years of automotive experience with General Motors Corporation. Her professional affiliations include being a member of ASQ Greater Detroit Section 1000 since 1998. Mary has served on the executive committee in elected officer positions, including secretary and vice-chair. She currently serves as treasurer. She is an ASQ CMQ/OE, as well as a Certified Quality Auditor (CQA). Mary holds an MBA from Central Michigan University.

Carole Elm, ASQ/CQE, is the outgoing Education Chair for the San Fernando Valley, California, section of ASQ. She remains on the board and is also a Health Care Division member. Carole’s background includes the use of SPC and LSS in various industries (polymers, batteries, and aerospace). Currently, Carole works in configuration management at Aerojet Rocketdyne, where she utilizes her manufacturing, quality, and engineering skills to assure the robustness and accuracy of documentation.

Dr. Roderick Munro has over thirty years of process improvement experience in the service and manufacturing industries, working from the floor up into the managerial ranks. He is a Fellow CQI and ASQ Fellow, CQE, CQA, and a CMQ/OE. Rod specializes in being a business improvement coach to organizational leadership.

Heather Shay is currently the Vice President of Clinical Quality and Accreditation at Torrance Memorial Medical Center. In this role she has oversight for clinical quality, patient safety, accreditation, continuous improvement / Lean program, HIM, coding, clinical documentation improvement, physician advisor program, care management, and social services.

Bud Sherman has 40 years of experience in technology product development, manufacturing, and process improvement. He has served in management positions at Plessey Microsystems, Dilog, Vixel and Western Digital. Bud is a founding principal of The UPWIND Group, a consulting practice focused on manufacturing, process improvement, and supply chains. Bud is a member of ASQ and the Society of Manufacturing Engineers.

Visit the new QMD website at www.asq-qm.org

(The ASQ heAlThcAre DiviSion MArShAll PlAn:"PuT Me in The GAMe coAch!", continued from page 5)


7

Attacking the White Spaces:Seven Super Tools for Breakthrough Health Care ImprovementBy Tom Pearson

Introduction

Health care providers everywhere face the same imperatives:

• Provide more, better, faster care, at lower cost.

• Make improvements faster at lower cost with less risk.

Meanwhile, vendors offering technology solutions to support health care improvement quickly recognized this as “the next big thing” for their businesss. This paper outlines how a combination of

modern methods such as Lean Six Sigma and modern technology at Franciscan St. Francis Health (FSFH) in Indianapolis, Indiana, helped achieve significant improvements in Emergency Department operations. It also investigates new options for speeding process improvement. Finally, it discusses the ROI advantages of combining the best of Lean Six Sigma/DMAIC methods with the new Seven Super Tools (Pearson, 2013), an array of big data and predictive analytics methods and technology tools that can accelerate

improvement. The Seven Super Tools are the modern extension of the Seven Basic Quality tools, and the Seven Management and Planning Tools (Pearson, 2012). The term Seven Super Tools is used here as a generic reference to the growing variety of big data analytics and technology tools flooding the market and does not refer to any specific offering by any software vendor. They are the product of lessons learned over six decades of process improvement in six different industries (Pearson, 2012).

Figure 1: Focusing on White Spaces to Improve Patient Throughput

(ATTAckinG The WhiTe SPAceS: Seven SuPer ToolS for BreAkThrouGh heAlTh cAre iMProveMenT,

(continued on page 8)


8

Background

Past experience with complex systems improvements in multiple industries led to information strategies that successfully combined big data, analytics, and real-time monitoring, control, analysis, and management alerts to improve overall system performance (Pearson, 1999). The leading cause of errors, delays, and other defects in complex system operations was found to be key information lost, delayed, or confused in the “white spaces” between organizational silos and management layers (Figure 1). For example:

• Delay 1 represents doctor late seeing the patient in ER due to other duties.

• Delay 2 represents a lost bed request from the ER to the inpatient unit.

• Delay 3 represents late discharge instruction teaching before patient release.

This finding was strongly reinforced recently when an extensive literature search yielded the case study “Focusing on white space to improve patient throughput” at St. Vincent Mercy in Toledo, Ohio (Platzke & Andrabi, 2012) During a site visit interview with Dr. Andrabi, he clearly stated, “…the most important thing is learning which processes to sub-optimize in order to optimize the total system.”

Lean Six Sigma (LSS)

A quick review of Lean Six Sigma shows where the new big data analytics and technology tools can be effectively applied. Lean Six Sigma has been the process improvement method of choice at FSFH for the last seven years. The key to LSS is the DMAIC system.

• Define the problem. This typically includes any clinical issues that impact quality of care, as well as any business or people issues that may impact the cost or speed of the care delivered.

• Measure the key input and output variables that will ultimately define the way the care system operates.

• Analyze how key inputs and outputs are related to produce overall system outcomes, and how to adjust the system or its settings to make improvements.

• Improve the process based on this understanding to provide better outcomes at lower costs in shorter time.

• Control the new process to maintain the gains and continuously monitor for any additional improvement opportunities.

It is also important to note that as improvement projects become more complex, DMAIC is typically not a “one-time, straight-through” recipe for improvement. Rather it is an iterative process that recycles whenever important changes occur (such as ED visit volumes rising rapidly during flu season or changes to the staffing plan). Any time new information becomes available during any phase of DMAIC, previous steps may be revisited and revised. In complex systems such as a modern ED, problem causes often

occur at different times and places than might be anticipated. For example, the unavailability of beds in busy inpatient units may cause ED patients awaiting admission to be “boarded” in the ED, thus clogging ED patient flows and running up unfunded expenses as well as delays.

Figure 2 shows how the Seven Super Tools interact with the DMAIC process to speed analysis, understanding, and improvement for complex systems. Note how DMAIC is presented as a continuous, iterative loop that is impacted by information and process understanding, coming from the Seven Super Tools. When applied interactively to the DMAIC process, improvement is made more efficiently and effectively to enhance health care improvement. Here is a brief description of how each of the seven tools helps speed and expand improvement.

1. Systems Thinking

Facilitate understanding and analysis of project ideas and big information. Statistical engineering plays a prominent role here (Hoerl, 2013). Three key statistical engineering principles provide direction for Big Data Analytics:

Figure 2: Seven Super Tools to Empower the LSS DMAIC Process

(ATTAckinG The WhiTe SPAceS: Seven SuPer ToolS for BreAkThrouGh heAlTh cAre iMProveMenT, continued from page 7)


9

• Data Quality—know the "pedigree" of the data

o Good Informatics can supply ample quality data

• Statistical studies are part of a sequential process of scientific discovery—NOT a "one-shot study" found commonly in textbooks

o Predictive Analytics, modeling, and simulation facilitate them

• Subject-matter knowledge is critical when developing predictive models.

o Visual Analytics helps make data clear to SMEs

2. Hospital Informatics

Big Data, Data Mining, Data Cleansing, Data Warehouses/Marts/Cubes support the Define and Measure phases of DMAIC. Modern electronic medical records now provide nearly unlimited data.

3. Exploratory Analysis

John Tukey said, “The greatest value of a picture is when it forces us to notice what we never expected to see” (Tukey, 1977). Understand system performance by exploring Big Data during the Define, Measure, and Analyze phases of DMAIC. Visual Analytics tools can help subject matter experts, operating managers, and staff see key elements hidden in Big Data. Visual Analytics is the process of analytical reasoning facilitated by interactive visual interfaces. Think of Visual Analytics as computer-aided EDA, the fastest way for people to explore and understand big data sets.

Warning: Tools that do little more than produce charts and dashboards are now laying claim to the Visual Analytics label. Virtually any software application can produce a chart, gauge, or dashboard. Visual Analytics offers something much more profound.

4. Predictive Analytics

Managing and process improvement are much about predicting system performance under various systems changes and improvement alternatives to support the Improve phase of DMAIC.

Predictive Analytics has many components:

• Informatics

• Big Data Analytics

• Visual Analytics

• Modeling and simulation

• Statistical engineering

Smart companies are using Predictive Analytics to turn data into knowledge to gain competitive advantage and improve the bottom line:

• Streamlining operations

• Better targeting of resources

• Risk/opportunity identification and assessment

• Optimized decisions

Hospitals need up-to-the-minute information about their patients, processes, suppliers, competitors, and markets to operate effectively and efficiently.

