Health Operations Management (HMP 4500) Final
FTE - Hours Annualized
1 ____ is equal to 2,080 hours a year or 173.33 hours a month
Pareto diagrams
1 of 7 Quality Control Tools (Ishikawa); convert histogram to __________ by rank ordering events from greatest to least frequency >If events have to do with breakdowns in meeting target (cause 1, 2, 3, 4) - rank from greatest frequency to least frequency >Focus on events that have highest frequencies = 80/20 rule *By converting histogram to ________, we are making it a decision making chart!*
X-bar Charts
1 of the 2 control variable charts used in control charting; when plot upper and lower control limits and the mean in Excel related to the data of performance standards and targets, look for instances over the 2 week period where the target went above/exceeded the upper control limit (indicates something is wrong with the process that day), so look into what caused us to miss the target
X-bar Charts
1 of the 2 control variable charts; is a control variable chart for the mean; monitors the changes that occur regarding the central tendency
Workload Standard
1 of the 2 elements to determining the staffing requirements; is the amount of time to perform 1 procedure (ex: hour per procedure)
Process quality
1 of the 2 sub-types of technical quality; examples include: >medication errors >declined claims - frequency of denied claims (process issue b/c left information out of necessary field - so kicked back >technical errors >procedural errors >bed sores >low scores for blood tests >nosocomial infections - the longer you are on a ventilator, the more likely you will get a respiratory infection = no longer than 4 hours >sentinel events = causes of most are breakdowns in processes
Outcomes quality
1 of the 2 sub-types of technical quality; examples include: >readmission rate >immunization rates outside of hospitals >percentage of patients undergoing colonoscopies = tests for colorectal cancer >ability to function = ability to play golf again after knee replacement surgery
Technical Quality
1 of the 2 types of service quality that includes clinical quality indicators and medical errors (things patients aren't aware of)
Functional Quality
1 of the 2 types of service quality that includes the amenities of the services provided, not clinical quality
Technical Quality
1 of the 2 types of service quality; is based on technical accuracy and correct procedure
Technical Quality
1 of the 2 types of service quality; making accurate diagnosis and/or achieving expected outcomes without error and in an efficient manner: >accurate diagnosis and expected outcomes are achieved through effective and efficient processes >efficient pertains to resources and time quality that pertains to the clinical aspects of the stay; includes 2 subtypes: 1) process 2) outcomes
Quality
1 of the 5 pillars of excellence that has the performance indicator of turnaround time ex: turnaround time for lab tests to be performed and results sent to physicians is 30 minutes
Control Charts
1 of the 7 Isihikawa quality control tools; rather than waiting for the end of the month to see if met performance standards for quality, collect data from 1 to 2 week time and in Excel, plot the upper and lower control limits of the data; variables: 1) works with the X-bar chart and R chart in tandem with one another 2) looks at the mean, not the standard deviation 3) uses continuous data 4) there are 2 causes = assigned variation and natural variation - but only look at assigned variation (not natural variation)
Check sheets
1 of the 7 Quality Control Tools (Ishikawa); are a structured form for collecting and analyzing data; is a generic tool that can be adapted for a wide variety of purposes and minimizes the chance of different users collecting data in different ways
Flow charts
1 of the 7 Quality Control Tools (Ishikawa); illustrate the flow of a process
Use of flow charts
1 of the 7 Quality Control Tools (Ishikawa); includes process mapping, which is converted into value stream mapping (current then future state map); regarding the steps in the process, there are steps that: 1) Value added 2) Non-value added 3) Process Cycle Efficiency
Check sheets
1 of the 7 Quality Control Tools (Ishikawa); table prepared to standardize data knowing that different people are collecting and recording data
Check sheets
1 of the 7 Quality Control Tools (Ishikawa); way of collecting primary data to get at cause of why there is an issue with some performance standard; collect primary data knowing that person collecting data is changing shifts; standardized format of collecting data to get at greater understanding of cause of problem
Use of check sheets to standardize data collection and data organization
1 of the 7 Quality Control Tools (Ishikawa); way of collecting primary data to get at cause of why there is an issue with some performance standard; used in different organizations - particularly in hospitals b/c hospitals never close; collect primary data knowing that person collecting data is changing shifts
Functional quality Ex: Food being warm, cleanliness, nurse's attitude, nurse's responsiveness >Doesn't require clinical but rather amenities of services provided
Between the two types of service quality, which receives more attention from the patient?
