Generic Project Definitions for Improvement of Health Care Delivery: A Case-Based Approach

Background: The purpose of this article is to create actionable knowledge, making the definition of process improvement projects in health care delivery more effective. Methods: This study is a retrospective analysis of process improvement projects in hospitals, facilitating a case-based reasoning approach to project definition. Data sources were project documentation and hospital-performance statistics of 271 Lean Six Sigma health care projects from 2002 to 2009 of general, teaching, and academic hospitals in the Netherlands and Belgium. Results: Objectives and operational definitions of improvement projects in the sample, analyzed and structured in a uniform format and terminology. Extraction of reusable elements of earlier project definitions, presented in the form of 9 templates called generic project definitions. These templates function as exemplars for future process improvement projects, making the selection, definition, and operationalization of similar projects more efficient. Each template includes an explicated rationale, an operationalization in the form of metrics, and a prototypical example. Thus, a process of incremental and sustained learning based on case-based reasoning is facilitated. Conclusions: The quality of project definitions is a crucial success factor in pursuits to improve health care delivery. We offer 9 tried and tested improvement themes related to patient safety, patient satisfaction, and business-economic performance of hospitals.

[1]  Ronald J. M. M. Does,et al.  Quality Quandaries: Efficiency Improvement in a Nursing Department , 2009 .

[2]  Pascal Pommier,et al.  Optimizing clinical practice with case-based reasoning approach. , 2008, Journal of evaluation in clinical practice.

[3]  Gerald F. Smith.  Quality Problem Solving: Scope and Prospects , 1994 .

[4]  John Davies,et al.  The theory of constraints: a methodology apart?--a comparison with selected OR/MS methodologies , 2005 .

[5]  J. Klein,et al.  Using industrial processes to improve patient care , 2004, BMJ : British Medical Journal.

[6]  Marc Berg,et al.  Quality Management: Does it Pay Off? , 2006, Quality management in health care.

[7]  Albert Trip,et al.  Quality in trauma care: improving the discharge procedure of patients by means of Lean Six Sigma. , 2010, The Journal of trauma.

[8]  J Jay Yamamoto,et al.  Facilitating Process Changes in Meal Delivery and Radiological Testing to Improve Inpatient Insulin Timing Using Six Sigma Method , 2010, Quality management in health care.

[9]  L. Locock,et al.  Healthcare redesign: meaning, origins and application , 2003, Quality & safety in health care.

[10]  Ronald J. M. M. Does,et al.  Lean Six Sigma for Service and Healthcare , 2006 .

[11]  Ronald J. M. M. Does,et al.  Six Sigma in a Dutch Hospital: Does It Work in the Nursing Department? , 2004 .

[12]  Stephen Slade,et al.  Case-Based Reasoning: A Research Paradigm , 1991, AI Mag..

[13]  J. Corn,et al.  Six sigma in health care. , 2009, Radiologic technology.

[14]  Jeroen de Mast,et al.  Integrating the Many Facets of Six Sigma , 2007 .

[15]  Robert G. Cooper,et al.  Performance typologies of new product projects , 1995 .

[16]  Robert G. Cooper,et al.  Stage-gate systems: A new tool for managing new products , 1990 .

[17]  Ronald J. M. M. Does,et al.  Standardizing Healthcare Projects , 2006 .

[18]  Jaap van den Heuvel,et al.  The Effectiveness of ISO 9001 and Six Sigma in Healthcare , 2007 .

[19]  Peter W. G. Morris,et al.  The Anatomy of Major Projects: A Study of the Reality of Project Management , 1988 .

[20]  Aaron J. Shenhar,et al.  From theory to practice: toward a typology of project-management styles , 1998 .

[21]  Agnar Aamodt,et al.  Case-Based Reasoning: Foundational Issues, Methodological Variations, and System Approaches , 1994, AI Commun..

[22]  Kees M. van Hee,et al.  Workflow Management: Models, Methods, and Systems , 2002, Cooperative information systems.

[23]  Timothy J Hoff,et al.  No Payment for Preventable Complications: Reviewing the Early Literature for Content, Guidance, and Impressions , 2011, Quality management in health care.

[24]  Ronald J. M. M. Does,et al.  Reducing Start Time Delays in Operating Rooms , 2008 .

[25]  D. Wren.  The History of Management Thought , 2004 .

[26]  Alex Mu-Hsing Kuo,et al.  A Healthcare Lean Six Sigma System for Postanesthesia Care Unit Workflow Improvement , 2011, Quality management in health care.

[27]  D. Partington.  The project management of organizational change , 1996 .

[28]  Martin Marshall,et al.  Applying quality improvement approaches to health care , 2009, BMJ : British Medical Journal.

[29]  Allen Newell,et al.  Heuristic programming: ill-structured problems , 1993 .

[30]  Isabelle Bichindaritz,et al.  Medical applications in case-based reasoning , 2005, The Knowledge Engineering Review.

[31]  Jeroen de Mast,et al.  The CTQ flowdown as a conceptual model of project objectives , 2007 .

[32]  James R. Langabeer,et al.  Implementation of Lean and Six Sigma quality initiatives in hospitals: A goal theoretic perspective , 2009 .

[33]  Michael Hammer,et al.  Reengineering Work: Don’t Automate, Obliterate , 1990 .

[34]  Benjamin P. H. Kemper,et al.  Quality Quandaries*: The Availability of Infusion Pumps in a Hospital , 2009 .

[35]  Anuj Saraogi,et al.  Assessing the evidence of Six Sigma and Lean in the health care industry. , 2011, Quality management in health care.

[36]  Daniel Fischman,et al.  Applying Lean Six Sigma Methodologies to Improve Efficiency, Timeliness of Care, and Quality of Care in an Internal Medicine Residency Clinic , 2010, Quality management in health care.