5. Natural Language Interfaces

Recent advancements in natural language processing have dramatically improved communications between computers and users. When we consider Big Data results, it is logical to extend this to include graphics and animation, to ensure that process improvement team members can quickly receive full benefit of these new information resources.

6. Knowledge Management

Managing Lessons Learned, including the results of Predictive Analytics to speed subsequent understanding and improvement efforts, is re-emerging as a serious contributor to overall process quality and efficiency.

7. Real-time Analytics

Fully automated process monitoring and event detection eliminate defects and waste due to unexpected process changes.

FSFH ER Patient Flow Project Summary Defining the problem

1. Capacity was constrained by the newly completed Emergency Room at FSFH Indianapolis campus.

2. Demand would increase significantly when FSFH Beech Grove ER closed.

3. Typically, by midday, all ER rooms were full, causing patients to back up in the waiting room until beds opened up.

4. Additional ED Rooms are too costly (approximately $1M each!)

5. This results in long waits for arriving patients to see the doctor, and

6. Patients leaving without treatment.

Project Objectives

The following project objectives were established:

1. Improve patient satisfaction.

2. Improve patient safety.

3. Reduce door-to provider time < 20 minute median.

4. Reduce ED discharge Length of Stay (LOS) by at least 30 percent.

5. Create capacity for expanding census when two hospitals combined.

The new Epic Electronic Medical Record (EMR) system provided detailed operations data for the Measure phase of the project. The mining and analysis of these data were complex and time consuming, but the project proceeded in classic DMAIC sequence, aided by daily performance data that helped tune the process design changes as we went. A discrete simulation model for the expected ER patient flows also helped avoid potential backlogs and surges. The end results were well worth the effort, and helped define the requirements for next-generation tools.

Summary of First Year Results

So how did the ED patient flow project turn out at Franciscan St. Francis ER?

• ER patient satisfaction up from 13th to 75th percentile (Press Ganey)

(ATTAckinG The WhiTe SPAceS: Seven SuPer ToolS for BreAkThrouGh heAlTh cAre iMProveMenT,

continued on page 10)


1 0

• ER LOS for all patients decreased by 16 percent (patient waits dropped from 200 minutes for the 12 months before the new ER opened to 167 minutes for the 12 months after it opened).

• Median ER LOS for admitted patients decreased by 6.7 percent.

• Median door to provider time decreased 52.2 percent to 13.8 minutes.

• Patients leaving ER without being seen by doctor (LWBS) decreased from 1.46 percent to 0.36 percent.

• ER bed turns per year improved from 1180 to over 1400.

• 53 percent of all ER patients are now seen in the “No Wait” (Now) ER (66 percent during the hours Now ER is open).

• 44 percent higher visit volumes at the Indianapolis ER.

• 89 percent increase in inpatient admissions from ER due to higher patient acuity levels.

These results are continuing to improve in the second year as we expand the approach to House-Wide Patient Flow and consider how to implement additional elements of the Seven Super Tools.

Evaluating the Benefit of Faster Improvement Projects and Faster Implementations

When faced with a difficult situation, a good first step is always to survey your resources as you start your improvement project. Often, modern information systems are at the top of the resource list—but with this important caveat:

Computers are incredibly fast, accurate, and stupid. Human beings are incredibly slow, inaccurate, and brilliant. Together they are powerful beyond imagination. —Albert Einstein

This powerful man/machine partnership is often the key to making more improvement faster. Experience has shown that complex systems like healthcare depend on highly coordinated efforts of many departments and individuals. Every care path is different, with its own specific requirements (refer again to Figure 1). Every time this care path crosses a silo (for example, from admissions to ER triage, to ER admission, to lab tests, to imaging, to procedures, consults, inpatient admissions, or discharge) there is another opportunity for delays, miscommunications, disruptions, or mistakes. Immediate availability of resources and information is critical to improvement. It is often overlooked that the best improvement projects rely on effective use of data to make good, timely improvement decisions. A complex project such as redesigning ER patient flow may take 12 to 18 months to complete. Both the duration and effectiveness of the project depend on getting the right data in a timely fashion in order to facilitate the best improvement decisions.

Consider this example: During a project to reduce readmissions, the improvement team waited over six months for reports that contained readmissions data for the Measure/Analyze phases. With modern Big Data tools, this time could be slashed to one to two months at most. The alternative might be to “settle” for a sparse sample of data that could be collected manually, but would give an incomplete picture of the relationships between individual patient records and likelihood of readmission. So the tradeoff is a more complete analysis that takes too long, or a more timely analysis that might miss important cause-and-effect understanding. Compare the effects

of a traditional DMAIC project with abbreviated sample projects and a Big Data Analytics project over a typical three-year ROI period (Table 1).

Interestingly, these results “compound” when you consider that the enhanced project option allows twice as many projects to be completed in any 12-month period. The actual comparison could be $2.5M vs. $7.5M. Clearly this accounts only for direct savings, while well-executed projects include important but less easily quantified benefits, as shown above.

Conclusion

Predictive or Big Data Analytics have become important weapons in the health care process improvement arsenal. The example project described in this paper used only a fraction of the new toolset and still showed significant gains over previous methods. As additional capabilities are added, the improvement rate can be expected to accelerate even more quickly.

ReferencesHoerl, R. (2013). Big data: A challenge for statistical

leadership. SAY Award Presentation (May).

Pearson, T. (2013). Seven super tools for health care improvement. WCQI session ICQI 20, Indianapolis, IN.

Pearson, T. (2012). Healing healthcare in the digital age. Six Sigma Forum Magazine, 11(3), 30–31.

Pearson, T. (1999). Measurements and the knowledge revolution. Quality Progress, September, 31–37.

Platzke, S. M. & Andrabi, I. A. (2012). Focusing on white space to improve parient throughput. Healthcare Financial Management, August, 102–108.

Tukey, J. W. (1977) Exploratory Data Analysis. Reading, PA: Addison-Wesley Publishing Company.

Tom Pearson is a Lean Six Sigma Master Black Belt at Franciscan St. Francis Hospital in Indianapolis, Indiana. Tom is an ASQ Fellow and systems improvement expert with experience in aerospace, automotive, electronics, pharmaceutical and healthcare industries. He has authored numerous articles for Quality Progress, Six Sigma Forum Magazine, co-authored the Exploratory Quality Control Handbook, Wisdom on the Green, and The CSSBB Primer. Tom can be reached at [email protected].

Table 1: Enhanced DMAIC Project Comparison

Year 1 Year 2 Year 3 Total

12 mo. traditional project $0 savings $1M $1M $2.5M

6 mo. abbreviated project $250K $500K $500K $1.25M

6 mo. enhanced project $750K $1.5M $1.5M $3.75M

(ATTAckinG The WhiTe SPAceS: Seven SuPer ToolS for BreAkThrouGh heAlTh cAre iMProveMenT, continued from page 9)


1 1

Affordability in Hospital Care DeliveryBy Eric Hung Le, Ph.D., Michelle Le, Pharm.D., Don Brideau, MD, and John Audett, MD

Overview

The US health care system has attracted considerable attention as health care costs continue to rise. Rapidly increasing costs and their adverse effect on premium rates and health plan profitability continue to fuel concerns about the future of the US health care system and our collective ability to pay for health care.

Data from the top 15 countries based on their per capita income in the Organisation for Economic Co-operation and Development (OECD) showed that the US has the highest per capita expense for health care as well as the most rapid growth. Between 1980 and 2008, the rate of health care spending as a percentage of GNP rose from 9 percent to 16 percent, more than any other country (OECD 2011).

According to the Centers for Medicare & Medicaid Services 2011, hospital care spending accounts for 31 percent of the total US health care cost. Hospital costs have risen for a variety of reasons. The aging population and the rise of chronic diseases such as diabetes, obesity, and cancer have contributed to not only more patients needing hospitalization but also a higher intensity of service per hospitalization. Prices have also grown due to increased demand and expectations of the population, more costly technology, and inefficiencies in delivering care. While average US salary increased 38 percent from 1999 to 2009, health care premiums rose 131 percent.