Assigned variation b/c this is something you can change/affect
In control charting and process mapping/flow charts (2 of 7 Ishikawa quality control tools), do you pay attention more to the assigned variation or natural variation?
PERT b/c... 1) Gantt requires changes to be done manually 2) If you have to adjust 1 or more activities in the timetable, you can change the start and end dates and it adjusts the precedent relationships with PERT 3) With PERT, can key in behind completing this activity and generates what changes 4) PERT is used for more complex projects that have lots of planning activities 5) Is more flexible than Gantt b/c can automatically change the completion date of the many activities that follow and the other dates for the activities will follow
Is PERT or Gantt used more for planning and scheduling projects? Why?
People
Of the 5 pillars of excellence, which one is most important?
1. Competition will beat us to market 2. Interest rates >Interest rates higher than in permanent financing >If can shorten deadline, can bring cost savings b/c shortened time when paying high interest for contracting
Project Compression: Why would boss ask to cut down time in project?
a) Greatest staffing inefficiency = census of 1 >1 RN for 1 patient b) Next greatest inefficiency = census of 5 >b/c have to add additional personnel
Staffing Grids (determine the number of RNs and techs needed based on census)- Which is the most inefficient from the staffing grid?
We can fix the assigned variation, not the natural variation.
The 7 Quality Control Tools (Ishikawa): Do control charts address assigned variation or natural variation (aka, what is causing the variation for not meeting a particular performance standard)?
The mean
The 7 Quality Control Tools (Ishikawa): Do the parameters of control charts work with the mean or standard deviation?
1. Value-added steps- a) From patient's perspective b) From organization's perspective, not patient's perspective but needed to keep step in according to organization 2. Non-value added steps- a) Step to be eliminated - would be identified with kaizen burst and indicated as muda (Japanese term) 3. Process Cycle Efficiency- a) Sum of value-added time divided by total process cycle time b) Total up time that adds value to patient only (smaller number) divided by total process cycle time
The 7 Quality Control Tools (Ishikawa): What are the 3 types of steps in the flow chart process (ex: process mapping and value-stream mapping)?
True >This is bad
True or false? If the process cycle efficiency is 18%, then the patient is only experiencing 18% value to them.
True
True or false? In doing an X-bar chart as part of control charting, an organization may still hit the 95% performance target for the month, but X-bar chart looks into wanting to know what happened at those instances/days that we didn't meet the target.
True
True or false? Regarding control charts as a quality control tool (of ishikawa), the control charts address assigned variation, not natural variation.
True
True or false? Regarding control charts as a quality control tool (of ishikawa), the parameters include the mean, not standard deviation.
True >Higher percentage indicates that most of the steps in the process are value-added to the patient. >Ex: If the process cycle efficiency is 22%, then this is bad b/c only 22% of time in process adds value to patient, and 78% is only bringing value to organization. *So want process cycle efficiency rate to be as high as possible*
True or false? The higher the process cycle efficiency percentage, the better/more appropriate the process.
1. The third party company (information exchange/data mediator) is expensive 2. HIPAA privacy concerns - patients' information being accidentally leaked
What are 2 concerns with EMR - Information Exchange/Data Mediator?
1. Low morale 2. Broken process 3. Antiquated equipment 4. Floor plan/layout/room design 5. Incompetency across staff 6. Turnover >Forever training new people and learning curve takes time - pressed to assign standard workload to new employee 7. Age
What are some detractors from efficiency?
1. Rate of change (i.e., advances in technology, employee turnover) >when a process changes or introduces new equipment, it is change and humans don't handle change well) 2. Manpower shortages 3. Variability in census 4. Declining reimbursement >we get paid this much for procedure last year and this year we are paid less - hard to meet quality targets when have to reduce expenses (if biggest expense is salaries, then would have to cut back on staff) 5. Antiquated facilities (old equipment) 6. Employee/staff morale >if people are coming to work unhappy (low employee satisfaction), then will get low patient satisfaction 7. Complex nature of healthcare particularly hospitals 8. Turnover retention 9. Floorplan/room layout 10. Staffing shortages >using travel nurses detracts quality b/c don't know procedures/policies at beginning and will take a while to learn them but only will be there for 6 months)
What are the 10 detractors from efficiency?
