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About this Book, This book The Executive Guide to Healthcare Kaizen is a follow up edition to. our book Healthcare Kaizen Engaging Front Line Staff in Sustainable Continuous. Improvements This book a derivative of that earlier work is intended for senior. leaders and other healthcare leaders who can initiate and sponsor a Kaizen program. of staff engagement and continuous improvement for their organization. Healthcare Kaizen is a longer book with over 200 full color illustrations. including 100 examples of real Kaizen improvements from different healthcare. organizations We thankfully received many positive reviews of the book with. the only real criticism being that the book was too complete or too heavy for an. executive to carry onboard a flight, This edition is intended to cover the why why Kaizen and the what. what is Kaizen and a Kaizen culture while Healthcare Kaizen has more of the. how There is significant overlap between this book and Healthcare Kaizen. so there is a consistent approach taught by both books We envision The Executive. Guide to Healthcare Kaizen as a smaller more affordable book that covers the. basics of Kaizen while Healthcare Kaizen is the more encyclopedic guide for. practitioners, Each chapter in this book starts with a quick take list of key points from the. chapter At the end of each chapter are discussion questions that we hope you will. use to prompt discussion with your leadership team We invite you to interact with. us via our website http www HCkaizen com, While this book has two coauthors Mark Graban and Joe Swartz we have. done our best to write in a single voice Any work that we directly participated. in is written about in the third person to avoid confusion about who was writing. particular sections, Franciscan St Francis Health is a three hospital system in Indianapolis. Throughout this book we will often refer to individual hospitals in this system. in an abbreviated form like Franciscan That three hospital system is part of. the Franciscan Alliance a 14 hospital system located throughout Indiana and. northeastern Illinois Where we focus on one of their other 11 hospitals we will. call them out uniquely such as Franciscan St Elizabeth Health. Book Comparisons,Visit www HCkaizen com for more information. Chapter Comparisons,Visit www HCkaizen com for more information. To view a 3 minute video about the practice of, Healthcare Kaizen at the Franciscan St Francis Health. System including comments from their CEO Bob,Brody and their COO Keith Jewell visit. http www HCkaizen com FranciscanVideo,Healthcare Kaizen was named a recipient of the. prestigious Shingo Professional Publication and,Research Award in 2013 Learn more at. http www HCkaizen com ShingoAward,Visit www HCkaizen com for more information. Introduction, The value of using Kaizen to improve healthcare systems is indisputable At Virginia. Mason we have been using Kaizen based on the Toyota Production System for. more than a decade The Virginia Mason Production System as we call it has. allowed us to deliver safer better and more affordable care to our patients. One of the keys to successful implementation of Kaizen is the serious com. mitment of leaders including the CEO senior executives physician leaders and. boards of directors In our organization all leaders attend mandatory Kaizen train. ing are required to lead formal improvement events each year and are expected. to routinely coach and train employees about how to improve their work using. Kaizen tools and methods Kaizen is not a program or an activity that is the sole. responsibility of one department it is the management method used by all leaders. at Virginia Mason to guide and operate every aspect of the organization. Physician leadership is an important part of leadership commitment An orga. nization that reforms around physicians but doesn t involve them in the process will. have difficulty succeeding in the long run In my experience the organizations with. strong physician leadership and active physician involvement at all levels are best. prepared to deliver change through Kaizen, Kaizen tools encourage and guide change in day to day work by all employ. ees As employees gain a better understanding of Kaizen they use its methods to. improve how they do their work At Virginia Mason we encourage employees to. record their improvement ideas as Everyday Lean Ideas and share them with the. organization so they can be replicated across the medical center. As it relates to employee engagement Kaizen can t be imposed from above. Leaders should introduce teach and encourage the adoption of Kaizen methodolo. gies but it is only sustained when employees are engaged because they have found. that it makes their work easier and more satisfying Employees become champions. of Kaizen when they see it reduces the burden of work and the waste of rework. and waste of time that come with inefficiency It frees them to do the important. things that add value for our patients and helps them recapture the passion that. drove their original career decisions to work in healthcare. xxxii Introduction, Learning to use Kaizen consistently and effectively requires serious culture. change and takes many years This is really not unexpected as using Kaizen requires. deep organizational changes changes that challenge long held beliefs and many. accepted practices Our results have been gratifying and propel us to work even. harder to deploy these methods and tools deeply within our organization I believe. this book will help any willing healthcare leader who sets out on the Kaizen journey. to achieve similar success,Gary S Kaplan MD, Chairman and CEO Virginia Mason Medical Center Seattle. About the Authors,Mark Graban is an author consultant and speaker. in the field of Lean healthcare He is the author of. Lean Hospitals Improving Quality Patient Safety,and Employee Engagement 2nd