Index
4P model, 97
5S Red Tag, 384
A
AAA (Area Activity Analysis), 349-357
abuse, 53
ACC (adult critical care), 208
access, linkage between diversion and, 208
accuracy in managed care operating room carve-outs (Virtua Health) case study, 215-219
acute myocardial infarction (AMI), 168, 182
adaptability, 290
administration
Six Sigma Team (SST) members, 276-285
adult critical care (ACC), 208
adverse drug reactions, 4
advocates (Six Sigma), finding and developing, 244
Allied Signal
leadership teams, 445
Six Sigma, 42
alpha risk, 133
alternate hypothesis, 131
ambulances, reducing diversions case study (PAMC), 208, 211
American College of Healthcare Executives, 171
American Customer Satisfaction Index, 415
American Society for Quality (ASQ), 42, 47
AMI (acute myocardial infarction), 168, 182
analysis
Area Activity Analysis (AAA), 349-357
efficiency, 352
Failure Modes and Effect Analysis (FMEA), 118-120
measurement system analysis (MSA), 109
Six Sigma strategic plans, 245-250
Analysis of Variance. See ANOVA
cardiac medication administration case study, 183-185
cause and effect analysis, 113-114
central venous catheter (CVC) infections, reducing, 189
Failure Modes and Effect Analysis (FMEA), 118-120
Ishikawa diagrams, 115
Lean Six Sigma, 383
tools, 112
ANOVA (Analysis of Variance), 139-140
Area Activity Analysis (AAA), 349-357
Arthur Andersen Consulting, 246
ASQ (American Society for Quality), 42, 47
assignable versus random variation, 107
assumed requirements (unspoken), 93
AT&T Network Systems, 358
development of control charts, 146
attributes
control charts, 147
data, 105
Average Outgoing Quality Level (AOQL), 406
B
Bachman, Brian, 53
basic statistical analysis, 105-106
bed management (Nebraska Medical Center) case study, 220-228
bell-shaped distribution, 106
Berwick, Donald M., 403
best-of-breed processes, 339
beta blockers, 403
beta risk, 133
better patient charge capture (YNHH) case study, 211-215
between variation, 113
billing, Commonwealth Health Corporation case study, 167
Black Belts, 37, 305-307, 437-443
certified as Green Belts, 341
failure
of exams, 341
of Six Sigma systems, 421
Master Black Belt (MBB), 305, 314-319
with no Six Sigma training, 341
bloodstream infection (BSI), 188
Bloom’s Taxonomy, 326
Bloom, Benjamin, 326
Blue Cross Blue Shield of Tennessee, 47
Body of Knowledge (Six Sigma), 437-443
Bossidy, Lawrence A., 42
BPIn (Business Performance Index), 65
Braden Scale, 194
Brown, Tawnya, 52
building Six Sigma cases, 260
BUS (Business Unit Sponsor), 304
Bush, George W., 405
business drivers, 247
business errors, 23
Business Non-Value Added (BNVA), 389
business opportunity awareness, 70-73
Business Performance Index (BPIn), 65
Business Process Improvement, 339
business processes, evaluating importance of, 256
business reviews, control phase, 151-152
Business Unit Sponsor (BUS), 304
C
CABG (Coronary Artery Bypass Graft), 168
cafeterias in hospitals, quality of, 29
calculations
Defects Per Million Opportunities (DPMO), 84
t-tests, 140
Call Handling datasets, 105
CAMC (Charleston Area Medical Center), 32, 411
reducing surgical site infection (SSI) rates, 185-187
Canada, 404
CAP (Change Acceleration Process), 176
cardiac medication administration (Virtua Health), 182-185
care cycles, patient journeys, 253
caring, 68
Cascading Customer/Supplier Model, 349
case studies. See also clinical case studies
accuracy in managed care operating room carve-outs (Virtua Health), 215-219
ambulance diversions (Providence Alaska Medical Center), 208-211
bed management (Nebraska Medical Center), 220-228
better patient charge capture (YNHH), 211-215
cath lab utilization (Memorial Hermann Heart & Vascular Institute-Southwest), 231-232
corporate advance directive (VBMC-H), 229-231