1. For projects in which uncertainty exists in the amount of time to complete certain activities - probabilistic nature of completion times 2. Use of precedence of information to visualize a network of activities
What are the 2 main features of PERT?
1. Process 2. Outcomes
What are the 2 types of technical quality?
1. Forming 2. Honeymoon 3. Storming 4. Norming 5. Performing
What are the 5 development stages in team formation?
1. Sort 2. Set in order 3. Shine 4. Standardize 5. Sustain
What are the 5S-Pillars of Lean?
1. Use of check sheets to standardize data collection and data organization 2. Use of flow charts 3. Cause-and-effect fishbone diagrams 4. Histograms 5. Pareto diagrams- >Converting histogram to Pareto chart by rank ordering events from greatest to least frequency >If events have to do with breakdowns in meeting target (cause 1, 2, 3, 4) - rank from greatest frequency to least frequency >Focus on events that have highest frequencies = 80/20 rule *By converting histogram to Pareto chart, we are making it a decision making chart!* 6. Scatter diagrams 7. Control charts
What are the 7 Quality Control Tools (Ishikawa)?
1. Generated by doing both internal benchmarking and external benchmarking 2. If the workload standard is too thin (ex: 1:6 or 1:7 instead of the 1:5 ratio), the consequences could negatively affect all 5 pillars of excellence >ex: could affect employee morale >ex: could increase turnover rate >ex: less quality >ex: fewer patients coming to the hospital
What are the considerations/factors for workload standards?
Technical Quality
What are the following examples of - technical quality or functional quality? Appropriate medical diagnoses, compliance with professional specifications, and proper testing
Technical Quality
What are the following examples of - technical quality or functional quality? Competence of the medical staff, including the surgeons' operating skills and the nurses' familiarity with drug administration
Program Evaluation and Review Technique
What does PERT in PERT Charts stand for?
Can negatively affect all 5 pillars of excellence: 1) Less quality 2) People (could affect staff morale - increase employee turnover rate) 3) Service (less patients coming to hospital)
What happens if workload standard is too thin?
To identify all the pathways associated with the activities in a project to ultimately identify the critical pathway (is the longest pathway/takes the longest amount of time and becomes an important reference)
What is the purpose of a network (e.g., activity on the arc and activity on the node)?
Assigned variation
Which is most important for process mapping and control charting? >Assigned variation or Natural variation?
b/c multiple persons are collecting and recording data >brings validity and completeness >to standardize data collection and data organization
Why are check sheets needed?
1. Use the mean, not the standard deviation 2. Continuous data 3. Always work with X-bar charts and R charts in tandem with one another 4. Look for assigned variation, not natural variation
With control charts, what are the variables you work with?
Genbutsu
a Japanese term commonly used with Six Sigma Lean and is associated with process mapping; means "go down and observe the process/work being performed"
Gemba
a Japanese term commonly used with Six Sigma Lean and is associated with process mapping; means "to leave/get out of your office"
EMR - Interoperability
a capability not included in an EMR; involves exchanging patient information but this isn't happening b/c different organizations did not select the same vendor from the vendor approved list from the government's American Recovery and Reinvestment Act of 2009
Network
a diagram of project activities and precedence relationships as shown with arrows and nodes; shows the sequence in which activities must be performed; two types: 1) activity on arc 2) activity on node
Pillars of Excellence
a system of accountability that involves the 5 dimensions related to performance improvement in operations management, including: 1) Cost 2) Growth 3) Service 4) People 5) Quality
a) Full time equivalence b) 1 FTE = 2,080 hours a year
a) What does FTE stand for? b) How many hours is 1 FTE annually?
