-: Hi everyone, and welcome to this week's lecture
on, "Process Design and Continuous Quality Improvement
for Operational Change in Global Health."
And in this chapter we're going to introduce
operations management principles,
models, tools, techniques, and methods that are widely used
for quality improvement in global health settings.
We're also going to provide an overview of concepts
that are important for people seeking process improvements
that will truly add value for clients,
constituents, stakeholders, communities,
and this health sector as a whole.
So to begin with,
we'll look at the simplified value chain model
and the value chain is the sequence
of internal organizational activities
including acquiring, producing,
selling, delivering and collecting,
and external organizational activities
like system relationships that together create a product
or service to meet clients' needs and wants
or the client's demand.
This figure shows a simplified representation
of the value chain model.
And you'll note one key vocabulary term
throughout this chapter is KSFs, or key success factors,
which are factors that are considered critical
for an organization's ability
to meet client and customer needs and wants
and to achieve sustainability or a competitive advantage,
depending on whether you're working in a non-for-profit
or for-profit environment.
So next we'll look at an example of the supply chain
in a healthcare setting.
So we know that the management of interface relationships
and the value system is called supply chain management,
in the case of a health system, as we see in this figure,
the supply chain includes activities
at various provision levels
such as primary, secondary, and specialized care,
as well as other personal
and non-personal healthcare activities.
We see here that the different supply and demand areas
are broken down into outbound logistics,
input logistics, processes, outbound logistics again,
input logistics, again, the process,
and then finally more outbound logistics.
And then at the end of the value system,
we see both a depiction of the key success factors
and the sigma value.
Next, when we discuss service design,
we see that service design is an emerging field
concerned with the design of services
and ways to improve and innovate services
through the application
of established design processes and skills.
It involves designing the processes
that produce a product or service
and designing the product or service itself.
These are both interrelated activities,
that's because product design or service design
has an impact on process design and vice versa.
This can sometimes be the distinction between the two,
process design and service design
cannot always be super clear in healthcare,
so it's important to pay attention
to the relationship between the two.
Next, we'll discuss design thinking.
So design thinking is a problem solving discipline
that takes a human-centric approach to service innovation
and improvement with the customer
or the user experience at its core.
In the case of healthcare settings,
typically that customer or user is going to be the patient.
There's been a growing amount of attention
paid to applications of design thinking
to improve public services, including public healthcare.
This was popularized
as an approach to creative problem solving
through the works of several individuals in the mid 2000s
and it's described as, "A discipline
that uses the designer's sensibility and methods
to meet people's needs
and match them with what is technologically feasible
and what a viable business strategy can convert
into customer value and market opportunity."
Design thinking incorporates the concept of co-design,
which we see at the center of this diagram.
This is the active involvement of all stakeholders,
including employees, partners, customers, citizens,
end users, et cetera, in the design process to ensure
that the end result meets their needs and is usable
and the figure on the slide depicts this process.
Next, when we're thinking
about process design and service design,
it's very important oftentimes
to be able to diagram these processes visually
because they can be quite complicated,
involve many steps, and different beneficiaries.
This is one example of process mapping
and a patient's journey map.
So process mapping is a tool for examining the activities
involved in the delivery of service
and the ways that those activities are managed,
while a patient journey map is a visual representation
of a patient's journey through a set of clinical services.
In this diagram, a patient journey map,
we see a condensed visual summary
of patient actions and experiences
that are linked to the steps of a healthcare process.
When making these maps,
they can be specific to a particular service
like a visit to a general practitioner
or they can be more macro or larger scale in nature,
taking into account the coordination of multiple services,
like the steps from diagnosis to treatment
of prostate cancer, such as in this example.
Another example of a diagram oftentimes used
in process and service design is a diagram like this
that's depicting the design thinking
and service design process
and one thing to call your attention to here
is the emphasis on iteration and prototyping.
