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Профессиональный Документы
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=
(
=
s
x USL
or
s
LSL x
C
x USL
or
LSL x
C
s
LSL USL
C
LSL USL
C
pk
pk
p
p
3 3
min
by estimated is and
3 3
min
6
by estimated is and
6
o o
o
Copyright 2008 Health Administration Press. All rights reserved. 8-23
Process Capability
Cp and Cpk
(
=
(
=
s
x USL
or
s
LSL x
C
x USL
or
LSL x
C
s
LSL USL
C
LSL USL
C
pk
pk
p
p
3 3
min
by estimated is and
3 3
min
6
by estimated is and
6
o o
o
Copyright 2008 Health Administration Press. All rights reserved. 8-24
Process Capability
Cp and Cpk
-7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7
1.5 o shift
LSL
USL
3.4
DPM
O
Copyright 2008 Health Administration Press. All rights reserved. 8-25
Rolled Throughput Yield
Step 2
95/100
error-free
products
Step 3
95/100
error-free
products
Step 4
95/100
error-free
products
Step 1
95/100
error-free
products
Proportions
Step 2
95 in
90 error-
free
products
out
Step 3
90 in
86 error-
free
products
out
Step 4
86 in
81 error-
free
products
out
Step 1
100 in
95 error-
free
products
out
Actual
Copyright 2008 Health Administration Press. All rights reserved. 8-26
Quality Function Deployment (QFD)
House of Quality
Correlation
matrix
Design
requirements
Customer
requirements
Competitive
assessment
Relationship
matrix
Specifications
or
target values
I
m
p
o
r
t
a
n
c
e
Importance weight
I
m
p
o
r
t
a
n
c
e
Importance weight
Copyright 2008 Health Administration Press. All rights reserved. 8-27
Customer
needs
Knowledge that it is time for an office visit
Knowledge of why follow-up is needed
Convenient to schedule
Known appointment length
Appointment on time
Goal: Develop a system to
ensure that diabetes patients
receive preventive exams
QFD Example
Copyright 2008 Health Administration Press. All rights reserved. 8-28
Technical
responses
O
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f
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o
n
Time knowledge
Why knowledge
Convenient
Appointment length
Appointment time
QFD Example
Copyright 2008 Health Administration Press. All rights reserved. 8-29
Importance:
Patient desire
Cost
Competitive
advantage
Time knowledge 5
Why knowledge 3
Convenient 4
Appointment length 3
Appointment time 4
QFD Example
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n
Copyright 2008 Health Administration Press. All rights reserved. 8-30
Time knowledge
5
Why knowledge
3
Convenient
4
Appointment length
3
Appointment time
4
QFD Example
O
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a
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I
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a
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f
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c
a
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i
o
n
Relationships:
Strong = 5
Medium = 3
Weak = 1
Copyright 2008 Health Administration Press. All rights reserved. 8-31
Time knowledge
5 5 3
Why knowledge
3 5
Convenient
4 3
Appointment length
3 5 3
Appointment time
4 3 5
QFD Example
O
n
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Replace icons with numbers
Relationships:
Strong = 5
Medium = 3
Weak = 1
Copyright 2008 Health Administration Press. All rights reserved. 8-32
Time knowledge
5 5 3
Why knowledge
3 5
Convenient
4 5
Appointment length
3 5 3
Appointment time
4 3 5
25 15 15 20 27 29
QFD Example
O
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a
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i
o
n
Multiply by importance and sum
Copyright 2008 Health Administration Press. All rights reserved. 8-33
Time knowledge
5 5 3
Why knowledge
3 5
Convenient
4 5
Appointment length
3 5 3
Appointment time
4 3 5
25 15 15 20 27 29
QFD Example
O
n
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a
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o
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i
f
i
c
a
t
i
o
n
Technical
correlations
Relationships:
+ = Strong positive
= Strong negative
+
+
Copyright 2008 Health Administration Press. All rights reserved. 8-34
Time knowledge
5 5 3
Why knowledge
3 5
Convenient
4 5
Appointment length
3 5 3
Appointment time
4 3 5
25 15 15 20 27 29
QFD Example
O
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Target:
100
diabetics/month;
85% compliance
Copyright 2008 Health Administration Press. All rights reserved. 8-35
QFD Example
Outcome
To: Dan McLaughlin
From: Southview Clinic
Dear Dan,
You had an appointment with Dr. Adams about six months ago, and it
is now time for another visit. We need to check your blood pressure,
do some blood tests, and adjust your prescriptions if needed. We
would like to review these preventive procedures in advance, so
please see www.southview.com/prev22.