To control overall US health care costs, hospital costs must be controlled. Hospitals must reverse the increased cost per patient or service provided. This article provides new insight into the affordability of health care delivery in hospitals.

What Does Affordability Mean?

Affordability is derived from the transitive verb afford; one definition of afford would be to manage to bear without serious detriment. A product or service is therefore deemed affordable when the ratio of the cost of willingness to pay and the cost of functionality/performance are balanced. In the health care industry, this balance is reflected in the perceived value of multiple stakeholders. These stakeholders include those who require the service (patients), those who provide the service (hospitals, doctors), those who finance the service (insurance plans, individuals, and government), and those financial intermediaries that also serve as the regulators of this industry (third party payers, including government).

As discussed in Le et al (2013), the Value Equation provides several insights to the overall concept of affordability. Value is best viewed by the relationship of three factors including quality, patient experience, and cost.

Value = Quality + Patient Experience Cost

Quality can be determined by measuring specific patient outcomes as well as undesired complications of treatment. Patient experience has evolved from the less sophisticated concept of patient satisfaction by requiring patients to evaluate specific behaviors that support optimal patient care. Currently, the patient experience is reflected in the Hospital Consumer and Healthcare Providers and Systems (HCAHPS) scores; recent trends in the literature note a high correlation between HCAHPS scores and patient safety. This has advanced the suggestion that patient experience actually represents one aspect of quality. While the numerator of the Value Equation applies an additive function relative to quality and patient experience, a case can be made that in high reliability organizations the patient experience can be viewed as a multiplier (i.e., Value = (Quality x Patient Experience) / Cost); this can be viewed as a flywheel effect, thereby further enhancing customer loyalty. Although affordability remains the major focus of this paper, it is important to note that the overall quality and patient experience must be considered as integral to the concept of value creation; that is, while the consumers desire low cost, they do not seek a “cheap” product or service.

To summarize, inherent to the Value Equation is the concept that affordability does not equate solely with cost reduction. As suggested above, a superior product or a higher level of service may warrant a higher cost. In addition, risk mitigation or deferred future costs are examples of scenarios wherein an increase in short-term cost may make sense in the long-term financials. Despite these caveats, in the current health care environment cost reduction remains the most significant factor associated with value creation and as such will serve as the primary focus of this paper.

Why Health Care Cost Continues to Grow and How Do We Contain It?

According to the Institute of Medicine, in 2009 the US spent $2.5 trillion on health care; of this, waste accounted for $765 billion, or 30 percent of those dollars. The waste in hospitals mirrors those in the US health care system. These include:

(AfforDABiliTy in hoSPiTAl cAre Delivery, continued on page 12)


1 2

• Unnecessary services—defensive medicine, unnecessary use of high-cost services

• Excessive administrative waste—duplicative costs of administering different plans, unproductive documentation

• Inefficiently and ineffectively delivered services—medical errors, uncoordinated care, and inefficient operations

• Missed prevention opportunities—poor delivery of clinical prevention services

Although most, if not all, hospitals in the US have been implementing some form of cost reduction initiatives, hospital care delivery costs continue to grow. Many of these improvement

efforts result in some positive gain, but the gain is often marginal, not resulting in a notable impact on the bottom line, and the efforts are ultimately not sustainable over time. Many cost reduction initiatives also resort to some sort of labor reduction due to lack of more effective strategies. This can result in inadequate staffing, which—when coupled with inefficient and ineffective processes—can create care delivery quality problems that further compound the issue of increased operating costs. Best practices and treatment guidelines from agencies and authoritative bodies such as professional societies exist in abundance to help guide treatment processes at hospitals, and if implemented correctly would reduce cost significantly. However, with the underlying challenge of inadequate staffing and/or inadequate type of staffing coupled with the lack of a sound cost reduction framework, many hospitals find it difficult to implement these best practices effectively. Hospitals often must devote their already limited resources reactively, such as putting out fires while tackling day-to-day operational issues. Even hospitals that have rolled out a structured methodology, such as Lean, often tackle small segments of the processes and do not address end-to-end process cycles. Thus, the suggested financial gains are not completely realized and are therefore unable to impact the hospital’s bottom line in a significant way.

Figure 1 shows the cost gap between “will cost” and “should cost” concepts. These are concepts borrowed from the Department of Defense (DoD). The DoD uses the “will cost” and “should cost” concepts in their Better Buying Power initiatives to incentivize productivity and reduce major program acquisitions cost. The use of “should cost” management allows the DoD to challenge the business-as-usual approach that program costs will inevitably grow and exceed current costs (Carter & Mueller, 2011). The concepts from the DoD can be applied to hospitals to force strategic identification of cost reduction opportunities, thus avoiding fragmented, reactive, and ineffective cost cutting initiatives. Closing the cost gap will require key hospital leadership to work from a disciplined “should cost” management framework, resulting in a paradigm shift in cost-cutting strategies for many hospitals.

Affordability Drivers and Improvement Approaches

With the “should cost” management framework, the DoD also strategically evaluates their major cost drivers using a brainstorming technique shown in Table 1.

The categories include resources, process, materials, services, and requirements. The SCAMPER approach (Eberle, 1996) is used as a creative brainstorming technique to help generate ideas to lower the cost or improve the quality of the services over time. In adapting the SCAMPER technique from the DoD, hospitals can ask brainstorming questions for each letter of the SCAMPER mnemonic as below (Table 2):

Process Model to Proactively Drive AffordabilityWith SCAMPER as a brainstorming technique to generate cost reduction ideas in order to achieve “should cost,” there is still a need for hospitals to have a structure with appropriate skilled leaders to drive this change. In the Executive Insight July

Figure 1: "Will Cost" vs. "Should Cost" Framework

Table 1: Identification of Major Cost Drivers Using SCAMPER

Category Drivers/Sources of Cost & Productivity Improvement Approaches

Resources • Labor• Facilities• Suppliers/Subcontractors

S—Substitute/Standardize

C—Combine

A—Adapt/Automate

M—Modify/Simplify

P—Put to Other Purpose

E—Eliminate

R—Reverse/Rearrange

Process • Core—Provide/Manage Patient Care

• Enabling/Support—IT, Finance, HR, Facilities, Materials

• Supply Chain• Procurement• Subcontracts• Reporting

Materials • Materials & Supplies• Pharmaceuticals• Equipment• IT Systems

Services • Internal & External Services

Requirements • Internal Process Requirements,

• Security• Government Regulations

(AfforDABiliTy in hoSPiTAl cAre Delivery, continued from page 11)


1 3

2013 article, the authors introduced an “affordability model” that can help hospitals identify and implement effective cost reduction initiatives in a comprehensive manner. This model was adapted from the DoD for the hospital industry and can help hospitals achieve a significant impact to their bottom-line. With this model, hospitals can actively seek out cost reduction opportunities using various strategies instead of the common

flat across-the-board cut applied to all departments that often include labor cuts, which as previously discussed, when coupled with existing ineffective and inefficient processes, can eventually hurt the hospital bottom-line in addition to quality.

Table 2: Examples of Affordability Actions

Affordability Approach Some Examples of Affordability Actions

Substitute • Can we substitute external labor for internal labor, i.e. outsourcing? Many hospitals have noted a favorable trend by outsourcing the labor to specialists in the field, i.e. food services, engineering/construction, environmental services, security, emergency department, anesthesia, information technology, etc. This has not only allowed overall cost reduction but has also allowed hospitals to refocus their already limited resources on core services.

• Can we substitute a costly drug with less costly ones that are just as effective in treating patients?

• For tasks that do not require a nursing degree, can we substitute the nurse with a clinical technician?

• Why do we only have multiple suppliers for a particular material or group of materials? Many hospitals have been able to leverage a single supplier for a best price in exchange for an exclusive arrangement. Conversely, are there times when several suppliers will increase competition to allow more favorable pricing?

Combine • Can we combine services within a hospital, or even between several hospitals? Hospitals have begun to combine managerial positions to promote flat organizational management to lower their cost.

• Example: One regional pharmacy director versus two directors overseeing two hospital pharmacy departments, one nursing director versus 3 nursing directors overseeing 3 patient care areas. It is very important to adequately provide for next level management resources to support the new structure, as this new structure could help to not only lower labor cost, but also help standardize and align services as these various operations are now under one leader.