Precedence
an activity/step in a project that can't start without another activity/step being completed before it; which activities need to be completed before start other activities
5S-Pillars of Lean
an efficiency tool commonly used when doing performance improvement to maintain efficiency and prevent messes/disorganization from happening; includes: 1) Sort 2) Set in order 3) Shine 4) Standardize 5) Sustain
EMR - Information Exchange/Data Mediator
aspect of an EMR in which it is able to exchange patient information when healthcare organizations are using different EMR vendors so don't have interoperability unless they enter into a contract with this expensive third party company; is the company that is used to send patient information and share it with other healthcare organizations
Baldridge Award
award that is considered to be the "trifecta" - it is like winning the World Cup but the award comes around every year award that is sought after by some health systems more than others - health system must go through rigorous evaluation process in order to be considered for the award; third party award that selects a health system that displays the best quality of care - indicates that the health system is the premier health system when it comes to quality of care
Lean
concept in health care that focuses on efficiency
EMR - Meaningful Use
criteria of capabilities of an EMR that healthcare organizations implement; of the EMR vendors the government has approved, they need to have certain capabilities >ex: capability of EMR to have ability to graph and plot the progress/changes and trended information from test results of a patient >ex: capability of EMR to have MyChart patient portal so patients can access their medical information from EMR >ex: capability of EMR to have the ability to determine whether the patient's different medications are suitable and don't conflict - such that can be taken together
Bounded Rationality
identified problem through DMAIC: there is an ideal way to address the problem/cause of issue but we don't have the resources although this is the best way/solution, it can't be a choice due to lack of resources
Precedence
indicated in the number of times in time table; certain step or activity has to be completed before other steps can be started; ex: can't do step C before A and B, can't start activity D and E before step C, have to complete E before steps F and G
Cost
is 1 of the 5 pillars of excellence pertaining to revenue/budget and asks are you hitting expense budget in income statement
Growth Ex: is it possible to exceed patient surgeries and be down in revenue? >Yes, some procedures generate a lot of revenue and others don't generate a lot of revenue - volume can be up but can miss revenue budget
is 1 of the 5 pillars of excellence that has 2 dimensions: 1) Revenue 2) Volume = level of busyness both of these - revenue and volume - are addressed in income statement
Service
is 1 of the 5 pillars of excellence that has the performance indicator of meeting or exceeding expectations of patients ex: patient satisfaction surveys >consumerism transparency = indicates patient satisfaction scores - major issue associated with pricing transparency (being transparent to customers the costs of services)
People >when do you want turnover to be high? >>when have to lay off employees that aren't good and want them to leave (ex: 35% turnover rate) >a shortage of people emphasizes turnover
is 1 of the 5 pillars of excellence that has the performance indicator of retention/turnover rate
FTE - Hours Annualized
is 2,080 hours annually
Probabilistic
is an approach when doing project compression and think in terms of: 1) optimistic time 2) pessimistic time 3) most likely time asks: what likelihood is it that we can reduce it by _____ (ex: 2 weeks) - meaning how can you shorten the critical path?
Deterministic
is an approach when doing project compression and think in terms of: have every level of confidence that can cut down time - "I control what is going on and not concerned about factors"; is the next extreme of most likely - pretty much control/know every aspect
Workload Standard
is defined as the predetermined allocation of time available for a unit of service to maintain an appropriate level of quality
Process Cycle Efficiency
is defined as the ratio of value-added time to total cycle time; this metric assists in identifying how much of a process actually adds value; it requires the following six steps to compute: 1) map the process using a flowchart 2) identify the value-added steps, non-value-added steps 3) group the map according to two categories, one for value-added process items and one for non-value-added items 4) estimate the time to complete all the activities on the process map 5) sum the value-added times and calculate the process cycle time (i.e., the time for the entire process to be completed) 6) then divide value-added time by cycle time to obtain process cycle efficiency
Contract Labor
is one of the strategies to flex up but it is the least preferred of all strategies when trying to add staff on short notice (reallocation); involves using an agency that is very expensive
Process Capability
is the ability of a process to consistently meet its performance standards and related targets (is it hitting the work standard)
Expected Utilization
is the percentage of time that is assumed that a staff member is busy in performing tasks; varies depending on the department; ex: 90% of time that lab techs are busy - not performing tasks 10% of time b/c caught up with getting stuff done but can't go home b/c you know other tests will be added to the queue