We have two openings available next week, on Tuesday at 8:30 am
and Thursday at 2:30, to see Dr. Adams. Click on one of these days to
make the appointment, or e-mail us with dates and times that work
for you.
We appreciate you continuing your care with us, and Dr. Adams looks
forward to seeing you.
Copyright 2008 Health Administration Press. All rights reserved. 8-36
Taguchi Methods
Taguchi loss function
- A quality product is a
product that causes a
minimal loss
(expressed in $) to
society during its entire
life.
Design of Experiments
(DOE)
Design for Six Sigma
(DFSS)
Taguchi Loss Function
Y ($)
LSL Target USL
Loss
( ) | |
2
2
2
$
where Loss
A
= + = k T Y k o
A
Copyright 2008 Health Administration Press. All rights reserved. 8-37
Design of Experiments (DOE)
A structured approach to the investigation of
a system or process that determines the
level of each input variable for each trial and
does not require all possible levels of every
input variable
Requires fewer trials because it eliminates
the need to change one variable at a time
Can find effects of combinations of input
variables
Copyright 2008 Health Administration Press. All rights reserved. 8-38
Benchmarking
Process of identifying, understanding, and
adapting outstanding practices and
processes to improve organizational
performance
Steps in benchmarking:
- Determine what to benchmark
- Determine how to measure it
- Gather information and data
- Implement the best practice within the
organization
Best
Worst
Range
of
values
Your
organization
Best
Worst
Range
of
values
Range
of
values
Your
organization
Your
organization
Copyright 2008 Health Administration Press. All rights reserved. 8-39
Mistake Proofing (Poka-Yoke)
A mechanism that either:
- Prevents a mistake from being made
- Makes the mistake immediately obvious
Eliminates errors
Copyright 2008 Health Administration Press. All rights reserved. 8-40
Riverview Generic Drug Project
Riverview Drug Prescription Process
Patient
needs
drug
Clinician
prescribes
drug
Information
on drugs
Type of
drug
Drug
efficacy
End
Drug
efficacy
End
Generic
Drug
works
Non-Generic
Drug
works
Drug
doesnt
work
Drug doesnt work
Copyright 2008 Health Administration Press. All rights reserved. 8-41
Riverview Generic Drug Project
Drug Type and Availability
65% 35%
15%
20%
Generic
Non-Generic,
Generic
Available
Non-Generic,
Generic Not
Available
Microsoft Excel screen shots reprinted with permission from Microsoft Corporation.
Copyright 2008 Health Administration Press. All rights reserved. 8-42
Riverview Generic Drug Project
Microsoft Excel screen shots reprinted with permission from Microsoft Corporation.
Clinician Prescriptions
0
5
10
15
20
Davis Jones Smith Swanson Anderson
Clinician
N
o
n
-
g
e
n
e
r
i
c
p
r
e
s
c
r
i
p
t
i
o
n
s
w
h
e
r
e
a
g
e
n
e
r
i
c
i
s
a
v
a
i
l
a
b
l
e
/
m
o
n
t
h
Non-Generic Prescriptions Where There Is a Generic Available
0
5
10
15
20
O W J V B H M A C I G D K L T U N P Q R
Drug
P
r
e
s
c
r
i
p
t
i
o
n
s
/
m
o
n
t
h
Copyright 2008 Health Administration Press. All rights reserved. 8-43
DMAIC Process
Seven Quality Control Tools
Tools and Techniques
D
e
f
i
n
e
M
e
a
s
u
r
e
A
n
a
l
y
z
e
I
m
p
r
o
v
e
C
o
n
t
r
o
l
Cause-and-Effect Diagram x
Run Chart x x
Check Sheet
Histogram x x
Pareto Chart x x x
Scatter Diagram x x
Flowchart x x
Copyright 2008 Health Administration Press. All rights reserved. 8-44
DMAIC Process
Other Tools
Tools and Techniques
Bar Graph x
Line Graph x
Pie Chart x
5 Whys/ Root Cause x
FMEA x x
Hypothesis Testing x
Regression Analysis x
DOE x
Control Chart x x x
Process Capability x x x
Simulation x
Copyright 2008 Health Administration Press. All rights reserved. 8-45
DMAIC Process
Other Tools
Tools and Techniques
Quality Function Deployment x x x
Poka-Yoke x
Brainstorming x x x
Benchmarking x x x x
Project Planning x x x
Charters x
Gantt Chart x
Tree Diagram x
Force Field Analysis x x
Activity-Based Costing
Balanced Scorecard
Cost and Benefit Analysis x