“North Star” goals toward an ideal integrated behavioral health and ambulatory care setting Tips, resources, and real-world examples of how others are doing it What not to do, or the pitfalls to avoid when integrating behavioral health An interactive integration self-assessment checklist with immediate feedback linked to guidance Access to the Academy Community, an online forum for peer-topeer networking and sharing

Agency for Healthcare Research and Quality (AHRQ)

Patient Flow: Reducing Delay in Healthcare Delivery

Process mapping (PM) supports better understanding of complex systems and adaptation of improvement interventions to their local context. However, there is little research on its use in healthcare. This study (i) proposes a conceptual framework outlining quality criteria to guide the effective implementation, evaluation and reporting of PM in healthcare; (ii) reviews published PM cases to identify context and quality of PM application, and the reported benefits of using PM in healthcare. We developed the conceptual framework by reviewing methodological guidance on PM and empirical literature on its use in healthcare improvement interventions. We conducted a systematic review of empirical literature using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. Inclusion criteria were: full text empirical study; describing the process through which PM has been applied in a healthcare setting; published in English. Databases searched are: Medline, Embase, HMIC–Health Management Information Consortium, CINAHL-Cumulative Index to Nursing and Allied Health Literature, Scopus. Two independent reviewers extracted and analysed data. Each manuscript underwent line by line coding. The conceptual framework was used to evaluate adherence of empirical studies to the identified PM quality criteria. Context in which PM is used and benefits of using PM were coded using an inductive thematic analysis approach. The framework outlines quality criteria for each PM phase: (i) preparation, planning and process identification, (ii) data and information gathering, (iii) process map generation, (iv) analysis, (v) taking it forward. PM is used in a variety of settings and approaches to improvement. None of the reviewed studies (N = 105) met all ten quality criteria; 7% were compliant with 8/10 or 9/10 criteria. 45% of studies reported that PM was generated through multi-professional meetings and 15% reported patient involvement. Studies highlighted the value of PM in navigating the complexity characterising healthcare improvement interventions. The full potential of PM is inhibited by variance in reporting and poor adherence to underpinning principles. Greater rigour in the application of the method is required. We encourage the use and further development of the proposed framework to support training, application and reporting of PM. Prospero ID: CRD42017082140

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Process mapping in healthcare: a systematic review.

Hospital Survey on Patient Safety Culture--Short

Head and neck cancers are multi-factorial diseases that can affect many sides of people's life and are due to a lot of risk factors According to their characteristics, the treatment can be surgical, use of radiation or chemotherapy The use of a surgical treatment can lead to surgical infections that are a main theme in medicine At the University hospital of Naples “Federico II”, two antibiotics were employed to tackle the issue of the infections and they are compared in this paper to find which one implies the lowest length of hospital stay (LOS) and the reduction of infections,The Six Sigma methodology and its problem-solving strategy DMAIC (define, measure, analyse, improve, control), already employed in the healthcare sector, were used as a tool of a health technology assessment between two drugs In this paper the DMAIC roadmap is used to compare the Ceftriaxone (administered to a group of 48 patients) and the association of Cefazolin plus Clindamycin (administered to a group of 45 patients),The results show that the LOS of patients treated with Ceftriaxone is lower than those who were treated with the association of Cefazolin plus Clindamycin, the difference is about 41% Moreover, a lower number of complications and infections was found in patients who received Ceftriaxone Finally, a greater number of antibiotic shifts was needed by patients treated with Cefazolin plus Clindamycin,While the paper enhances clearly the advantages for patients' outcomes regarding the LOS and the number of complications, it did not analyse the costs of the two antibiotics,Employing the Ceftriaxone would allow the Department of Maxillofacial Surgery to obtain lower LOS and a limited number of complications/infections for recovered patients, consequently reducing the hospitalization costs,There is a double value in this paper: first of all, the comparison between the two antibiotics gives an answer to one of the main issues in medicine that is the reduction of hospital-acquired infections; secondly, the Six Sigma through its DMAIC cycle can be employed also to compare two biomedical technologies as a tool of health technology assessment studies

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A health technology assessment between two pharmacological therapies through Six Sigma: the case study of bone cancer

Short discharge time from hospitals increases both bed availability and patients' and families' satisfaction. In this study, the Six Sigma process improvement methodology was applied to reduce patients' discharge time in a cancer treatment hospital. Data on the duration of all activities, from the physician signing the discharge form to the patient leaving the treatment room, were collected through patient shadowing. These data were analyzed using detailed process maps and cause-and-effect diagrams. Fragmented and unstandardized processes and procedures and a lack of communication among the stakeholders were among the leading causes of long discharge times. Categorizing patients by their needs enabled better design of the discharge processes. Discrete event simulation was utilized as a decision support tool to test the effect of the improvements under different scenarios. Simplified and standardized processes, improved communications, and system-wide management are among the proposed improvements, which reduced patient discharge time by 54% from 216 minutes. Cultivating the necessary ownership through stakeholder analysis is an essential ingredient of sustainable improvement efforts.

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Using Six Sigma DMAIC Methodology and Discrete Event Simulation to Reduce Patient Discharge Time in King Hussein Cancer Center

Clinical RelevanceProlonged wait times for image-guided breast interventions are ruining the patient experience and negatively affect healthcare workers. Adopting lean methodology helps streamline the process and improve patient satisfaction.PurposeThis is a quality improvement project which aims to create an efficient interventional breast imaging workflow using lean methodology by reducing wastes of all kinds including time and materials. It aims to improve patients’ satisfaction by decreasing the wait timesMaterials and MethodsWe used the lean six Sigma Define, Measure, Analyze, Improve and Control (DMAIC). The team members used tools such as affinity diagram to define the current problems in the workflow and the root cause of prolonged wait times. Team members gathered observations. Root cause analysis using a fishbone diagram and wasteful steps were identified. Brainstorming sessions discussed ideas for improvement. A consensus was reached on countermeasures and a pilot project was planned.ResultsThe target of decreasing the wait time was met on the days when the counter measures were fully implementedConclusionStreamlining the breast imaging intervention is considered in its preliminary phase; further work and reviews are needed towards full implementation and sustainability. Despite the many challenges, embarking on quality improvement project and promoting lean culture not only helped us to meet the target of decreasing wait time but have improved the work environment and patient satisfaction

Streamlining The Interventional Breast Imaging Workflow by Lean Methodology Implementation

Following the famous institute of medicine report To Err is Human the healthcare policy makers sensed an urging need to introduce and implement quality and patient safety strategies in the US and worldwide. In response to that wave the importance of quality measurement was magnified in the light of "You cannot improve what you cannot measure". In this work we present the experience of King Hussein Cancer Center KHCC in developing and implementing an institutional approach toward quality measurement. This approach is supported by real life examples to improvement initiatives that were supported by data along the way. We also illustrated the managerial framework KHCC adopted in terms of leadership support, stakeholders engagement and patient centrality

Dana M. K. Nashawati

Papers

Using Six Sigma DMAIC Methodology and Discrete Event Simulation to Reduce Patient Discharge Time in King Hussein Cancer Center

Streamlining The Interventional Breast Imaging Workflow by Lean Methodology Implementation

Towards a Framework for Quality Measurement in a Tertiary Care Hospital: the Case of King Hussein Cancer Center