Automate/Adapt • Can we use automation to improve the productivity and quality of services? Hospitals have utilized robots in compounding chemotherapy drugs, delivering supplies/pharmaceuticals, and even in performing surgeries. Already scarce skilled resources can then be deployed to clinical decision making and services. Bar code bedside scanners and pharmacy automation have also been successfully used in many hospitals to reduce medication errors and improve efficiency.

• On a more strategic level, can we adapt a new strategic cost reduction model that has been proven to be effective in another industry?

Modify • Can we modify/streamline/standardize processes to improve efficiency? With CMS requiring hospitals to improve on core measures such as congestive heart failure and acute myocardial infarction, many are forced to look for best practices to modify their current processes to meet core measure metrics.

• Beside the “must do” core measure metrics, can hospitals look at other disease states, i.e., high cost diagnosis like sepsis, and modify their processes to meet “should cost” dollars?

• In evaluating services to provide “value-added” to the customers, can hospitals modify certain roles to create more value?

Put To Other Use • Can we use a pharmacist in a different role to help drive quality of care delivery? Hospitals that have decentralized their pharmacists to the nursing floor have seen improved care through better communication with physicians, nurses and patients. Pharmacists can also be put to use as process improvement leaders to drive clinical effectiveness initiatives in hospitals.

• As information technology has a great impact on nursing work flow, can selected nurses be put to use in a different role as nurse informatics? Likewise, selected physicians such as Chief Medical Information Officers can also drive information technology changes at a high level. Equipment and hardware, if no longer needed in a department, can be modified and put to use in other departments. Processes, once perfected in one area, can also be modified and put to use in another department.

Eliminate • If a service is not producing clinical outcome or financial gain, do we need to continue this slow death, or can we courageously “cut the limb so the tree can survive”? This opportunity is often overlooked by many hospitals as “letting go” is difficult emotionally for many hospitals, as well as other industries.

• One elimination that hospitals embrace is the idea of elimination of waste, i.e. extra steps of a process that do not provide value by creating re-work, long waiting time, staff sitting idle without producing work, etc. Despite widespread acceptance of this principle, most hospitals have not fully reaped the potential savings from waste elimination due to lack of effective waste reduction methodology and the right personnel to drive change. The Lean and /or Lean Six Sigma methodology can be deployed in this area as a tool to enable waste reduction/elimination effectively.

Reverse/Rearrange • Can we reverse or rearrange steps of a process to improve workflow?

• Should the initial step remain the initial step, or should the order be different?

• In storing supplies, should the supplies be rearranged in an order that would minimize staff movement?

• Should appropriate labor resources be placed early in the process versus later in the process to ensure work is done “right the first time”?

• Can interdependent departments be moved closer to each other to facilitate information flow? Can departments/services that are needed on an out-patient basis be relocated to areas that are more noted/easily found by patients?

• Can equipment in a patient room be rearranged to prevent falls, accidents?

(AfforDABiliTy in hoSPiTAl cAre Delivery, continued on page 14)


1 4

The framework requires the hospital to establish an Affordability Director position as a clearinghouse for all cost reduction initiatives. The Affordability Director captures affordability ideas, builds the business case, develops project plans with a multi-disciplinary team, executes the plan with teams, and is responsible for producing the bottom-line impact for the hospital. The affordability model creates a pipeline of projects covering a wide range of cost opportunities. A smaller number of projects are then selected from the pipeline, which has the greatest potential for cost reduction for project execution. The cost savings from these projects should yield a return-on-investment of at least 20–30 times the cost of the investment. Figure 2 below shows the proposed Affordability Process Model.

The skill set of the Affordability Director will require not only knowledge of project management, finance, process improvement, but also clinical medicine. Traditional thinking might assume only financial acuity is needed for this position. With an abundance of literature showing clinical ineffectiveness as being one of the major factors of increased cost in hospitals, the addition of clinical familiarity as a skill set will be needed to facilitate the management of the affordability more effectively.

Given labor resources being a challenge for hospitals, hospitals might choose to test this model out by utilizing an existing director for 6–12 months. If executed appropriately, the financial savings will more than cover the cost of the position.

Summary and ConclusionCompared to the traditional model of each department trying to cut cost reduction arbitrarily, or working on one segment of the process/area at a time with the consequence of a less-than-projected financial outcome, this proposed affordability model, coupled with the SCAMPER brain storming technique, will allow hospitals to achieve significant improvement in their bottom-line. This model requires a dedicated resource to serve as an Affordability Director to systematically generate cost reduction opportunities for the hospital and to then execute with teams to arrive at the desired financial results.

For the proposed model to be effective, it is important that the dedicated resource has the skill set of project management, finance, team facilitation, and clinical familiarity. As cost cutting often carries a negative image to staff and physicians, it is equally important that efforts are made to tie any initiative to positive clinical outcomes for the patient and an improved experience for stakeholders. Quality metrics should be monitored closely during any cost reduction project to ensure that there is no diminution of quality as an unintended consequence of the initiative.

Manage and maintain balanced portfolio of affordability projects

Figure 2: Proposed Affordability Process Model

(AfforDABiliTy in hoSPiTAl cAre Delivery, continued from page 13)


1 5

ReferencesCarter, A. B., & Mueller, J. (2011). AT&L: Better Buying Power, September.

Eberle, B. (1996). Scamper: Creative games and activities for imagination development. Waco, TX: Prufrock Press Inc.

Le, E. H., Audett, J., Le, M., & Duffy, G. (2013). Applying affordability to strategic cost reduction in hospitals, Executive Insight, July, 13–15, 42.

Organization for Economic Co-operation and Development. (2010). OECD health data, OECD Health Statistics (database). doi: 10.1787/data-00350-en (Accessed on 14 February 2011).

Eric Hung Le is currently the Sector Lead of Affordability and Lean Six Sigma Master Black Belt at Northrop Grumman Information Systems Sector. Dr. Le holds a PhD in mathematical statistics from George Mason University and a Wharton MBA in finance and management. He has authored and presented over 30 technical papers in the areas of intelligent simulation, statistical methods and applications, and Lean Six Sigma.

Michelle Le is the Regional Director of Pharmacy, overseeing the pharmacy departments at Inova Alexandria Hospital and Inova Mount Vernon Hospital in Northern Virginia. She is a certified

Black Belt. Dr. Le received her Doctor of Pharmacy degree at Xavier University and completed a residency program at The Johns Hopkins Hospital.

Donald Joseph Brideau Jr. is currently the Chief Medical Officer/VPMA and Interim CEO at Inova Mt Vernon Hospital, Alexandria, Virginia. He is also president of and a practicing family physician at Springfield Family Medicine, Ltd, as well as president of ProHealth Corporation. Dr. Brideau received his medical degree from George Washington University School of Medicine and a master’s degree in medical management from the Heinz School of Public Policy and Management, Carnegie Mellon University.

John R. Audett currently serves as the Chief Medical Officer at Inova Alexandria Hospital. Dr. Audett received his medical degree and residency training in internal medicine from St. Louis University and an MBA from the University of Rhode Island. His primary administrative interest is clinical effectiveness as it contributes to the value equation.

Quality Management Journal PreviewQMJ vol. 21, no. 1 Executive BriefsAs a continuing feature of the QMF, we are showcasing the most recent articles in our sister publication, the Quality Management Journal (QMJ). The QMF focuses on the practical application of quality principles, and the QMJ focuses on the research aspect of quality. We hope that you will visit their website and begin the synthesis process of merging theory with application to advance the field of quality. http://www.asq.org/pub/qmj/index.html

The QMJ provides relevant knowledge about quality management practice that is grounded in rigorous research. They seek:

• Empirical articles that provide objective evidence concerning actual quality management practice and its effectiveness.

• Research case studies that consider either a single application or a small number of cases.

• Management theory articles that present significant new insight and demonstrated practice.

• Review articles that create links to the existing academic literature and aid in the development of an identifiable quality management academic literature.

Here is a summary of their most recent articles.