edition and coau. thor of Healthcare Kaizen Engaging Front Line,Staff in Sustainable Continuous Improvements Mark. has worked as a consultant and coach to health,care organizations throughout North America and. Europe He was formerly a senior fellow with the, Lean Enterprise Institute and continues to serve as a. faculty member Mark is also the chief improvement, officer for KaiNexus a startup software company that. helps healthcare organizations manage continuous, improvement efforts Mark earned a BS in industrial. engineering from Northwestern University and an MS in mechanical engineering. and an MBA from MIT Sloan Leaders for Global Operations Program Visit his. website at http www MarkGraban com and his blog at http www LeanBlog org. Joseph E Swartz is the director of Business,Transformation for Franciscan St Francis Health. of Indianapolis Indiana He has been leading con, tinuous improvement efforts for 18 years including. 7 years in healthcare and has led more than 200,Lean and Six Sigma improvement projects Joseph is. the coauthor with Mark Graban of Healthcare Kaizen. Engaging Front Line Staff in Sustainable Continuous. Improvement and coauthor of Seeing David in the Stone. and was previously an instructor at the University of. Wisconsin Joseph earned an MS in management, from Purdue University as a Karnnert Scholar for aca. demic excellence,The Need for Kaizen,Quick Take, Because healthcare faces such great challenges we have no choice but to get. everybody involved in identifying and implementing improvements. Kaizen is a Japanese word that means change for the better. Kaizen is a key part of the Lean management philosophy and strategy. Kaizen engages all staff physicians and leaders in making improvements to. safety quality access and cost while improving staff morale. Responsibility for Kaizen cannot be outsourced to consultants or delegated. to a Quality Department, Kaizen creates higher engagement which leads to better quality which. results in lower cost, The return on Investment ROI on a Kaizen program can be impressive. millions per year with little investment, Kaizen creates more a more flexible and adaptive organization to better cope. with conditions of extreme uncertainty, It is not the strongest of the species that survives nor the most intel. ligent but the one most responsive to change,Charles Darwin. Franciscan St Francis Health is a three hospital system in Indianapolis Indiana. that is part of the Franciscan Alliance a 13 hospital system located throughout. Indiana and northeastern Illinois Founded over 135 years ago by a group of. Final edits not done yet pre publication copy,2 The Executive Guide to Healthcare Kaizen. Catholic Sisters they take their inspiration from St Francis of Assisi Franciscan. St Francis Health has received numerous awards including. Number one ranking in Indiana by HealthGrades for cardiac services. and one of America s 100 best hospitals for cardiac care and coronary. intervention, Top 5 in the nation and number one in Indiana for joint surgery according. to HealthGrades 2007 2011, The HealthGrades Distinguished Hospital Award for Clinical Excellence in. 2012 for being in the top 5 in the nation in overall clinical quality. In 2005 after several years of suboptimal performance the organization went. looking for ways to capitalize on its foundation of excellence. Paul Strange MD then Franciscan s vice president of quality convinced the. leadership team to launch a Lean Six Sigma program Robert J Brody president. and chief executive officer of St Francis Health and Keith Jewell the chief oper. ating officer brought in a team of people from the outside including one of this. book s coauthors Joe Swartz and professors from Purdue University Their Lean. Six Sigma journey began in 2006 and Franciscan added a formal Kaizen program. of continuous improvement in April 2007, What started small with a housekeeping staff member improving the way cof. fee filters were stored has turned into an organization wide program and more. importantly a significant culture change Today Franciscan St Francis empowers. their staff members to identify problems and take action leading to improvements. both large and small Some of these improvements made life a little better for the. patients in a fun or charming way some changed clinical practice and others saved. significant sums of money, Since 2007 the three Franciscan St Francis hospitals have implemented more. than 17 000 improvements that have an estimated hard dollar cost savings of over. 5 7 million all with very little investment other than time focus and leader. ship If every hospital in the United States could save 2 million a year through. Kaizen it would add up to 10 billion That may seem like a small drop in the. healthcare cost bucket but the hard numbers from Franciscan don t include other. soft savings such as staff time savings that can be reallocated to better patient. care increased patient and staff satisfaction reduced error rates and reduced. waiting times, The cost savings at Franciscan have been impressive but cost is far from. the primary goal of Franciscan s Kaizen culture Throughout this book we. will be sharing stories from Franciscan and other hospitals to demonstrate how. they engaged their staff in improvements that made a difference for all of their. stakeholders patients employees physicians and the organization itself CEO. Bob Brody said There is every reason for any organization to encourage and. support the Kaizen concepts It creates a more efficient and productive work. The Need for Kaizen 3, environment a more satisfied patient and a more satisfied workforce These are. linked to one another and to hospital performance 1. For Franciscan and other leading organizations Kaizen is just the right thing to. do in terms of furthering its mission and fulfilling its desire to treat all staff mem. bers physicians and other stakeholders with the utmost of