optimizing respiratory care services (VBHS), 233-237
reducing ambulance diversions (PAMC), 208-211
Six Sigma
Commonwealth Health Corporation (CHC), 166-168, 204-208
Decatur Memorial Hospital, 177-178
Nebraska Medical Center, 178-179, 220-228
New York-Presbyterian Hospital (NYP), 175-177
North Shore-LIJ Health System, 172-173
North Shore University Hospital, 388-390, 395, 399
Thibodaux Regional Medical Center (TRMC), 174-175
Valley Baptist Health, 171, 229-236
Virtua Health, 168-171, 215-220
timeliness on self-pay collections (CHC), 204-208
cases, building Six Sigma, 260
cath lab utilization (Memorial Hermann Heart & Vascular Institute-Southwest) case study, 231-232
cause and effect
Cavanaugh, Barry, 55
CDC (Centers for Disease Control), 191
Center for Learning and Innovation (CLI), 172
center points, setting new, 268
Centers for Disease Control. See CDC
Centers for Medicare and Medicaid Services, 185
central venous catheter (CVC) infections, reducing, 188-190
Champions (Six Sigma), 302
Change Acceleration Process (CAP), 176
Charleston Area Medical Center (CAMC), 32, 411
reducing surgical site infection (SSI) rates, 185-187
charters
projects, 103
SSTs, 276
charts
Chassin, Mark, 164
CHC (Commonwealth Health Corporation), 32
case studies, 166-168, 204, 208
reducing post-operative infections, 191-193
CHF (congestive heart failure), 170, 182
checklists
Six Sigma 20 Question, 445-446
Six Sigma Student, 447
Cherry, Jean, 168
Christus Schumpert Health System (CSHS), 411
Clarkson Hospital, 178
cardiac medication administration (Virtua Health), 182-185
central venous catheter (CVC) infections, reducing, 188-190
glucose control in adult ICU (Valley Baptist Health System), 199-202
nosocomial pressure ulcers, reducing (TRMC), 193-199
post-operative infections, reducing (CHC), 191-193
preventing infections (Decatur Memorial Hospital), 190-191
surgical site infection (SSI) rates (CAMC), reducing, 185-187
clinical research, 67
collections, timeliness on self-pay collections (CHC), 204-208
Columbia University College of Physicians and Surgeons, 175
commercial accounts, timeliness on self-pay collections (CHC), 204-208
commitment, 69
Committee on the Quality of Healthcare in America (QHCA), 403
common regions, 135
common variation, 107
Commonwealth Fund, 368
Commonwealth Health Corporation (CHC), 32
case studies, 166-168, 204, 208
reducing post-operative infections, 191-193
communications, 357
control phase, 151
outcomes and errors, 74
community service, 67
comparative experiments, 140-142
compensation, 366
conclusions (Six Sigma), 48-50
potential in healthcare, 50-52
conducting testing of hypothesis, 133-139
congestive heart failure (CHF), 170, 182
Considine, Jill M., 409
constructing controls charts, 147
consultants, selecting, 263-265
Consumer Reports, 54
consumer-centric healthcare, 13
consumerism in healthcare, 54
Continuous Quality Improvement (CQI), 42, 193
communication, 151
Cooper, Alan, 174
Cooper, Mary R., 175
Cooper-Standard Automotive Global Fluid Systems division, 409
COQ (cost of quality), 107, 109
Coronary Artery Bypass Graft (CABG), 168
corporate advance directive (VBMC-H) case study, 229-231
cost of quality (COQ), 107-109
costs, 14
healthcare, 16
IT, failure to invest in, 27
Six Sigma, 80
courses that propagated the Six Sigma philosophy, 78
CPIs (Critical Performance Indicators), 249
CQI (Continuous Quality Improvement), 42, 193
critical processes, selecting, 256
critical regions, 135
CRM (customer relationship management), 93
Crosby, Phil, 33
Cruz, Ramon, 54
CSHS (Christus Schumpert Health System), 411
CT scans, North Shore University Hospital case study, 388-399
cultures, internalizing, 344-353, 355-368
curve distribution, 106
Customer Critical to Quality Requirements (CTQs), 319
customers
