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Using Multivariate Statistics

Background Plan–do–study–act (PDSA) cycles provide a structure for iterative testing of changes to improve quality of systems. The method is widely accepted in healthcare improvement; however there is little overarching evaluation of how the method is applied. This paper proposes a theoretical framework for assessing the quality of application of PDSA cycles and explores the consistency with which the method has been applied in peer-reviewed literature against this framework. Methods NHS Evidence and Cochrane databases were searched by three independent reviewers. Empirical studies were included that reported application of the PDSA method in healthcare. Application of PDSA cycles was assessed against key features of the method, including documentation characteristics, use of iterative cycles, prediction-based testing of change, initial small-scale testing and use of data

https://qualitysafety.bmj.com/content/qhc/23/4/290.full.pdf

Systematic review of the application of the plan–do–study–act method to improve quality in healthcare

Lean in healthcare: A comprehensive review

The Leadership Challenge: How to Keep Getting Extraordinary Things Done in Organizations

Background: Lean and Six Sigma are improvement methodologies developed in the manufacturing industry and have been applied to healthcare settings since the 1990s. They use a systematic and reproducible approach to provide Quality Improvement (QI), with a flexible process that can be applied to a range of outcomes across different patient groups. This review assesses the literature with regard to the use and utility of Lean and Six Sigma methodologies in surgery.

The use of Lean and Six Sigma methodologies in surgery: A systematic review

Background:
The demand for the highest-quality patient care coupled with pressure on funding has led to the increasing use of quality improvement (QI) methodologies from the manufacturing industry. The aim of this systematic review was to identify and evaluate the application and effectiveness of these QI methodologies to the field of surgery.

Methods:
MEDLINE, the Cochrane Database, Allied and Complementary Medicine Database, British Nursing Index, Cumulative Index to Nursing and Allied Health Literature, Embase, Health Business™ Elite, the Health Management Information Consortium and PsycINFO® were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Empirical studies were included that implemented a described QI methodology to surgical care and analysed a named outcome statistically.

Results:
Some 34 of 1595 articles identified met the inclusion criteria after consensus from two independent investigators. Nine studies described continuous quality improvement (CQI), five Six Sigma, five total quality management (TQM), five plan-do-study-act (PDSA) or plan-do-check-act (PDCA) cycles, five statistical process control (SPC) or statistical quality control (SQC), four Lean and one Lean Six Sigma; 20 of the studies were undertaken in the USA. The most common aims were to reduce complications or improve outcomes (11), to reduce infection (7), and to reduce theatre delays (7). There was one randomized controlled trial.

Conclusion:
QI methodologies from industry can have significant effects on improving surgical care, from reducing infection rates to increasing operating room efficiency. The evidence is generally of suboptimal quality, and rigorous randomized multicentre studies are needed to bring evidence-based management into the same league as evidence-based medicine. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Systematic review of the application of quality improvement methodologies from the manufacturing industry to surgical healthcare.

In response to an increasing body of evidence on the importance of employee health and well-being (HWB) within health care, there has been a shift in focus from both policymakers and individual organizations toward improving health care employee HWB. However, there is something of a paucity of evidence regarding the impact and value of specific HWB interventions within a health care setting. The aim of this article was to systematically review the literature on this topic utilizing the EMBASE, Global Health, Health Management Information Consortium, MEDLINE, and PsycINFO databases. Forty-four articles were identified and, due to a large degree of heterogeneity, were considered under different headings as to the type of intervention employed: namely, those evaluating changing ways of working, physical health promotion, complementary and alternative medicine, and stress management interventions, and those utilizing multimodal interventions. Our results consider both the efficacy and reliability of each intervention in turn and reflect on the importance of careful study design and measure selection when evaluating the impact of HWB interventions.

Interventions to improve employee health and well-being within health care organizations: A systematic review.

Healthcare-OH is the only healthcare-specific measure of organizational health currently in use and for this concept to be truly applied in a healthcare context then reliable and valid measurement ...

Christopher R. Nicolay

Papers

Systematic review of the application of quality improvement methodologies from the manufacturing industry to surgical healthcare.

Interventions to improve employee health and well-being within health care organizations: A systematic review.

Organizational health in healthcare organizations – psychometric validation of the Healthcare-OH survey across fifteen acute NHS trusts in England