respect. Kaizen Change for the Better, The word Kaizen is translated from Japanese in a number of ways most simply as. change for the better 2 The Japanese characters are shown in Figure 1 1. Breaking down the word Kai means change zen means good. A Kaizen is an improvement that is made by those who do the work It is. typically a small low cost low risk improvement that can be easily implemented 3. Kaizen is an ongoing methodology and philosophy for challenging and empow. ering everyone in the organization to use their creative ideas to improve their. daily work, The word Kaizen the way it is typically used is synonymous with the phrase. continuous improvement An effective Kaizen approach is connected to measur. able results and a deeper purpose Children s Medical Center Dallas Texas. has a process improvement campaign that asks the simple question Is there a. better way Clay York manager of the core laboratory and other leaders help. tie the department s local improvement efforts to the organization s mission and. purpose by asking team members if proposed changes will help provide better. care for kids 4, Figure 1 1 The word Kaizen in Japanese kanji characters. 4 The Executive Guide to Healthcare Kaizen, Beyond the measurable results Kaizen organizations value the. organizational learning that results from the improvement pro. cess as well as the personal learning and satisfaction of all. who are involved, IU Health Goshen Hospital has saved more than 30 million. since 1998 with a program called The Uncommon Leader as. part of its broader improvement program In 2009 CEO James. Dague now retired promised to shave his head if employees. generated ideas that saved 3 5 million that year The hospital. more than doubled that savings goal so Dague made good on. that promise in front of his colleagues The culture at Goshen. has shifted to one where every person is empowered to make. improvements to his or her daily work making suggestions. that can impact cost quality and patient care For example. an emergency nurse educator saved 4 000 by changing the. type of napkins used on patient trays and the GI department. saved 22 000 by switching from disposable paper gowns. to cloth gowns 5 Goshen has gone 17 years without layoffs. undoubtedly being a key reason its employees are so enthusi. astic about improvement 6 Goshen was also named one of the. top ten large employer workplaces in Indiana in part due to its. workplace culture where employees feel valued 7,Kaizen Meaningful Improvements. Paula Stanfill s husband had open heart surgery Paula is the manager of the neo. natal intensive care unit NICU at Franciscan St Francis Health In the recovery. room Paula s husband could not speak because he was intubated with a breathing. tube He was trying to communicate by furrowing his eyebrows and squinting He. knew sign language and was motioning at his arm and trying to use his fingers to. tell Paula something but he could not make his hands do what he wanted them to. do Paula remembers her panic in realizing that something serious might be hap. pening to her husband He also began to panic thinking the surgery had caused. a serious problem with his arms They were deeply distressed until the anesthesia. wore off and he could speak again, Paula learned that her husband s arms and hands were numb He was a big. man and when the surgeons performed the procedure they had leaned over his. arms and put pressure on them reducing the blood supply and causing the numb. ness His arms remained numb for several weeks, After this episode Jessica Clendenen a nurse in Franciscan s cardiac operat. ing room learned that several other patients had experienced similar postoperative. The Need for Kaizen 5, numbness She decided to do something about it In January 2011 Jessica found. some sled positioners that could be used to help tuck the patient s arms in place. in a way that allowed the IV lines to be seen through the clear material The use. of positioners reduced the pressure on the patient which meant improved quality. patient safety and satisfaction, This small simple improvement can be described as a Kaizen It was an improve. ment that made a difference to open heart patients at Franciscan and was one that. Paula will never forget When she started making workplace improvements Paula. never realized it would touch her so personally But after her husband s experience. Paula realized that the heart of Kaizen is the difference it can make in people s lives. Kaizen was no longer just a concept or a program to her it had become a way of life. Healthcare s Opportunity for Improvement, The largest room in the world is the room for improvement. Author unknown, As summarized in the Institute of Medicine s 2012 report titled Best Care at Lower. Cost The Path to Continuously Learning Health Care in America healthcare in the. United States is underperforming in many ways with problems including. 750 billion in unnecessary health spending in 2009. 75 000 needless deaths that could have been averted in 2005 if every state. performed as well as the best state8, Of the 750 billion in waste 130 billion is estimated to come from ineffi. ciently delivered services which includes mistakes errors and preventable compli. cations fragmented care and operational inefficiencies 9 These costs are in the span. of control of health systems and represent a great opportunity for improvement. While healthcare spending in the United States is far higher than any other. country rising costs along with costs that are too high for national budgets are a. problem throughout the developed world Diabetes costs alone threaten to bank. rupt the National Health Service NHS in England10 and the NHS is being. forced to cut costs by 20 billion by 2015 11 The budget cuts are leading to nurse. layoffs and warnings from some NHS finance staff that patient care will suffer. as a result 12 Hospitals in Canada face government budget cuts as public health. care costs could comprise 70 of the Ontario provincial budget by 2022 13 Michel. T treault CEO of St Boniface General Hospital Winnipeg Manitoba says his. hospital has to each year deliver care to 4 more patients who are 4 sicker with. the same staffing and resources 14, With American hospitals now facing the additional financial pressures of the. Patient Protection and Affordable Care Act of 2010 also known as ObamaCare. 