customer/supplier relationships, 345-349
external requirements, understanding, 255
focus, 421
Kano’s model of requirements, 93-94
relationships, developing, 352
service, comparing hospitals to hotels, 29
vision statements, 247
D
Decatur Memorial Hospital, 413
preventing infections, 190-191
dedication to perfection, 53-54
defects, 379
defects per million opportunities (DPMO), 80, 84, 182
defects/errors per unit (DPU), 80, 84
Defense System Electronics Group (DSEG), 48
defensive medicine, 27
Define, Measure, Analyze, Improve and Control (DMAIC), 66, 269, 343
Define phase, 90
defining
Area Activity Analysis (AAA), 352
scope of opportunities, 266-267, 270
improvement opportunities, 250-260
Deming, Dr. W. Edwards, 107
Depository Trust and Clearing Corporation (DTC), 409
descriptive statistics, 104
Design for Six Sigma (DFSS), 409
Design of Experiments (DOE), 77, 142-144, 383
Design phase, 90
project charters, 103
Desmarais, John, 166
development
of advocates, 244
customer relationships, 352
supplier partnerships, 353
Diagnosis Related Groups (DRGs), 71, 171
comparing, 189
diagrams
fishbone, 114
diversion, linkage between access and, 208
DMAIC (Define, Measure, Analyze, Improve and Control), 66, 269, 343
documentation, Control phase, 149-150
DOE (Design of Experiments), 77, 142-144, 383
Dominican Hospital, 412
Donabedian model, 45
Dowling, Michael, 173
DPMO (defects per million opportunities), 80, 84, 182
DPU (defects/errors per unit), 80, 84
DRGs (Diagnosis Related Groups), 71, 171
comparing, 189
drugs, adverse reactions, 4
E
Economic and Social Research Institute, 405
effectiveness, 289
efficiency, 289
analyzing, 352
healthcare, 8
elements of Six Sigma, 79
business scorecards, 65
elimination
of defects, 21
EMC Corp, 409
English, John R., 48
Enterostomal Therapy Registered Nurse (ETRN), 194
EPU (errors per unit), 84
errors
communicating, 74
error-free processes, 336
medical, 4
Medication-Administration Records (MAR), 260
errors per unit (EPU), 84
Eschete, Sheri, 198
evaluation. See also testing
importance of business processes, 256
improvement opportunities, 256
multiple treatments using ANOVA, 139-140
weighted-selection approach, 257-259
exams, failure of Black Belt, 341
excellence, 69
recognizing, 75
Executive Sponsors, 262
Executive Teams
approving and organizing Phase III, 261-262
role of, 302
executives, values, 361
expecting improvements, Six Sigma, 73
expenditures, 14. See also costs
experiments
Design of Experiments. See DOE
External Consultants, selecting, 263-265
requirements, understanding, 255
extra processing steps, 379
F
F-tests, 138
facilities, vision statements, 247
Failure Modes and Effect Analysis (FMEA), 83, 118-120
failure
of Black Belt exams, 341
Fairfax Hospital, 52
Fairview University Medical Center, 53
Federal Office of Personnel Management, 72, 405
females, demographics, 11
fertility rates, demographics, 11
finding Six Sigma advocates, 244
Fisher, Sir Ronald, 139
FMEA (Failure Modes and Effect Analysis), 83, 118-120
focus
customers, 421
processes, 422
Food Safety Management Systems, 405
Foothill Medical Centre, 55
Ford Motor Company, 409
Ford, Sr., Henry, 424
forming Six Sigma Teams (SSTs), 340-342
Forming Stage (SST team development), 281
formulas, Defects Per Million Opportunities (DPMO), 84
Fosdick, Glenn, 178
fraud, 53
Froedtert Memorial, 32
full factorials experiments, 142-146
future states, 294
G
Gage Repeatability and Reproducibility (R&R), 109
gaining process knowledge, 96-97
GE (General Electric), 79
General Motors, 404
glucose control in adult ICU (Valley Baptist Health System, 199-202
goals, Six Sigma Teams (SSTs), 278
Good Samaritan Hospital Medical Center, 54
government problem with healthcare, 404-405
Black Belts certified as, 341
Gregg, Vicky, 47
