Linda Gleespen’s default image

By: Linda Gleespen

Ten years after the Institute of Medicine released its influential report "To Err Is Human" (, hospital care still has many safety problems, and the quality of care remains lower than it should be in many institutions.

Hospitals could improve both quality and patient safety by using health information technology to standardize the processes of care and to ensure that vital information is available to clinicians when they need it. However, electronic health record (EHR) systems are multi-faceted and challenging to implement in acute-care settings, and few health care facilities have complete EHRs. As an initial step toward the automation of patient care, about 10 percent of U.S. hospitals have implemented computerized physician order entry (CPOE), which includes medication orders and orders for laboratory and imaging tests, as well as the ability to view test results and medication lists. While this falls short of a complete EHR, which also incorporates clinical documentation, CPOE, when it is properly implemented and utilized, represents a giant step toward better patient care.

Maribeth Kuzmeski’s picture

By: Maribeth Kuzmeski

It happens to the best of us. An upset client calls to complain about a product or service, and you’re completely caught off guard. How do you react? Do you fly off the handle right along with him? Or do you respond in a calm, thoughtful way that salvages and even strengthens your relationship? A high-pressure scenario doesn’t have to blow your client relationship sky-high—in fact, you can use it as an opportunity to truly connect with your client and keep him around for the long haul.

Conflict is a normal part of business, and we all need to learn how to deal with it in the right way. Some clients are just plain difficult. And yes, “easy” clients can also become dissatisfied for a variety of reasons. The good news is that there are effective ways to handle conflict and resolve issues—and these methods will actually strengthen your relationship.

Remember that quite often, unhappy clients will not even tell you that they have a problem. They simply move their business elsewhere. So, if a client thinks enough of you to give you the chance to repair a bad situation, take it. Play an active role in making your customer happy so that you can be sure to keep him or her on board with you.

Tom LAcey’s default image

By: Tom LAcey

In 2005, according to a BBC News report at the time, operating rooms all over the United Kingdom were thrown into chaos and operations canceled due to broken, missing, or dirty surgical instruments. The Royal College of Surgeons called for a national audit of decontamination units, following a report in the April 2008 Clinical Services Journal on surgery being canceled due to instruments being returned with visible blood and bone contamination. A report from the United Kingdom’s National Health Service (NHS) decontamination program revealed that 1,765 operations were called off at the last minute in 2005 and 2006 because of instrument problems.

This was a high-profile problem for the NHS and was taken very seriously, particularly because an audit eight years ago highlighted the need to upgrade and modernize decontamination facilities. Many hospitals have entered into contracts with commercial sterilization services, while others, such as the New Royal Infirmary in Edinburgh, have an in-house unit.

Andrea Kabcenell’s default image

By: Andrea Kabcenell

What if hospital leaders had an easier, more streamlined way to chart an improvement path for their organizations? Imagine a list of key processes that could—if implemented reliably—lower mortality,  reduce harm, lessen delays, create a better patient experience, and lower costs. This possibility is now within reach. 

For the past year, the Institute for Healthcare Improvement (IHI) and several scientific partners have been hard at work developing a tool that will offer an alternative to the current state of affairs in which U.S. hospitals must figure out how to juggle and work on nearly 1,500 quality indicators and long lists of requirements from organizations such as the Joint Commission, the Leapfrog Group, and the Centers for Medicare & Medicaid Services, and other payors. Plus, hospitals must participate in various quality assessment programs. While all worthy in their intent and specificity, this everexpanding list of expectations risks creating more frustration and confusion than improvement. 

GKS Global Services’s picture

By: GKS Global Services

In this case study of reverse engineering and rapid prototyping we will look at a company that developed an initial prototype of an anti-snoring device based on many years of research in the field of dentistry. The company’s main dental advisor is a pioneering dentist in the research and development of mandibular advancement devices to treat snoring and obstructive sleep apnea (OSA). He designed and created a functional device that comfortably and healthily helps cure snoring. 

The challenge came after the initial anatomical design and fabrication work was done, when modifications were needed to make the device more functional. The first version tested the shape and size, but the company wanted a way to quickly prototype different features into the base design. They also wanted to try different FDA-approved resins for improved functionality and comfort. And, as is typical for a one-of-a-kind prototype, the company did not have CAD files of the part. The development schedule allowed for flexibility, but the company wanted to move forward to get its anti-snoring device into production and on the market. 

WinWare Inc.’s picture

By: WinWare Inc.