Lean Healthcare and Quality Management: The Experience of ThedaCareMelissa Mannon

ThedaCare is an integrated healthcare delivery system in Wisconsin, with five hospitals and 27 physician clinics. The orga nization realized that changes taking place in the industry, such as consumer demand for improved outcomes and pressure on providers and payers to reduce costs, called for a new methodology—Lean.

Lean implementation at ThedaCare changed the role of qual ity management from a system that was reactive to quality issues to one that proactively pursues methods, processes, and strategies to improve quality for the patient and prevent any future crises. In this article, the author provides her perspective about the role of the quality man ager in ThedaCare after adopting lean operations.

Leadership for Quality and Innovation: Challenges, Theories, and a Framework for Future ResearchJohn R. Latham, University of Northern Colorado

While there are many concepts that make up many different lead ership theories, there is not much consensus as to what constitutes effective leadership. The current knowledge about

(QuAliTy MAnAGeMenT JournAl PrevieW, continued on page 16)


1 6

leadership consists of narrow definitions of leader effec tiveness that are disconnected from their context, so the application to practice is difficult.

In this article, the author pro vides his perspective regarding the need for quality management researchers to examine leadership issues in quality management. He notes that failure of leadership researchers to achieve convergence on a basic theory is an opportunity for other researchers to reframe how one measures leadership and incor porate it into the current theories of quality management. He says there is a need for theories that explain how leaders can create value for multiple stakeholders, and a need for the courage to throw out the the ories that do not.

Impact of ISO 9000 on Business Performance in Pakistan: Implications for Quality in Developing CountriesMahnaz Fatima, Institute of Business Administration, Pakistan

Quality has always been essential for businesses to be competitive and successful, regardless of the mar ket the organization operates in. In recent years, a large number of firms in Pakistan have been seek ing ISO 9000 certification to either compete in international markets or to compete with imported products as the demand for products made by ISO-certified companies increases. But the question is whether ISO 9000 has had a favorable impact on the financial performance of ISO-certified companies in Pakistan.

Prior research has demonstrated that ISO helps in the pursuit of excellence and has been success ful in a large majority of small and medium enterprises. The impact of ISO 9000, however, varies across organizations and external market pressures. Firms benefit only if they genuinely adopt the quality phi losophy and improve their internal business processes.

The author researched how ISO 9000 implementation has affected business performance by studying ISO 9000 adoption and financial performance in Pakistan. She sur veyed 95 companies and found mixed results. ISO 9000 improved financial performance in medium and large firms in Pakistan, but it did not improve performance in small firms.

An Information Processing Perspective of Process Management: Evidence from Baldrige Award Recipients Matthew W. Ford, Northern Kentucky University; James R. Evans, University of Cincinnati; and Suzanne S. Masterson, University of Cincinnati

The concepts of processes and process management are central to quality management. But how does process management affect performance? In their study, the authors of this article

employ information processing theory to conceptualize process manage ment as a means for coping with information processing demands under varying degrees of uncer tainty. The authors propose that as the amount of uncertainty surrounding an organization’s task environment increases, per formance should benefit from managing processes to progres sively higher degrees of maturity. To do this the authors explore the validity of their conceptual frame work using data feedback reports of 11 past recipients of the Malcolm Baldrige National Quality Award that included each of the award categories except manufacturing.

By employing an informa tion processing perspective, the authors offer a fresh perspective for both practitioners and scholars by framing process management/performance as an approach that can be progressively deployed to develop mature processes that better meet the information pro cessing needs of organizations. The authors conclude that informa-tion processing theory does provide a useful framework for explaining the relationship between process management and performance, although future research is needed to clarify the role of process man agement in turbulent contexts.

Linking Quality Practices to Knowledge Management Capabilities in HealthcareKathleen L. McFadden, Northern Illinois University; Jung Young Lee, Northern Illinois University; Charles R. Gowen III, Northern Illinois University; and Barton M. Sharp, Northern Illinois University

While recent research on administrative process innovation has found that practices designed to capture and create knowledge resources during Six Sigma proj ects can improve the performance of process innovation projects, the link between knowledge resources and general administrative pro-cess initiatives has not been well examined. And, it remains unclear whether different types of admin istrative innovation initiatives can directly relate to building organi zational knowledge management capabilities, which in turn could associate with patient safety learn ing outcomes.

The study the authors con ducted attempts to examine the issues from the context of health care organizations by focusing on two popular administrative or process innovation practices, specifically continuous quality improvement and Six Sigma ini tiatives. The authors collected survey data from a sample of 273 U.S. hospitals. Results indi cate that a three-stage knowledge management process mediates the relationship between qual ity improvement initiatives and patient safety learning. The results of this study provide new insight into the relationship of knowledge management capabilities and quality initiatives in healthcare.

(QuAliTy MAnAGeMenT JournAl PrevieW, continued from page 15)


1 7

Book ReviewBy Bruce Johnson

Quality Function Deployment and Lean Six Sigma Applications in Public Health By Grace L. Duffy, John W. Moran and William J. Riley.

I have enjoyed several previous works by these authors, and this book was no exception. The book was clearly written and the concepts followed a natural progression throughout the chapters. The goal of the book, as the title suggests, is to introduce the public health professional to the concepts, tools, and techniques of quality function deployment (QFD) and Lean Six Sigma (LSS) and to illustrate how the these methods can be used to solve problems and redesign processes.

The first three chapters introduce the reader to basic quality improvement concepts, quality function deployment and Six Sigma. The authors don’t assume any preexisting level of quality expertise, and they provide a good foundation for the non-quality professional. The method of analyzing an organization in terms of its macro, meso and micro levels of operation is explained and integrated with strategic planning, QFD, and LSS. These concepts are a recurring theme and are woven throughout subsequent chapters. Specific public health examples are also provided to illustrate the methods and tools.

Chapter 4 expands upon and reinforces the importance of understanding your internal and external customers and develops the idea of critical to quality (CTQ) factors. Tools such as flow charts, relationship models, process-customer relationship matrixes, QFD, and cause-and-effect diagrams are employed to illustrate how customers can be differentiated in order to better understand their wants and needs.

The next five chapters (5–9) elaborate further on the basic concepts introduced earlier and provide detailed examples, charts and graphs to illustrate their points. Step-by-step instructions are included on how to create a process map and analyze current and future states to eliminate the eight types of waste. Illustrations are included from the authors’ experience to

clarify the concepts, which helps keep a nice balance between the academic and “real world” information. The concept of the “cost of quality” is introduced with specific tools that can be used to determine operational, prevention, appraisal, and failure costs (PAF Model). The use of QFD to develop milestones and performance measures is discussed, along with efforts by the Public Health Accreditation Board and the Public Health Foundation to develop performance measurement and assessment tools. The inclusion of these references, as well as the endnotes, provides the reader with valuable resources for further reading and information. Rapid cycle improvement projects, project management, and the DMAIC method are examined to show how they can be used to create an infrastructure for managing improvement efforts and focusing public health departments’ resources. Chapter 10 compares and contrasts the concept of incremental improvement versus redesign strategies.

The last three chapters of the book (11–13) provide a detailed treatment of how to conduct a QFD LSS project. They start by discussing the forming, storming, norming, performing, and adjourning stages of team development and illustrate how they relate to the “house of quality.” They provide details on how to conduct a QFD study and create four cascading houses of quality to analyze departmental, functional, process, and implementation operations. Specific diagrams, charts, and tables are included to illustrate the points with public health examples.

Overall the book is very well organized and the concepts well integrated, with a consistent writing style and smooth transitions from one chapter to the next. Each chapter starts with a brief introduction and ends with a summary and endnotes that include references. The key concepts of QFD and LSS are carried throughout the book and integrated with the content of each chapter to emphasize their relevance. I would recommend this book to quality professionals who want to brush up on their QFD, and professionals entering the world of QFD and LSS for the first time. However, it is a must read for public health service professionals who are new to quality.

Bruce Johnson is the president of Johnson Consulting Services, LLC. He specializes in strategic planning, process improvement, and project management for health care, social service, and government organizations. He can be reached at [email protected] or (513) 223-6871.