grids, Process Maturity Grid, 330-340
ground rules (SSTs), 278
Guidance on the Application of ISO 22000:2005, 405
“Guidelines for Process Improvements in Health Services Organizations,” 405
H
Harrington’s Wheel of Fortune, 421-423
Harvard Medical School, 403
Harvard School of Public Health, 172, 414
Hawkins, Jeff, 97
Health Savings Accounts (HSAs), 5, 54
healthcare
consumer-centric, 13
costs, 16
efficient, 8
government problem with, 404-405
quality
views of, 48
Six Sigma. See Six Sigma
Healthcare Excellence project forms, 121-128, 153-160
Heart Surgery Protocol Flow Committee, 263
HEDIS (Health Plan Employer Data and Information Set), 405
Heparin, 53
Hewlett-Packard, 424
HHRG (Home Health Resource Group), 170
Hospital Quality Alliance, 414
hotels, comparing hospitals to, 29
Hottois, Patricia Ann, 55
HSAs (Health Savings Accounts), 5, 54
Hurricane Katrina, 174
Hurricane Rita, 174
hypotheses, testing, 83, 131-139
I
ideas, 363
Implementation phase (Six Sigma), 299-307
implementation processes, 243
implementers, 263
cardiac medication administration case study, 183-185
comparative experiments, 140-142
full factorials experiments, 142-146
testing of hypothesis, 131-139
improvement opportunities, defining, 250-260
The Improvement Process, 42
incentives
errors by, 23
for inefficiency, 28
income, equality, 13
indexes, process capability, 110
India, 404
inefficiency, incentives for, 28
inequality errors, 23
infections
central venous catheter (CVC) infections, reducing, 188-190
post-operative, reducing, 191-193
preventing (Decatur Memorial Hospital), 190-191
sepsis, 4
surgical site infection (SSI) rates, reducing, 185, 187
inferential statistics, 104
influence on SSTs, 285
information technology. See IT
Ingraham, David, 208
Institute for Healthcare Improvement, 403
Institute of Health, 33
Institute on Medicine (IOM), 403
instructors, 263
insurance, pluralistic healthcare insurance system, 14
integrity, 68
intent of Six Sigma, 79
internalizing Six Sigma culture, 344-368
International Organization for Standardization (ISO), 405
International Journal of Health Care Quality Assurance, 5
interpreting control charts, 148-149
inventory, 379
investments, failure to invest in IT, 27
“Is Health Care Ready for Six Sigma?,” 164
Ishikawa diagrams, 83, 114-115
Ishikawa, Kaoru, 113
IT (information technology), failure to invest in, 27
J
JCAHO (Joint Commission on Accreditation of Healthcare Organizations), 70, 182, 402
J.D. Power and Associates’ Distinguished Hospital Program, 179
Jarvis, William, 54
Jha, Ashish, 414
Joan and Sanford I. Weill Medical College of Cornell University, 175
John Hopkins University, 412
Johnston, Bob, 55
Joint Commission on Accreditation of Healthcare Organizations (JCAHO), 70, 182, 402
Jones, Pam, 204
Journal of the American Medical Association, 4
Juran, Joseph M., 358
K
Kaiser Permanent, 417
Kaizen events, North Shore University Hospital case study, 389-395
Kanban, 380
Kano’s model of customer requirements, 93-94
Kano, Noriaki, 93
knowledge, gaining process, 96-97
KPIs (Key Performance Indicators), 248, 328
L
launching the Six Sigma initiatives, 64
leadership for Six Sigma, 73-75
Lean Six Sigma, 375
case studies
North Shore University Hospital, 388-399
Lebsack, Jason, 179
Legacy Emanuel Hospital and Health Center, 410
legal errors, 22
lessons learned, Six Sigma, 416
life cycles, teams, 283
Loeb, Jefod, M., 402
Lonmin PLC, 409
Louisiana Performance Excellence Award for Quality Leadership, 198
love-to-hate requirements (unspoken), 93-94
M
maintenance, 380
Malcolm Baldrige Award (1988), 32, 35
Malcolm Baldrige National Quality Program, 417
managed care, 17
accuracy in managed care operating room carve-outs (Virtua Health), 215-219
analyzing, 247
management
CRM (customer relationship management), 93