What does a 13-person military team need to survive in Iraq and Afghanistan for five days by themselves without any base support? What types of protective gear and critical life saving items are needed? How much? Inside the storage warehouse of the 56th Security Forces Squadron (56SFS) at Luke AFB where these items are stored are the massive 463L aircraft pallets that hold up to 10,000 lb of equipment. These readiness pallets must be all set to ship in 24 hours even if one hasn't shipped in three years. Having the inventory in stock when needed is imperative. Matthew Owen, Resource Advisor 56 SFS, knows precisely the items needed for the readiness pallets, from the food and water to the weapons and ammunition. Managing these supplies and other types of inventory are his top priority.

Georgia Institute of Technology’s picture

By: Georgia Institute of Technology

Radio frequency identification (RFID) systems are widely used for applications that include inventory management, package tracking, toll collection, passport identification, and airport luggage security. More recently, these systems have found their way into medical environments to track patients, equipment assets, and staff members.

Ralph Herkert, director of GTRI’s Medical Device Test Center, recently began developing protocols to test how RFID systems affect the function of implantable and wearable medical devices, such as this pacemaker.


Georgia Tech Photo: Gary Meek

However, there is currently no published standardized, repeatable methodology by which manufacturers of RFID equipment or medical devices can assess potential issues with electromagnetic interference and evaluate means to mitigate them.

Jay Arthur—The KnowWare Man’s picture

By: Jay Arthur—The KnowWare Man


n his inauguration speech, President Obama called for improving health care quality and reducing costs. In 2008, U.S. health care costs exceeded $2.4 trillion and are expected to climb to $3.1 trillion by 2012, according to the National Coalition on Health Care.

Of these costs, 25 percent to 40 percent are caused by unnecessary delays, defects, and deviations that can be easily corrected with lean Six Sigma. That’s $600 billion to nearly $1 trillion dollars a year in unnecessary costs.

Although most visits to the emergency department (ED) take two to four hours (from admission to discharge), the Robert Wood Johnson University Hospital in Hamilton, New Jersey, a 2005 Baldrige Award winner, does it in 38 minutes for a discharged patient. The hospital offers a 30-minute door-to-doctor guarantee. The staff accomplished this by rethinking the emergency experience from the patient’s point of view.

The clinical side isn’t the only issue to be addressed. Health care operations—billing, ordering, and so on—waste even more money. Insurance companies are quick to reject claims and slow to pay the claims they do accept, which causes more problems. One health care provider found ways, using lean Six Sigma, to reduce denied claims by $330,000 a month.

Ron Bialek, Jack Moran, Kim McCoy, William Riley, Lillian Shirley’s default image

By: Ron Bialek, Jack Moran, Kim McCoy, William Riley, Lillian Shirley


n emergency response organization differs substantially from our usual public health organization for day-to-day business. However, as the spring 2009 H1N1 (also referred to as swine flu) outbreak highlighted, usual public health processes are fundamental for effectively responding to a public health emergency. The key challenge we will face in the fall and winter of 2009 is not the planning for an H1N1 outbreak but the establishment of clear criteria for the public health workforce to determine priorities in their jurisdictions.

The federal government grants for emergency preparedness to states and local jurisdictions include a program element that requires a Homeland Security Exercise Evaluation. A key aspect of this requirement is an improvement plan based on learning from required exercises of the preparedness plans. However, a 20-page after-action report may not be helpful in real-time decision making. The challenge is to make these reports actionable and nimble. Using quality improvement (QI) methods and tools alongside our situation status reports as actual information and data unfolds can be an invaluable way to determine next steps in our response cycle.

Raissa Carey’s picture

By: Raissa Carey

To Chris Collins, lean and Six Sigma, just like government and business management, go hand in hand.

In Erie County, where he fiercely advocates that a lean government can and will save taxpayers millions of dollars, Chris Collins became the first county executive in the nation to implement lean Six Sigma in a government setting.

A businessman with 35 years of private sector experience, Collins runs Erie County like a business, with what he calls “The 3 Rs”—reforming Erie County government—rebuilding the local economy—and ultimately, reducing taxes. Needless to say, the road to getting there is paved by lean Six Sigma all the way. To date, 19 Erie County employees are trained and certified Six Sigma Green Belts. Forty employees earned Yellow Belts and more than 250 employees are trained in lean Six Sigma. Bill Carey, a lean Six Sigma Black Belt, is the program director of the county.

The lean and Six Sigma methodologies have helped the county accrue savings of nearly $144,000 by streamlining social services application workflow. The county reduced the cost of repairing of park equipment by $95,000 annually. It has reduced the backlog of child support enforcement cases from 7,281 to 103 cases in less than one year.

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