1 8

Book ReviewBy Robert Spencer

The Business Process Management Guidebook: An Integrated Enterprise Excellence BPM System. Forrest Breyfogle III Austin, TX: Citius Publishing, 2013

Business Process Management (BPM) is a methodology for identification, documentation, alignment, and management of strategically critical processes throughout the organization. With BPM there is an orchestration of performance and quality metrics that promotes doing the right activity at the right time to create and drive value for customers.

This guidebook presents the details on how to conduct Business Process Management from a strategic Enterprise Process Management (EPM) perspective. A “How to Do It” directional strategy is clearly communicated in what Breyfogle calls Integrated Enterprise Excellence (IEE, or “I double E”). IEE is an understandable roadmap to design, establish, and conduct BPM. Breyfogle refers to this strategy as IEE BPM/EPM. In effect, IEE is the methodology to integrate BPM with EPM. IEE provides the framework to develop metrics and enterprise-wide performance measurement scorecards that drive business improvements, innovative efforts, and increased profits.

Breyfogle introduces this guidebook with the statement, “Organizations need to establish an orchestrated business process management system that continually moves them toward achieving the 3Rs of business, i.e., everyone doing the Right things, and doing them Right, at the Right time.” A BPM system must help executives create a long-lasting organizational culture that is independent of people, personalities, and business circumstances. Wise use of the IEE roadmap, with a focus on enterprise-level metrics, offers organizations a standardized structure to improve productivity, increase flexibility, and promote better decision-making to benefit the whole enterprise.

Lean and Six Sigma practitioners will find this guide full of useful examples and explanations for applying traditional process-focused efforts to the enterprise level. Five key BPM goals are presented to help in this transition:

1. A system for managing the business using effective scorecards and action plans to keep business processes in alignment with strategic organizational needs identified in the IEE value chain (this value chain is a description of what an organization does and how it measures its performance).

2. An enterprise analysis process to identify performance gaps and focus areas that lead to whole-system success. Needs should flow out of the organization’s vision and mission; often, performance metrics are required first to establish the correct strategies.

3. Implementation of a robust improvement methodology that ensures timely gains in overall enterprise performance (improved management governance and innovation driven through IEE).

4. Clear and actionable performance metrics, including realistic, time-based financial objectives, enterprise rules that are managed through the IEE value chain, and targeted analytical and innovative strategies aligned with operational value chain performance goals.

5. Successful improvement projects that include metric improvements that positively impact the enterprise as a whole and embrace systematic day-to-day management controls to sustain gains and improved performance.

In the diagram on the next page, Breyfogle presents the IEE Enterprise Process Management 9-step system. Notice that these steps follow the traditional DMAIC process; however, there is a focus here on the entire enterprise through using 30,000-foot-level metrics, determining recent region of stability (to allow accurate predictions), and reporting numerical values of process capability.

Working through these nine steps will require understanding in each of these areas.

Measurements—Use measurement tracking tools in EPM to monitor performance, which provides insights on whether the process is adequate (Has BPM improved the process or not?).

Process Workflow Effectiveness—Lean, Six Sigma, PDCA, and other quality methods are recommended to improve the existing BPM application or improve processes if the workflow performance is inadequate.

Rules—Develop process management rules and verify their adequacy to ensure a good final process before applying BPM improvement and automation tools.

Process Design—New processes need efficient and effective workflows that include meaningful specifications and integrate effectively with other processes.

Process Analysis and Modeling—Ensure that new processes will perform well as the business grows and future problems arise.

Process Management Plan—Ensure that identified process metrics are adequate to manage the process.


1 9

From Figure 4.4. The Business Process Management Guidebook: An Integrated Enterprise Excellence BPM System, Forrest W. Breyfogle, III, Citius Publishing, ©2013

From Figure 7.2. The Business Process Management Guidebook: An Integrated Enterprise Excellence BPM System, Forrest W. Breyfogle, III, Citius Publishing, ©2013

(Book revieW, continued on page 20)


2 0

Process Automation—Determine if an IT solution is appropriate for the process that will fulfill the needs of process monitoring.

Relevant to the topic of health care in this edition of the Quality Management Forum, the IEE value chain above for a hospital highlights a drill down to a 30,000-foot-level metric report, where arrows describe IEE value chain drill downs.

The BPM ScorecardBreyfogle makes a case for a different perspective in using scorecards. He states, “A scorecard helps manage an organization’s performance through the optimization and alignment of organizational units, business processes, and individuals. A scorecard can also provide goals and targets, which helps individuals understand their organizational contribution. Scorecards span the operational, tactical, and strategic business aspects and decisions.” These scorecards report on enterprise performance using 30,000-foot-level operational

metrics and satellite-level metrics (financial metric) to focus on determining whether a process is stable, and if so, reporting on how the process is performing in meeting the needs of the business. Scorecards should show process variability to confirm a recent region of stability from which accurate predictions can be made. If the scorecard metric has a specification requirement, then capability can be displayed as a nonconformance percentage or DPMO (i.e., using the current process, deliveries will be late about two percent of the time). If the metric does not have a specification requirement, then capability can be displayed in terms of the median response and 80 percent frequency of occurrence rate (i.e., using the current process, the predicted monthly profit margin will average about 14 percent, and 80 percent of the monthly reported values will be between 10 percent and 18 percent).

At this point we have only begun to present the features of the IEE BPM/EPM system. A series of book reviews will follow to explore more fully the data analysis and execution techniques provided in IEE BPM/EPM to direct process management implementation. Through the methodologies and examples in the following books, the Lean Six Sigma practitioner can move toward achievement of the three Rs of business—everyone doing the Right things, and doing them Right at the Right time.

The integrated enterprise excellence system: An enhanced, unified approach to balanced scorecards, strategic planning, and business improvement. (2008).

Integrated enterprise excellence volume I—the basics: Golfing buddies go beyond Lean Six Sigma and the balanced scorecard. (2008).

Integrated enterprise excellence volume II—business deployment: A leader’s guide for going beyond Lean Six Sigma and the balanced scorecard. (2008).

Integrated enterprise excellence volume III—improvement project execution: A management and black belt guide for going beyond Lean Six Sigma and the balanced scorecard. (2008).

Integrated enterprise excellence improvement project execution volume III—improvement solutions manual: A management and black belt guide for going beyond Lean Six Sigma and the balanced scorecard. (2009). (Includes over 140 Minitab datasets on CD demonstrating process DMAIC analyses and conclusions).

Lean Six Sigma project execution guide: The integrated enterprise excellence (IEE) process improvement project roadmap. (2012).

Additional resources and training are offered on Breyfogle’s website: www.smartersolutions.com

Robert Spencer is the editor of the Quality Management Forum

A New QMD Sub-Group on Linkedin!Having just launched in 2012 the “Organizational Excellence Technical Committee,” the OETC Linkedin Group now has over 350 members from 42 countries participating in rich, experiential discussions on various Excellence Frameworks.

Are you interested in the use of excellence criteria such as Baldrige, EFQM, and others to help organizations of all types attain higher levels of performance? Then join the QMD's Organizational Excellence Technical Committee (OETC) on Linkedin. The OETC goals are to be a reference point on excellence frameworks and models; to contribute to a body of knowledge on excellence models; to promote the use of international, national and local excellence programs; to share case studies, lessons learned, and success stories about performance; to make assessment tools available; and to show how quality methods and tools integrate with excellence models. Also visit our webpage for a list of resource materials at http://www.asq-qm.org/organizational-excellence.

(Book revieW, continued from page 19)

2 1

The Laws of Simplicity*By Russell T. Westcott

Author John Maeda, graphic artist-designer, computer scientist, and MIT professor, presents simple but not simplistic insight about making things simple. His real life examples hit the troublesome complexities most of us encounter and abhor. A theme in his philosophy-mixed-with-engineering orientation is achieving balance between the perfectly simple and the extraordinarily complex. Ten laws are discussed:

1. The simplest way to achieve simplicity is through thoughtful reduction.

2. Organization makes a system of many appear fewer.

3. Savings in time feel like simplicity.

4. Knowledge makes everything simpler.

5. Simplicity and complexity need each other.

6. What lies in the periphery of simplicity is definitely not peripheral.

7. More emotions are better than less.

8. In simplicity we trust.

9. Some things can never be made simple.

10. Simplicity is about subtracting the obvious, and adding the meaningful.

Expanding on his ten laws, Professor Maeda observes that technology has made our lives fuller, yet we’ve become uncomfortably full. When in doubt, remove—but be careful what you remove. When reduction of a system’s functionality is achieved without penalty, he suggests three additional methods: shrink, hide, and embody (SHE). “Any design that incorporates lightness and thinness conveys the impression of being smaller, lesser, and humbler.”

