Healthcare Value Proposition
Creating a Culture of Excellence in Patient Experience

Never before in the healthcare industry has there been such intense emphasis and open debate on the issue of quality. The steady rise in the cost of healthcare coupled with the need for quality have combined to put the healthcare industry at the top of the national agenda. Quality, costs, and service are not just socially provocative ideas. They are critical criteria for decision-making by patients, physicians, and many key constituents of healthcare organizations.

The pursuit of improved performance has driven a host of executives and managers in search of techniques for structuring, rehabilitating, redesigning, and reengineering the organizations they serve. Unfortunately, the narrow-mindedness with which programs are implemented and the discontinuity in their application weaken the promise of success. The process of quality improvement can become an undisciplined search for illusions rather than reality.

For many years, healthcare managers have embraced the narrow definition of performance solely in the context of financial success. Forward-thinking executives now realize that the road to financial success begins with success in quality and service. Quality and service are no longer separate issues ? they are the same. Neither one by itself will bring about lasting success. The ultimate measure of performance is in an organization?s ability to create value for its customers, and true performance must be measured in the context of the customers? total experience.

This book is about how to manage performance in the context of value to the customer or patient. It brings together the many pieces of the performance improvement puzzle ? quality, technology, costs, productivity, and customer service. The author also covers process improvement tools including Lean and Six Sigma, and how to create a culture of continuous improvement as well as how to improve the patient experience and productivity improvement strategies. The book is filled with examples, illustrations, and tools for improving key aspects of a healthcare organization?s performance.

Contents

About the Author .......................................................................................xi

Introduction.............................................................................................xiii

1 The Healthcare Industry: Challenges and Opportunities............1

Healthcare Cost and Sustainability..............................................................1

The Aging Population in the United States.................................................3

The Growing Trend of Retail Healthcare....................................................4

Telemedicine and Virtual Healthcare..........................................................6

Population Health Management..................................................................7

Price Transparency in Healthcare...............................................................8

Behavioral Healthcare................................................................................10

Data Security..............................................................................................12

Healthcare Technology and Electronic Medical Records System.............13

Data and Insights in Healthcare................................................................16

Preventive Care..........................................................................................17

Empathy and Compassion.........................................................................19

Transition from Volume-Based Healthcare to Value-Based Healthcare........22

Questions for Discussion...........................................................................23

References..................................................................................................23

2 Determinants of Value: Patients’ Perspective.............................27

Privacy, Confidentiality, and Security........................................................30

Timeliness...................................................................................................31

Patient Safety..............................................................................................32

Care for the “Whole Person”......................................................................33

The Hassle Factor in Healthcare...............................................................34

Chief Complaint.........................................................................................35

Empathy, Sensitivity, and Compassion......................................................36

Post-Discharge Follow-Up..........................................................................37

Care Coordination......................................................................................37

Attention to Detail (ATD)..........................................................................39

Availability of Information.........................................................................39

True Cost and Value..................................................................................40

Clinical Outcomes as a Measure of Value.................................................41

Value Proposition: Health Outcomes Divided by Costs...........................42

The Patient Experience Value Manifesto...................................................43

Questions for Discussion...........................................................................46

References..................................................................................................47

3 The Patient Experience...............................................................51

Measuring Patient Experience: HCAHPS Surveys.....................................54

Tactics and Strategies for Improving HCAHPS Scores..............................57

HCAHPS and Health Plans........................................................................66

Questions for Discussion...........................................................................66

References..................................................................................................67

4 Value Is in the Attention to Detail..............................................71

Attentiveness—The Gold Standard............................................................76

The Power of Details.................................................................................79

Culture of Attention to Detail....................................................................80

Today’s Culture of Distraction...................................................................81

Core Value Principles of ATD....................................................................83

Questions for Discussion...........................................................................85

References..................................................................................................85

Additional Reading.....................................................................................85

5 Data and Information.................................................................87

Why Collect Data?......................................................................................88

Data Collection Methods...........................................................................89

Observation................................................................................................90

Focus Groups and Interviews....................................................................91

Conducting Focus Groups: Group Composition and Size....................91

Surveys.......................................................................................................93

Documents and Records............................................................................94

Experiments...............................................................................................94

Stratifying Data..........................................................................................94

Data Variations...........................................................................................95

Types of Data.............................................................................................96

Attribute or Discrete Data......................................................................96

Variable or Continuous Data.................................................................97

Distinguishing Data Types.........................................................................97

Summary....................................................................................................98

Questions for Discussion...........................................................................98

References..................................................................................................99

6 Lean Management System.........................................................101

The Lean Process.....................................................................................104

Lean Tools and Their Applications..........................................................107

Value Stream Mapping.............................................................................107

What Is Value Stream Mapping?..............................................................108

Defining Waste......................................................................................... 110

The Process.............................................................................................. 111

Poka-Yoke................................................................................................. 113

Kaizen....................................................................................................... 115

Kaizen Events........................................................................................... 116

Day 1—Current State Documentation................................................. 117

Day 2—Current State Evaluation......................................................... 117

Day 3—Characterize the Future State; Plan Its Implementation........ 118

Day 4—Implement the Future State.................................................... 118

Day 5—Operationalize the Future State and Debrief........................ 119

The Five S Method................................................................................... 119

Planning for 5S.........................................................................................121

The Steps for Implementing 5S Methodology.........................................122

Benefits of 5S...........................................................................................125

SMED........................................................................................................125

Examples of SMED Healthcare Applications..........................................127