pain, 294
Project Management tools, 433, 436
Six Sigma Team (SST) members, 276-285
Total Quality Management (TQM), 78
TQM, 42
training (Commonwealth Health Corporation case study), 166
Manam, Bob, 71
MAR (Medication-Administration Records) errors, 260
Maricopa Medical Center, 55
marketplace requirements (spoken), 93
markets, vision statements, 247
maturity, Process Maturity Grid, 330-340
MBB (Master Black Belt), 305
McDougal, Linda, 4
McGraw, Steven, 388
McLeod Regional Medical Center, 32, 412
MD Anderson Cancer Center, 32
mean value, 105
means, testing, 137
basic statistical analysis, 105-106
cost of quality (COQ), 107, 109
distribution, 106
measurement system analysis (MSA), 109
process performance measures, 110-111
random versus assignable variation, 107
measurement system analysis (MSA), 109
measurements
median, 105
medical errors, 4
medical objects accidentally left in patients, 4
Medication-Administration Records (MAR) errors, 260
Memorial Hermann Heart & Vascular Institute-Southwest, cath lab utilization case study, 231-232
Memorial Hospital and Health, 32
Mercy Health Center, 412
methodologies (Six Sigma), 82-83
quality systems, 87
readiness, 80
metrics, performance, 54
Miles, Ben, 384
Miller, Don, 177
Miller, Kurt, 246
Miller, Richard, 169
mission statements
Area Activity Analysis, 351
Mobilization phase (Six Sigma), 244-265
models, 4P, 97
modes, 105
Kano’s model of customer requirements, 93-94
monitoring performance, 72
motion, 379
Mount Carmel Health for Central Ohio, 411
Mount Carmel Health Providers, 72
Mount Carmel Health System, 32
MSA (measurement system analysis), 109
muda, 379
Mullin, Carol, 169
multiple treatments using ANOVA, evaluating, 139-140
Multivari analysis, 83
N
National Cash Register Company, 362
National Committee for Quality Assurance (NCQA), 248
National Health IT, 260
National Nosocomial Infections
Surveillance (NNIS) System, 188
national quality awards, Six Sigma, 417-418
Natural Work Team (NWT), 344-345
Nebraska Medical Center
bed management case study, 220-228
need for Six Sigma, 40-41, 402-410
New England Journal of Medicine, 55
New York Presbyterian (NYP), 32
Nicholls State University, 174
Non-Value Added (NVA), 389
nonparametric output, 141
nonparametric tests, 134
normal distribution, 106
control charts, 146
Norming Stage (SST team development), 282
North Shore-Long Island Jewish Health System, 32
North Shore-LIJ Health System case study, 172-173
North Shore University Hospital case study, 388-399
North Shore-Long Island Jewish Hospital System, 412
not invented here phenomenon, 26
null hypothesis, 131
NWT (Natural Work Team), 344-345
NYP (New York Presbyterian), 32
O
objectives, setting preliminary, 262
On Intelligence, 97
operating rooms (Virtua Health), 215-219
operational measurements, 65
opportunities
optimizing respiratory care services (VBHS)
order of trials, 144
organizational structures (Six Sigma), 299-301
Six Sigma Team (SST) members, 276-285
outcomes, communicating, 74
output, nonparametric, 141
outstanding patient experiences, 69-70
overproduction, 379
P
pain management, 294
PAMC (Providence Alaska Medical Center)
parametric tests, 133
Pareto charts, 204
partnerships, developing supplier, 353
patients
better patient charge capture case study (YNHH), 211-215
journeys, 253
patient care, 67
patient-to-patient errors, 22
patterns, practice, 26
Paul Revere Insurance Company, 362
PCDA (Process Control, Process Redesign, Problem Solving), 42
Pearson, James O., 409
Pennsylvania Health Care Cost Containment Council, 18
Pennsylvania, improving healthcare, 405
people, vision statements, 248
Perfect stage (4P model), 97
Perform stage (4P model), 97
performance
metrics, 54
monitoring, 72
reviewing, 75
Six Sigma initiative, 64