A VCR on which I continually fail to satisfactorily record a television program, in spite of re-reading the 40 pages of instructions over and over and attempting to understand the multi-function knobs and buttons, exemplifies my technical incompetence and the lack of useful explanations of how to use the device for the purpose intended.

“As style and fashion have become powerful forces in the cell phone market, handset makers have been pushed to find the balance between the elegance of simplicity and need-it-all complexity.” Should they hide some functions behind covers until it is really needed?

Does adding more features enhance the perception of quality or degrade the product to a point of uselessness and inconvenience? Where does having the latest-and-greatest override ease of use?

It is implied that organizing what goes with what and where aids simplicity. Or does it? Consider the design of the aspirin bottle of one manufacturer. To prevent access by children the bottle design has undergone redesign so that an adult’s hand pressure downward before twisting the cap is needed to prevent a young child from getting into the bottle. But what about the adult with severe arthritis or other disability, such as not being able to read the instruction printed in a font size and color nearly invisible? An adult wanting regular removable caps for prescription meds has to specify “no childproof caps” to the pharmacist, or else have a meat cleaver available at home to chop off the caps (as my mother did when the childproof-caps became law).

Some people no longer wear a watch because shrinking time can only go so far, leading to hiding references to time from the environment. However, cell phones

and computers defeat that action. The introduction of progress bars has tended to mediate the discomfit of waiting.

“Without the counterpoint of complexity, we could not recognize simplicity when we see it.” “More complexity in the market makes a simpler product stand out.” The rhythm of simple and complex captures our attention.

“Nothing is an important something…When there is less, we appreciate everything much more.” “Complexity implies the feeling of being lost; simplicity implies the feeling of being found.” “…fulfillment from living a meaningful life is the Return on Emotion...more is always better than less—more care, more love, and more meaningful actions.”

“Trusting a power greater than our own …is ingrained from birth when the adults that care for us provide the ultimate experience of simplicity.”

The “Return On Failure when trying to simplify is to learn from your mistakes”

A final tenet: “Technology and life only become complex if you let it be so.” I hope to remember that advice when my next computer glitch occurs, tomorrow most likely! Read this great little book.

*Publisher: The MIT Press, Cambridge, MA, 2006. 106 pages. See lawsofsimplicity.com for more.

Russ Westcott is an ASQ Fellow, CQA, and CMQ/OE. He is editor of the ASQ Certified Manager of Quality/Organizational Excellence Handbook, 4th ed. and a co-editor of the ASQ Quality Improvement Handbook. Russ instructs the ASQ CMQ/OE refresher course.

Reach Russ at [email protected] or R.T. Westcott & Associates, 263 Main Street, Suite 100, Old Saybrook, CT 06475.

QMF Book Summary


2 2

To see a QMD organization chart and complete roster of QMD officers, committee chairs, and volunteers, go to the QMD Organization pages on the QMD Web site at www.asq-qmd.org .

ChairMilt KrivokucaCell: (949) 892-7994E-Mail: [email protected]

Chair ElectKenneth F. SadlerSadler ConsultingOffice Phone: (902) 835-7482Fax: (902) 835-7482E-Mail: [email protected]

Past ChairJd Marhevko,JQLC, Inc.Principal ConsultantOffice/Cell: (419) 704-5603 E-Mail: [email protected]

SecretaryPeggy MilzL3 Communications—Crestview AerospaceOffice Phone: (850) 682-2746 ext. 568Fax: (903) 457-9883E-Mail: [email protected]

TreasurerSandra LowOffice Phone: (902) 827-3676E-Mail: [email protected]

Vice-Chair, MembershipJanice A. TuckerQuality Manager—MetaldynePhone: (734) 604-7354E-Mail: [email protected]

Vice-Chair, MarketingEllen C. QuinnQuality Programs ManagementNorthrop GrummanOffice Phone: (703) 907-4060Cell: (240) 606-2814E-Mail: [email protected]

Vice-Chair, Print InitiativesRobert SpencerCalifornia State University, Dominguez HillsOffice Phone: (314) 395-3383E-Mail: [email protected]

Vice-Chair, Face-to-Face InitiativesBill HackettValley Psychiatric Service, Inc.Cell: (508) 561-9336E-Mail: [email protected]

Vice-Chair, e-Blast InitiativesRonald L. MeierIllinois State UniversityOffice Phone: (309) 438-2905E-mail: [email protected]

Vice-Chair, OperationsJerry RiceOffice Phone: (573) 248-1707Cell: (217) 779-7605E-Mail: [email protected]

Vice-Chair, Technical CommitteesClaud RusseyFusion QHSEOffice Phone: (832) 282-0245E-Mail: [email protected]

QMD Officers

ADVISORY COUNCIL (WOW MENTORS)