Five Whys.................................................................................................129

Kanban.....................................................................................................130

Steps for the Implementation of a Two-Bin Kanban System.................132

Benefits of Kanban in Hospitals and Clinics..........................................134

Standardized and Standard Work............................................................134

The Process..............................................................................................135

Benefits of Standardized Work................................................................136

Questions for Discussion.........................................................................137

References................................................................................................137

Additional Readings.................................................................................138

7 Six Sigma..................................................................................139

Key Concepts of Six Sigma...................................................................... 142

Examples of Defects................................................................................ 142

Control Charts.......................................................................................... 143

Control Charts for Attribute Data............................................................ 143

Attribute Data Chart Categories...............................................................146

Attribute Charts for Non-Conforming Items...........................................146

Attribute Charts for Non-Conformities....................................................146

P Chart Example...................................................................................... 147

Procedure for Constructing a P Chart..................................................... 147

Results...................................................................................................... 150

An NP Chart Example............................................................................. 150

Results...................................................................................................... 153

Variable Sample Size................................................................................ 153

Results...................................................................................................... 153

A C Chart Example.................................................................................. 154

Results...................................................................................................... 156

A U Chart Example.................................................................................. 156

Results...................................................................................................... 159

Bringing the Process Under Control....................................................... 159

Evidence of an Unstable Process............................................................. 159

The Meaning of a Stable Process............................................................160

Control Charts for Variable Data.............................................................160

Variable Data........................................................................................160

Judging Process Stability.......................................................................... 162

Example of an X - R Chart.................................................................... 162

Procedure for Constructing an R Chart................................................... 162

Results......................................................................................................166

Procedure for Constructing an X Bar Chart............................................ 167

Results...................................................................................................... 167

An X - S Chart........................................................................................ 167

Process Improvement Tools.....................................................................168

Tools for Managing Ideas........................................................................ 170

Brainstorming........................................................................................... 171

The Creativity Phase............................................................................ 173

The Clarification Phase........................................................................ 173

The Assessment Phase......................................................................... 174

Multi-Voting.............................................................................................. 174

Tools for Gathering and Analyzing Data................................................ 175

Flow Charts.............................................................................................. 175

Process for Creating Flow Charts........................................................ 175

Pareto Analysis.........................................................................................177

An Example..........................................................................................177

Cause and Effect Diagrams (Ishikawa or Fishbone Diagrams).............. 178

Process for Creating a Cause and Effect Diagram.............................. 179

Scatter Diagrams............................................................................... 179

An Example......................................................................................180

Coefficient of Correlation (R)...........................................................181

Discussion Questions and Problems.......................................................183

References................................................................................................187

Additional Readings.................................................................................187

8 Creating Value Through Digital Transformation......................189

The Meaning of Digital............................................................................190

Digital Health Applications...................................................................... 191

Impact on Employees.............................................................................. 193

Role of Leadership................................................................................... 194

Important First Steps in Implementing a Digital Strategy...................... 195

Questions for Discussion.........................................................................196

References................................................................................................196

9 Telemedicine: The Quest for Quality and Value.......................199

What Is Telemedicine?.............................................................................199

Structure-Related Measures of Quality....................................................204

Process of Care Measures........................................................................204

The Institute of Medicine (IOM) Model..............................................205

Dimensions of Quality Measurement in Telemedicine.......................206

Effectiveness and Process................................................................ 211

Patient-Centeredness and Structure.................................................212

Patient-Centeredness and Process...................................................213

Timeliness and Structure..................................................................213

Timeliness and Process.................................................................... 214

Efficiency and Structure................................................................... 214

Efficiency and Process..................................................................... 215

Equitability and Structure................................................................ 216

Equitability and Process................................................................... 216

Implications for Outcomes....................................................................... 217

Questions for Discussions....................................................................... 219

References................................................................................................ 219

Index........................................................................................................ 223

Dr. Vincent K. Omachonu is a Professor of Industrial Engineering at the University of Miami, and holds a secondary appointment as Professor in the Department of Health Sector & Policy at the University of Miami. He received his Ph.D. in Industrial Engineering from the New York University Polytechnic, New York. He has two masters degrees one in Operations Research from Columbia University, New York, and the other in Industrial Engineering from the University of Miami, Florida. His B.S. degree is also in Industrial Engineering from the University of Miami. Dr. Omachonu was one of the early contributors to the field of health care quality management. His seminal book titled Total Quality and Productivity Management in Health Care Organizations received the Institute of Industrial Engineers Joint Publishers Book-of-the-Year Award in 1993. Dr. Omachonu is a Master Black Belt in Lean Sigma.

Dr. Omachonu’s other books include, Principles of Total Quality (co- authored with J. Ross), Healthcare Performance Improvement, 1999. His most recent book is titled Access to Health Care and Patient Safety (co-authored with M. Taveras Ponce [2013]) His book titled Principles of Total Quality was translated into the Spanish language (Principios de Calidad Total) in 2014. Dr. Omachonu has published several papers in technical and professional journals and has given hundreds of seminars and presentations to professional and management groups all over the United States and South/Central America.

He has supervised the implementation of the quality management process in several service organizations. He has successfully conducted industrial engineering efficiency and customer flow studies. Dr. Omachonu has served as the evaluator for federal and State funded projects (SAMHSA, OMH, Department of Health, Ryan White, etc.) He has been featured twice on CNN Business. He has served on the Boards of a number of organizations including Interim Healthcare Services