Performing Stage SST team development, 283
peripherally inserted central catheter (PICC), 189
Perry, Rick, 405
Pharmacists Association of Alberta, 55
phases
Analyze, 112
cause and effect analysis, 113-114
Failure Modes and Effect Analysis (FMEA), 118-120
Ishikawa diagrams, 115
tools, 112
Commonwealth Health Corporation case study, 166
control, 146
communication, 151
Design, 90
project charters, 103
improve, 130
comparative experiments, 140-142
full factorials experiments, 142-146
testing of hypothesis, 131-139
Measure, 104
basic statistical analysis, 105-106
cost of quality (COQ), 107-109
distribution, 106
measurement system analysis (MSA), 109
process performance measures, 110-111
random versus assignable variation, 107
PICC (peripherally inserted central catheter), 189
Picture Archive and Communication Systems (PACS) implementation, 168
pilot projects (Six Sigma), 45-47
Piloting Phase (Six Sigma), 296-298
planning, 422
project plans, preparing, 291-292
pluralistic healthcare insurance system, 14
PMBOK (Project Management Body of Knowledge), 291
PMBOK tools and techniques, 433
policy errors, 23
Poling, Harold A., 424
Positional variation, 83
potential in healthcare, Six Sigma, 50-52
PPI (project prioritization index), 82
PPOs (preferred provider organizations), 15, 72
practice patterns, 26
Pre-Control, 77
preferred provider organizations (PPOs), 15, 72
Prejeant, Darcy, 175
preliminary objectives, setting, 262
Preparation stage (4P model), 97
preparing
Area Activity Analysis (AAA), 350
Presbyterian Hospital (New York), 411
Press Ganey, 174
preventing infections (Decatur Memorial Hospital), 190-191
problem solving
control phase, 146
communication, 151
improve phase
comparative experiments, 140-142
full factorials experiments, 142-146
testing of hypothesis, 131-139
Process Control, Process Redesign, Problem Solving (PDCA), 42
Process Improvement Initiative Business Plan, 252
Process Maturity Grids, 330-340
Process Owners, 307
“Process Qualification-Manufacturing Insurance Policy,” 34
processes
best-of-breed, 339
capability indexes, 110
Define, Measure, Analyze, Improve and Control (DMAIC), 269
error-free, 336
experts, 263
focus, 422
inadequacy, 22
Pareto charts, 101
standardized, 422
world-class, 337
professional judgment errors, 22
Progress stage (4P model), 97
Project Management Body of Knowledge (PMBOK), 291
Project Management tools, 433, 436
project prioritization index (PPI), 82
projected national health expenditures, 404
projects
charters, 103
Providence Alaska Medical Center (PAMC) case study, 208-211
Q
quality
cost of quality (COQ), 24-25, 107-109
CQI programs, 42
healthcare, views, 48
Lean Six Sigma, 375
Six Sigma, 41
Allied Signal, 42
GE, 41
systems, 87
TQM, 42
quality review analysts (QRAs), 182
R
R&R (Gage Repeatability and Reproducibility), 109
racial diversity, demographics, 11
radiology, Commonwealth Health Corporation case study, 166
random versus assignable variation, 107
randomized order of trials, 144
range, 106
readiness, Six Sigma, 80
Red Cross Hospital, 413
reducing
ambulance diversions case study (PAMC), 208-211
central venous catheter (CVC) infections, 188-190
nosocomial pressure ulcers, 193-199
post-operative infections, 191-193
surgical site infection (SSI) rates, 185-187
variations, 268
regions of significance, 135
relative income, 13
regulatory imposed errors, 22
relationships
customer relationship management (CRM), 93
customers
developing, 352
requirements, Kano’s model of customer, 93-94
research, 67
resources, 259
respect, 68
respiratory care services (VBHS) case study, 233-237
returns, 259
reviewing
performance, 75
Riddle Memorial Hospital’s 2006 Process Improvement Initiative Business Plan, 252
Riebling, Nancy, 174
right-sizing, 376
risks, 259
alpha and beta, 133