So the act of iterating,
on creating something, evaluating it,
then changing aspects of it
in order to make a better version
is very important in healthcare,
because by doing so, you can achieve an optimal product
or an optimal service.
So this exhibit or this image depicts also the four stages
of the design thinking process,
discovery, definition, ideation, and delivery
and these stages are often described or broken down
into sub-stages as well.
So the delivery stage, there's piloting,
refining and delivery,
and the definition stage involves
problem framing, et cetera.
So now when we turn
to looking at service design in healthcare,
we see that it's so important to examine
the different dimensions of healthcare quality
and this is especially important in the 21st century,
in the 2020s, et cetera, as there are new innovations
and new challenges that healthcare faces.
There's been worldwide projects
and collaboration with prominent hospitals
to improve service design processes in healthcare
and as we mentioned with the design thinking process,
there's a real focus on the patient experience
and patient flow as well as cost efficiency.
So this diagram,
while it can be kind of intimidating and quite lengthy,
this exhibit presents different perspectives
along with the quality of domains and dimensions
as well as associated methods and measurements
in a somewhat simplified measure.
So the perspectives on the far left hand column
can be thought of as the four underlying perspectives
that one can use to approach quality and health systems.
So the first, the outcomes,
this perspective focuses on the benefits or effects
in economic or societal terms.
The next, number two, the clients,
considers the attributes needed or desired
by clients, customers, and stakeholders.
Then finally three and four, the process and the resources,
the process focuses on the internal activities
to meet clients, customers,
and stakeholders needs and desires
through the delivery of products or services
and the resources deals
with the tangible and intangible inputs
like human resources, organizational resources,
informational resources and systemic infrastructure
that's required for process activities.
The rest of this lecture
is going to focus mostly on number three,
the different processes, but I encourage you
to read more deeply
into these different dimensions and perspectives
when you have time.
And you see too on the far right column,
different measurements or methods that can be used
to evaluate that perspective and help.
So for example, when we're talking about processes,
we see that some important aspects
include clinical standards or clinical pathways,
consistency following clinical guidelines.
Two different tools or two different approaches
that we'll read more into later in the lecture
called Six Sigma and Lean,
examining wait times to ensure quick and accurate diagnoses
and treatments, reducing cycle times of care
and increasing patients' chances of success
in, "Returning to their normal lives."
And also standards,
public health accreditation, drug regulation,
clinical paths and guidelines, waste management,
and joint commission international accreditation.
And we see that all of these things are important,
but it's important that we don't forget
about the other aspects of quality methods systems
as we think about these.
And now finally we'll talk a little bit
about benchmarking in healthcare.
So benchmarking is a practice deeply embedded
in the TQM philosophy
or the total quality management philosophy
and it involves measuring the performance of an organization
against a standard or a benchmark.
The standard, which might be absolute,
so it might be a fixed number
or it might be relative to other organizations,
for example, will score in the 95th percentile
of some key health outcome,
it's often treated as a goal to be equaled to surpassed
and it's believed to reflect the, "Best practice,"
which is a method or activity
that has been shown to generate superior results.
Many organizations compare their own performance
against the performance of the strongest competitor
or a benchmark organization
renowned as a leader in the field
and the current highest performance level in the field
is regarded as the best in class.
The fundamental aim of benchmarking with the best in class
is to become the industry leader.
So one area in which the tool of benchmarking can excel
is in exposing areas where improvement is needed
and in providing guidance
for the adoption of processes or standards
that have been associated with superior performance
in other organizations.
Benchmarking is not a measurement itself,
but rather is a process of identifying gaps in performance
and putting in place action plans to choose such gaps.
This exhibit or this figure illustrates the way
in which performance gaps can be addressed
through benchmarking.
And here we see the upper line
depicting the best in class standard
with the lower line depicting the best practice standard
with CPIs standing for continuous process improvement
and the P next to the red lines and arrows
standing for design plans or programs
that are disruptive and can be used to reduce gaps.