R o n B a n eBil l D e n n e y

A r t Tr e p a nie rG r ac e D u f f y

J ac k M o r a nR u s s We s t c o t t

D a v id L i t t le

By Invitation Only

TREASURER

S a n d r a L o w CHAIR-ELECT

K e n S a dle rPAST-CHAIR

J D M a r h e v ko

DEPUT Y TREASURER

O p e nCONFERENCE / ICQI CHAIR

H e a t h e r M c C ain D a v id L i t t le

ARRANGEMENTS CHAIR

A n n e M o y e r

QMD AUDIT CHAIR

Dic k M a t t h e w s

AUDIT SUP T

D e a n B o t t o r f f

Program ChairMike EnsbyThane Russey- Gayle Norman

Speakers List ChairSteve Bogar- James Head

VICE-CHAIROPERATIONS

Jerry Rice

Operations Manual ChairJd Marhevko

CMQ/OE Exam Chair (Cert Board Committee)Karen Ambrosic-Tolf

CMQ/OE Exam Liaison (Workshops)Karen Ambrosic-Tolf

By-LawsDavid Little

DEPUT Y VICE-CHAIR OPERATIONS

Karen Ambrosic-TolfMichael Hirt

TECHNICAL COMMIT TEE CHAIRS

Operational Excellence ChairPrashant Hoskote

Project Management ChairJohn Iverson

Enterprise Risk Management ChairRon Meier

Healthcare ChairGrace Duffy

Finance & Governance ChairJd Marhevko

Standards ChairDenise Robitaille

Innovation & Value Creation ChairOpen

Professional Development ChairRuss Westcott

DEPUT Y VICE-CHAIR CONFERENCE AND EVENTS

Bill Hackett

VICE-CHAIRCONFERENCE AND EVENTS

Heather McCain

Marketing Communications CoordinatorEllen Quinn Interim

Partnership LiaisonDoug Wood

VICE-CHAIRMARKETING

Ellen Quinn

VOC ChairDennis LappOpen

Volunteer ChairCarol Beauchesne

Education ChairOpen

VICE-CHAIRMEMBERSHIP

Jan Tucker

Forum EditorRobert Spencer- Elizabeth Cudney

Editorial Review ChairDenis Leonard

VICE-CHAIRPRINT INITIATIVES

Robert Spencer

3rd Party Web HostSubscribed Service

Discussion Board ModeratorGeoffery Withnell

Web Reviewere-Blast Content ChairThane Russey

DEPUT Y VICE-CHAIR E-BL AST

Diane Dixon

VICE-CHAIRE-BL AST

Ron Meier

Social Sites

VICE-CHAIRE-BASED INITIATIVES

Thane Russey

QMD CHAIR

M il t K r i v o k u c a

SECRETARY

P e g g y M il z

DEPUT Y SECRETARY

O p e n

India Executive DirectorVineet Sharma

Egypt & Middle East Executive DirectorShady El-Safty Baher

Hong Kong Regional Executive DirectorSarah Mak

Mexico Executive DirectorOpen

Brazil Executive DirectorOpen

China/East Africa Executive DirectorRichard Feng

DEPUT Y VICE-CHAIR GLOBAL

Denis Devos

VICE-CHAIRGLOBAL

Bill Denney

VICE-CHAIRBUSINESS

DEVELOPMENT

Michael Mladjenovic

DEPUT Y VICE-CHAIR PRINT INITIATIVES

Troy Burrows


2 3

Coach's CornerBy J. R. McGee

Tools Versus Teams— Finding the Right BalanceRecently, I attended the ASQ Conference held in Tucson, Arizona. I had the opportunity to talk with many people about issues and challenges facing the quality profession. During dinner one evening, I had the privilege of dining with two people whom I hold in very high regard, Grace Duffy and David Little. If you ever get the chance to spend time with either of these two, take it! David is a fantastic resource for “Words of Wisdom,” as is Grace. And she is incredibly funny to boot! After dinner, our talk turned to a topic I believe should be of interest to each of us as quality professionals: the degree of focus we place on our tools versus teams and people. I’ve had a chance to talk with many of you at conferences and meetings across ASQ, and this topic comes up with dependable regularity. Several of you have even told me, “You spend too much time on ‘fluff ’; you should spend more time helping people learn more about the quality tools.” Fair enough! The thing I like most about being around large groups of very talented people is that there are more than enough opinions and beliefs to go around, and all of them have some degree of legitimacy. What some consider “fluff,” I consider the quintessential element that determines our ability to be a successful force for change in any organization. Something to consider is that some executives perceive quality managers who excel at team-based problem solving as a highly valued resource with a “seat at the table.” Too strong a focus on “just tools” runs the risk of being viewed as a “cost center” who only tells business leaders what they can’t do. Different views, different perspectives. Viva la difference!

Before I get controversial (and I will), let me fully acknowledge that we need our tools and techniques. Without them we would not be effective in our workplace, nor could we deliver the results that key leadership depends upon in order to make timely and effective decisions. I love

working with our toolset and have been leading efforts to “push the envelope” on how and where we can use them even more effectively in areas where they have traditionally been thought not to apply. Areas such as conducting Gage R&R studies on performance appraisals, and developing a modified DOE approach without software that allows people with no training in these tools to get an extremely effective result in a transactional process in hours instead of weeks. So do not think for one second I am belittling our technical capabilities or our long history of developing cutting-edge toolsets.

What I am saying is that many of us are too focused on the technical aspects of our profession. As a result, we may not be nearly as skilled with the influential toolset we need in order to be truly effective in our organizations. As Grace said, “the soft stuff is the hard stuff!” I have found many situations where highly skilled and superbly trained people generate a detailed report that is technically precise, mathematically elegant, and completely ignored. It doesn’t make any difference how well you know and can use statistical analysis or data evaluation; if you can’t work with people to help them make effective decisions or influence them to choose the best course of action, you are deluding yourself that you are doing a good job. Think about it people . . . we are the Quality Management Division! Out of the 26 Divisions of ASQ, ours has the charter most closely aligned with helping quality professionals become truly effective business people who have a seat at the table when momentous decisions are made in our organizations. For too many of us, not only do we not have that seat, we sometimes don’t even find out a decision has been made until it is too late to alter it when we know we could have helped them make a better choice.

I believe we should be offering (and taking) more classes and training sessions on the softer skills sets designed to help us become

more influential, more attuned to learning how people think and react and learning how to help our members (and ourselves) become more effective at communicating and leading. The data themselves are “things” artifacts. Data are one element of decision-based management. Of far greater importance is how we use the knowledge found in the data to influence decision makers, guide them to “truth,” and help them provide greater value to our customers in business and our patients in health care. It is only when we can use data to effectively influence others that we fully achieve our potential and responsibility as quality professionals.

For those of us who find we only want to play with numbers and crunch statistics, there are other forums and organizations. The Lean and Six Sigma Divisions in particular are appealing and highly focused specifically on those areas of interest. I am a member of both and I highly recommend them to you. But for quality management professionals, we owe it to ourselves and our organizations to be as well rounded and as fully capable as we can possible become if we are going to achieve our own personal performance goals and affect our people to greatest effect. To that end, I believe we need to strengthen our soft skills, our leadership focus, and provide even more training and developmental opportunities in this arena.

I promised you we were going to go in a more controversial direction with this column! I eagerly await your comments and opposing opinions at [email protected].

J. R. McGee Managing Partner and CEO 1248 Queen Street, Pottstown Pa 19464 610-212-6728 A Service-Disabled Veteran-Owned Small Business www.xstreamleadershipgroup.com

http://www.linkedin.com/pub/j-r-mcgee/5/470/5b1/

2 4

Quality Management

Division

American Society for Quality, Inc.Customer Service Center600 N. Plankinton Ave.Milwaukee, WI 53201-3005

Every quarter, the Forum can convey your advertising message to over 20,000 Quality Management Division members. These members include many of ASQ’s

quality executives, managers, supervisors, and team and project managers. Most are decision makers or influencers for products and services such as:

√ Consulting √ Training Publications √ ISO Registration√ Conferences √ Business Shows √ Software ... and more

For information on advertising in the Forum, contactRobert Spencer, Editor, at rspencer@csudh .edu .

Advertise in The Quality Management Forum

If you provide products or

services to the quality

profession, The Quality

Management Forum

will help you reach your target

market .

Quality Management Division Vice-Chair, Print Initiatives

Robert Spencer

Quality Management Forum EditorRobert Spencer

Chair, Editorial Review BoardDenis Leonard, Business Excellence Consulting

Editorial Review BoardHank Campbell, Professor Emeritus, Illinois State UniversityMark R. Chandler, Federal Highway Administration

Eleanor Chilson, Chilson Quality ServicesDeepak Dave, Bobcat—Ingersoll Rand Company

William Denney, Quality Texas FoundationMac McGuire, McGuire & Associates Consulting

Pradip V. Mehta, Mehta Consulting LLCNestor (Nick) Ovalle, CEO & Principle Consultant of PI Consult

Oz Rahman, Rayovac/Varta BatteryMatthew J. Roe, Dow Chemical

Mustafa Shraim, SQPS LtdGabriel Smith, John Deere

Chad Vincent, Baxter Health CorporationRobert J Vokurka, Texas A&M University—Corpus Christi

Jeanette Wilde, Los Alamos National LaboratoryConsulting EditorDave Roberts, PhD

The Quality Management Forum is a peer-reviewed publication of the Quality Management Division of the American Society for Quality. Published quarterly, it is QMD’s primary channel for communicating quality management information and Division news to Quality Management Division members. The Quality Management Division of ASQ does not necessarily endorse opinions expressed in The Quality Management Forum. Articles, letters and advertisements are chosen for their general interest to Division members, but conclusions are those of the individual writers.

Address all communications regarding The Quality Management Forum, including article submissions, to:

Robert Spencer, Adjunct ProfessorQuality Assurance ProgramCollege of Extended & International Education California State University, Dominguez Hills1000 East Victoria StreetQuality Assurance Office, M/S 2-120, EE-1300 Carson, CA 90747-0005Office Phone: (314) 395-3383E-Mail: [email protected]

Address all communications regarding the Quality Management Division of ASQ to:

Milt KrivokucaProgram Coordinator to Quality Assurance ProgramCalifornia State University, Dominiguze HillsPhone: (949) 892-7994E-Mail: [email protected]

Address all communications regarding QMD membership including change of address to:

American Society for QualityCustomer Service CenterP.O. Box 3005Milwaukee, WI 53201-30051 (800) 248-1946 or (414) 272-8575

For more information on how to submit articles or advertise in the Quality Management Forum see the Quality Management Division website at www.asq-qm.org. Articles must be received ten weeks prior to the publication date to be considered for that issue.

Contact the ASQ Customer Service Center at 1 (800) 248-1946 or (414) 272-8575 to replace issues lost or damaged in the mail.

T h e Q u a l i t y M a n a g e m e n t

ASQ Healthcare Division - A Peer-Reviewed Publication of the …asqhcd.org/wp-content/uploads/2014/01/ASQQMFWinter2014... · 2014-01-17 · ASQ Health Care Division, and I coauthored

Documents