6 The Executive Guide to Healthcare Kaizen, reimbursements to health systems and physicians are being reduced while penalties. for preventable medical errors and readmissions are increasing. The Institute of Medicine IOM report concluded that Left unchanged. health care will continue to underperform cause unnecessary harm and strain. national state and family budgets 15 Patients and their families are a powerful. motivation for improving quality and safety reducing costs and improving access. Beyond the financial strain there is also a big need to reduce the workplace strain. and stress on physicians nurses and staff members in all departments This stress. and frustration is caused primarily by process issues that can be fixed by healthcare. organizations and can often be fixed by local teams if they have a method for. improvement and a conducive environment, Today s health system executives around the world face the challenge of simul. taneously improving across many dimensions The old trade offs can no longer. hold true the notion that better quality must inherently cost more or that the. only way to increase capacity is spending more money on people resources and. facilities Leaders must figure out how to bust these old trade offs and this requires. new approaches When facing large challenges the most effective approach might. ironically begin with the smallest of steps, Small improvements are believable and therefore achievable 16. Tony Robbins,The IOM s Recommendations for Continuous Learning. The IOM report highlighted the need for continuously learning and continu. ously improving healthcare organizations They directly endorse the use of Lean. Six Sigma and other methods17 and their more detailed recommendations include. many aspects of a Kaizen approach such as, Recommendation 6 Care continuity Improve coordination and communi. cation within and across organizations, Recommendation 7 Optimized operations Continuously improve health. care operations to reduce waste streamline care delivery and focus on activi. ties that improve patient health, Recommendation 10 Broad leadership Expand commitment to the goals of. a continuously learning health care system 18, The IOM elaborates that the characteristics of a continuously learning orga. nization include a leadership instilled culture of learning where a system is. stewarded by leadership committed to a culture of teamwork collaboration and. adaptability in support of continuous learning as a core aim 19 The IOM also. envisions a learning health system as one in which complex care operations and. The Need for Kaizen 7, processes are constantly refined through ongoing team training and skill building. systems analysis and information development and creation of the feedback loops. for continuous learning and system improvement 20 That all describes Kaizen and. that is becoming the culture of Franciscan and other leading health systems. The idea of a learning organization is not new as the term has been used for. decades by the quality guru W Edwards Deming and his followers as well as the. systems thinking field popularized by MIT professor Peter Senge Many health sys. tems have found that Lean and Kaizen methods and principles can create a learning. organization 21 In increasingly uncertain times the organizational ability to learn. improve and adapt will be helpful if not absolutely necessary. Dr Berwick s Early Call for Kaizen in Healthcare, The word Kaizen was introduced to the West by Japanese author and consultant. Masaaki Imai in his 1986 book KAIZEN The Key to Japan s Competitive Success Imai. wrote simply Kaizen means improvement and Kaizen is everybody s business 22. Shortly after Imai s book other healthcare leaders took notice Dr Donald. M Berwick is legendary in healthcare quality and patient safety improvement. circles thanks to his advocacy and education work done as the founder and chair. man of the Institute for Healthcare Improvement and as the former administrator. of the U S Centers for Medicare and Medicaid Services In 1989 Berwick pub. lished an article called Continuous Improvement as an Ideal in Health Care in. the New England Journal of Medicine where he wrote that continuous improvement. holds some badly needed answers for American health care 23. Berwick cited Imai with the definition that Kaizen is the continuous search. for opportunities for all processes to get better and emphasizing that the self. development and the pursuit of completeness found in Kaizen are familiar themes. in medical instruction and history In highlighting what is different with Kaizen. Berwick criticized disciplinarian style leaders who look to punish bad apples. instead of improving processes He also argued that a leader cannot be a mere. observer of problems but instead needs to lead others toward solutions. Berwick highlighted a number of themes including, Leaders must take the lead in continuous quality improvement replacing. blame and finger pointing with shared goals, Organizations must invest managerial time capital and technical expertise. in quality improvement, Respect for healthcare professionals must be reestablished highlighting that. they are assumed to be trying hard acting in good faith people cannot be. frightened into doing better in complex healthcare systems. Berwick s summary of continuous improvement emphasized the culture change. required to have everybody work together removing fear shame and finger.
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