Assigned Variation
is the variation that can be traced to a specific reason or cause
PERT Charts
one of the software programs to schedule projects; used for more complex projects than Gantt charts b/c of its flexibility to adjust completion dates of the many activities that can affect precedent relationships
Process Cycle Efficiency
one of the steps of using flow charts as part of one of the seven quality control tools sum of value added time divided by total process cycle time total up time that adds value to patient only (smaller number) divided by total process cycle time
Assigned Variation
one of the variables related to control charting; is a variable you can address/change/affect >looks at what is broken in the process >>ex: bad floor plan, electronic communication being untimely = things you can change
Process Cycle Efficiency
percent that indicates the amount of time in the process that the steps are of value to the patient; in a process, if you measure the amount of time to complete the process from the first to the last step (total time) and then measure the amount of time there are steps just of value to the patient - then divide the total time into the subtotal amount related to patient value to get this percent
Workload Standard
pre-determined amount of time budgeted to provide a unit of service at an appropriate level of care (quality and satisfaction)
Expected Utilization
setting the performance expectations for the unit or department
7 Quality Control Tools (Ishikawa)
seven tools believed to solve the majority of quality issues; includes: 1) check sheets 2) flowcharts 3) cause-and-effect or fishbone diagrams 4) histograms 5) Pareto diagrams 6) scatter diagrams 7) control charts
Check sheets
standard way of collecting primary data - high level of confidence through standardization that data will be reliable and complete set up table in which staff populates table; ex: in hospital, different people populating data on this Ishikawa quality control tool
Forming
the first of the 5 development stages in team formation; is the composition stage in which you determine who you want on your task force or team and have approval from bosses and then schedule the first meeting; involves talking about the parameters - charge, timeframe, and minutes of the taskforce; time at which no one knows each other and none have worked together; stage that develops when something is broken in process so task force is created
Norming
the fourth of the 5 development stages in team formation; is the stage of "consensus building"; everyone is accepting of being open and disagreeing/agreeing so can focus on the purpose of the task force and be productive - begin to develop effective processes for solving the problem at hand
Performing
the last of the 5 development stages in team formation; the stage at which the team now addresses the problem/pursues the opportunity
Workload Standard
the number of man hours required to perform a particular unit of service; amount of time needed to efficiently produce 1 unit of service
Honeymoon
the second of the 5 development stages in team formation; stage at which everyone is nice to each other and want to impress one another
Storming
the third of the 5 development stages in team formation; stage at which people are comfortable enough to begin disagreeing; is the "agree to disagree" stage - want someone's input and if disagree, want to know they disagree; we have agreed to disagree and no one holds back
Network
the two types include activity on the arc and activity on the node; is how to graphically display precedent relationships
PERT Charts
tool for planning and coordinating large projects; developed in late 1950s by U.S. government and independent contractors to plan weapons development; features: 1) for projects in which uncertainty exists in the amount of time to complete certain activities - probabilistic nature of completion times 2) use of precedence of information to visualize a network of activities
PERT Charts
tool used for scheduling projects that requires the project manager to estimate each activity's duration under the most favorable conditions (minimum estimated duration = a), the least favorable conditions (maximum estimated duration = b), and the most likely conditions (most likely estimated duration = m)
7 Quality Control Tools (Ishikawa)
tools that people with Six Sigma Lean use
Project Compression
trade-offs between reduced project time and cost
Project Compression
trying to shorten the time it takes to complete a project - to complete the critical path in a shorter amount of time; is only significant if it affects the critical path
Workload Standard
what number of man hours are required to perform a particular unit of service (amount of time needed to efficiently produce 1 unit of service) ex: .4 technician hours to perform 1 unit of service (1 CT scan)
Bounded Rationality
when know the cause of a problem and have a determined ideal solution but the solution to fix the problem is too costly, so we have to find a solution that is less than ideal due to lack of money/capital from corporate office or lack other resources
Counter Measure
with Six Sigma Lean, this word is used instead of the word solution because solution suggests it is finished/finite; Six Sigma Lean focuses on how we can always do better with performance improvement this term suggests that we may fix the problem today but we know we can get better and better