Robert S. Hudgens Memorial Award for Young Healthcare Executive of the Year, 171
Robert Wood Johnson Foundation, 368
Robert Wood Johnson University Hospital (RWJUH), 410
Rockefeller, John D., 361
roles (Six Sigma), defining, 302-307
Rush Copely Medical Center, 67
Russia, 404
S
salaries, 27
Santa Barbara County Health Data Exchange, 260
Santa Rosa Memorial Hospital, 410
scope of opportunities, defining, 266-267, 270
Scottsdale Healthcare, 411
selecting
consultants, 263
critical processes, 256
sepsis infections, 4
Sertz, Mike, 53
service policies, 351
setting preliminary objectives, 262
sharing ideas, 363
Shewhart, Walter, 44, 107, 146
significance, regions of, 135
SIPOC (Supplier, Input, Process, Output, and Customer), 79, 98, 100
20 Question Checklist, 445-446
Analyze phase, 112
cause and effect analysis, 113-114
Failure Modes and Effect Analysis (FMEA), 118-120
Ishikawa diagrams, 115
tools, 112
case studies
accuracy in managed care operating room carve-outs (Virtua Health), 215-219
bed management (Nebraska Medical Center), 220-228
better patient charge capture (YNHH), 211-215
cath lab utilization (Memorial Hermann Heart & Vascular Institute-Southwest), 231-232
Commonwealth Health Corporation (CHC), 166-168
corporate advance directive (VBMC-H), 229-231
Decatur Memorial Hospital, 177-178
Nebraska Medical Center, 178-179
New York-Presbyterian Hospital (NYP), 175-177
North Shore-LIJ Health System, 172-173
North Shore University Hospital, 388-399
optimizing respiratory care services (VBHS), 233-237
reducing ambulance diversions (PAMC), 208-211
Thibodaux Regional Medical Center (TRMC), 174-175
timeliness on self-pay collections (CHC), 204-208
Valley Baptist Health, 172
communications, 357
potential in healthcare, 50-52
Control phase, 146
communication, 151
cost of healthcare and, 16
culture, internalizing, 344-368
Design phase, 90
project charters, 103
determining need for, 40-41, 402-409
elimination of defects, 21
Harrington’s Wheel of Fortune, 421-423
healthcare, views of quality, 48
implementation processes, 243
Improve phase, 130
comparative experiments, 140-142
full factorials experiments, 142-146
testing of hypothesis, 131-139
initiative
estimated costs, 80
launching, 64
Lean, 375
lessons learned, 416
Measure phase, 104
basic statistical analysis, 105-106
cost of quality (COQ), 107-109
distribution, 106
measurement system analysis (MSA), 109
process performance measures, 110-111
random versus assignable variation, 107
national quality awards, 417-418
organizational structures, 299-301
projects
quality, 41
Allied Signal, 42
GE, 41
systems, 87
readiness, 80
rewards and recognition, 364-368
Student Checklist, 447
Six Sigma Team. See SST
Smith, Bill, 78
solutions
Lean Six Sigma, 384
Six Sigma as part of, 406
Sonnenberg, Frank K., 362
South Africa, 409
SPC (Statistical Process Control), 77
special variation, 107
Sponsors (Six Sigma), 302
Springfield, Jim, 171
St Joseph’s Hospital, Carondelet Healthcare Services, 410
St. Charles Medical Center, 411
St. John Health case study, 381-388
staffing shortages, 55
stages of team development, 280. See also SST
standard deviation, 106
standard operating procedures (SOPs), 182
standardized processes, 422
Stanford University Medical Center, 410
STAR Initiative (Virtua Health), 69
“State of Healthcare Quality, The,” 248
starting points, training, 326-327
Statistical Process Control (SPC), 77
distribution, 106
healthcare quality crisis, 5-7
significance, 131
statistical thinking, 423
t-tests, 140
status, Six Sigma 20 Question Checklist, 445-446
steering committees, 302
Stock, Greg, 174
Storming Stage (SST team development), 282
strategic plans, analyzing, 245-250
strategies
errors, 23
Stratton, Donald, 358
structures
organizational (Six Sigma), 299-301
