Quality in Healthcare

Tools

The following tools have appeared in Healthcare Update: Quality Tools and Applications, an expansion of ASQ’s Healthcare Update Newsletter. Each monthly edition focuses on a specific tool and includes a template, how-to method, or example from a healthcare setting.

Advanced Implementation Quality Planning
When ER-One of Livonia, Michigan, needed to transition the management of newly acquired hospital emergency departments to its organization, it turned to advanced implementation quality planning (AIQP).

Affinity Diagram
An affinity diagram is the organized output from a brainstorming session. Use it to generate, organize, and consolidate information related to a product, process, complex issue, or problem. Group the information according to affinity, or similarity. See how an affinity diagram can help improve on-time delivery of medication.

Applying 5S to Healthcare Service
Kaiser Permanente Colorado used Lean Six Sigma to evaluate and improve its Medicaid enrollment processes while increasing Medicaid revenue by more than $1 million annually. An innovative application of 5S helped the team develop a new enrollment template.

Control Plan
A control plan is a written summary of actions, resources, and other requirements for ensuring that process owners sustain the gains of improvement efforts. Read a case study presentation (PDF, 882 KB) that includes a control plan created at SMDC Health System’s Duluth Clinic—Ashland Laboratory as part of a successful project to improve the handling of add-on laboratory test orders.

Critical Incident
The critical incident technique can aid the search for causes. Asking the people involved in a process which steps or factors typically cause them the most trouble can help you understand the general conditions that may have precipitated an event.  

Employee Instruction Sheet (XLS, 1.66 MB)
Use this employee instruction sheet, submitted by Matthew Bommarito, to capture the components of process documentation on one comprehensive worksheet. The downloadable spreadsheet includes separate tabs with instructions, a template, and an example from Heartland Regional Medical Center, St. Joseph, MO.

Five Whys and Five Hows
The five whys and five hows offer a questioning process for clarifying problem statements and developing solutions. Asking “why” and “how” five times helps drill down to root causes and root solutions.

Force Field Analysis
Force field analysis is based on the assumption that any situation is the result of forces for and against the current state being in equilibrium. Countering the opposing forces and/or increasing the favorable forces will help induce a change.

Gage Repeatability and Reproducibility (Gage R&R)
Gage (or gauge) repeatability and reproducibility (gage R&R) studies help assess the precision of measurement procedures and ensure that measurements are consistent and reliable. See an example (PDF, 503 KB) of a study of the precision of temperature measurements with an ear thermometer.

Histogram
A histogram is a graphic summary of variation in a set of data. Read a case study (PDF, 389 KB) about the University of Toledo Medical Center's use of Six Sigma to reduce the time needed to qualify patients for kidney transplants. Histograms from the beginning and end of the project help illustrate the progress made.

Holistic Healthcare—Heartland Health's Iceberg
Heartland Health’s iceberg is a pyramid that depicts the organization’s vision and illustrates its bottom-up, holistic approach to healthcare. Read a case study about this 2009 Baldrige Award recipient.  

Impact Effort Matrix
The impact effort matrix provides answers to the question of which solutions seem easiest to achieve with the most effects.

Job Aid: How to Create a SIPOC Diagram (PDF, 167 KB)
Use this job aid when you conduct team sessions to develop a suppliers, inputs, process, outputs, customers (SIPOC) diagram.

Kaizen Blitz Road Map
Team improvement projects are key to process improvement at Genesis Health System (GHS). Read a case study (PDF, 326 KB) in which GHS shares its road map for bringing together key stakeholders and process owners in kaizen blitz teams. 

Lean Nursing
A case study from Quality Engineering demonstrates the use of Lean Six Sigma to reduce length of stay for patients with total hip replacements while at the same time reducing costs.

Pareto Chart
A Pareto chart is a bar graph that visually depicts which factors or situations are more significant. Read a case study (PDF, 1 MB) that shows the role Pareto analysis played in applying Lean Six Sigma to reduce patient length of stay at the Red Cross Hospital in Beverwijk in The Netherlands.

Performance Excellence Framework—AtlantiCare’s 5Bs
AtlantiCare's 5Bs framework aims to make the organization the best in five areas: quality, customer service, people and workplace, growth, and financial performance. Read a case study about 2009 Baldrige recipient AtlantiCare.

Problem Concentration Diagram
A problem concentration diagram helps you connect events to physical locations, thus perhaps revealing patterns of occurrence.

Process Capability Studies
Process capability studies help you assess the ability of a process to meet specifications. Read a case study that shows how a hospital pharmacy used process capability studies as part of a Six Sigma and lean effort to improve wait times, efficiency, and patient flow.

Process Flow Mapping
A process flowchart offers a graphical representation of the steps of a process. Read a case study (PDF, 389 KB) that shows how the University of Toledo Medical Center used a process flowchart near the beginning of a Six Sigma effort to reduce the cycle time to qualify patients for kidney transplants.

The Purpose and Applications of Relations Diagrams
Relations diagrams can help you identify relationships in a complex or confusing problem situation.

SIPOC+CM Diagram
A suppliers, inputs, processes, outputs, customers (SIPOC) diagram offers a high-level view of the “as is” state of a process under investigation. The +C stands for constraints facing the system and the +M for the measures to be used.

SMART Matrix
A SMART (specific, measurable, attainable, resources, time) matrix is a communication and planning tool used to identify the specifics of actions or tasks.

Spaghetti Diagram
A spaghetti diagram is a visual representation using a continuous flow line tracing the path of an item or activity through a process. The continuous flow line enables process teams to identify redundancies in the work flow and opportunities to expedite process flow.

Success and Effect Diagram
Understanding successful processes can give you insight on how to improve other processes and continually improve efficiency and effectiveness. One tool that can help you analyze successful processes is a success and effect diagram, a hybrid of the popular cause and effect diagram.

Systems Thinking
Systems thinking helps you analyze how multiple processes fit together and work in tandem. Read about how two healthcare programs used systems thinking to improve service to patients, save money, and cut waste.

Download more tools and templates to help you collect and analyze quality data.

Have a tool to share? Submit your own template or example for ASQ’s Healthcare Update: Quality Tools and Applications. Read our guidelines and suggestions for submissions.

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