vision statements, 247
Supplier, Input, Process, Output, and Customer. See SIPOC
suppliers
customer/supplier relationships, 345-349
partnerships, developing with, 353
supply of workers, demographics, 12
Surgical Infection Prevention Project (SIPP), 185
surgical site infection (SSI) rates, reducing, 185-187
surgical wounds, 4
T
t-tests, 140
Taylor, G. Don, 48
TCS (Total Customer Satisfaction), 75
TD Bank Financial Group, 409
teaching, 67
teams
Black Belts, training, 319-324
Blue Belts, training, 326
development, 280. See also SST
Executive Teams
role of, 302
Green Belts, training, 324
Master Black Belt (MBB), training, 314-319
Natural Work Team (NWT), 344-345
Six Sigma Sponsors/Champions, training, 311-314
starting points, training, 326-327
training, 309
types of, 284
Yellow Belts, training, 325
teamwork, 69
technologies, vision statements, 247
F-tests, 138
means, 137
statistics, calculating, 133-138
t-tests, 140
of variance, 137
Texas Instruments, 48
Thibodaux Regional Medical Center (TRMC), 32
reducing nosocomial pressure ulcers, 193-199
Threat/Opportunity Matrix, 193
time requirements, SST membership, 272
timeliness on self-pay collections case study, 204-208
tools
Analyze phase (Six Sigma), 112
Design phase (Six Sigma), 90-98
Total Customer Satisfaction (TCS), 75
Total Improvement Management (TIM), 424
total participation, 423
Total Quality Control (TQC), 424
Toyota Production System (TPS), 376
TQM (Total Quality Management), 42, 78, 424
traditional healthcare system, 246
training, 423
Black Belts with no, 341
management (Commonwealth Health Corporation case study), 166
Six Sigma Team (SST) members, 273-275
teams, 309
Blue Belts, 326
Green Belts, 324
Master Black Belt (MBB), 314-319
Six Sigma Sponsors/Champions, 311-314
Yellow Belts, 325
transition states, 294
transportation, 379
treatments, validating, 133-139
trends, 113
outsourcing, 13
quality crisis in healthcare, 4-7
trials, randomized order of, 144
Trusko, Brett, 5
trust, 422
Tufts New England Medical Center, 417
types
of consultants, 263
of control charts, 146
of teams, 284
of vision statements, 247
U
U.S. Department of Health and Human Services, contracts awarded (in 2005), 260
U.S. News and World Report, 248
U.S. Office of Personnel Management, 15
“Us” relationships, 423
University of Michigan, 415
University of New Hampshire, 32
Upper Specification Limit, 383
V
Valley Baptist Health case studies, 171
Valley Baptist Health System. See VBHS
Valley Baptist Medical Center-Headquarters. See VBMC-H
Value Stream Mapping. See VSM, 378
Value-Added (VA) activities, 389
values
executives, 361
Van Kooy, mark, 170
Variability Reduction Methods, 77
variable control charts, 147
variable data, 104
variance, 106
ANOVA. See ANOVA
testing of, 139
variations
random versus assignable, 107
reducing, 268
VBHS (Valley Baptist Health System) case study, 233-237
VBMC-H (Valley Baptist Medical Center-Headquarters), corporate advance directive, 229-231
views of healthcare quality, 48
accuracy in managed care operating room carve-outs, 215-219
cardiac medication administration case study, 182-185
vision of Six Sigma initiative, 66-68
vision statements, 247, types of, 247
Voice of Management, 289
Voice of Supplier, 289
Voice of the Customer (VOC), 199, 288, 383, 389
Voice of the Employee, 289
Voice of the Process, 289
VSM (Value Stream Mapping), 378-380
Vytra Health Plans, 32
W
waiting, 379
waste-free production, 376. See also Lean Six Sigma
weighted-selection approach, 257-259
Welch, Jack, 79, 166. See also GE
worker shortages, demographics, 12
world-class processes, 337
X–Y–Z
Yellow Belts, 307
training, 325
Yingling, Lois, 188
YNHH (Yale-New Haven Hospital), better patient charge capture case study, 67, 211-215
Young, John A., 424
zero defects, 33