IHP 604 Module 4 Improvement Methods Paper Example

Choosing How to Improve: Three Methods Weighed for Crestline Medical Group

[Student Name]

Southern New Hampshire University

IHP 604: Healthcare Quality and Improvement

Module Four Paper

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Choosing How to Improve: Three Methods Weighed for Crestline Medical Group

An improvement method is a way of organizing learning: how a team understands a problem, generates changes, tests them and decides what to keep. Health care organizations often adopt a method because a consultant or a peer hospital used it, not because it fits their problem. This paper compares three widely used methods and recommends one for Crestline Medical Group's effort to improve diabetes control.

The Problem the Method Must Fit

The problem has several features that matter for method choice. It spans 18 clinics with different staff and patients. Its causes are multiple and partly unknown: missed follow-up, delayed medication changes, language barriers and gaps in education. The outcome, A1c, changes over months rather than days. And the group has no dedicated improvement staff, only a quality manager and clinic teams with limited time.

Lean

Lean originated in manufacturing and focuses on delivering value to the customer by removing waste and improving flow. Mazzocato et al. (2010) conducted a realist review of Lean in health care, asking not just whether it works but how and in what circumstances. They identified recurring mechanisms: helping staff understand processes so they can see value and waste, reorganizing work so patients and information move without waiting, catching mistakes closer to their source and building routines for ongoing problem solving. Most reported applications described positive results, although study designs were often weak and results depended on context, including leadership support and staff engagement.

Where Lean Fits Crestline

Parts of Crestline's problem are flow problems. When an A1c result above 9% comes back, it passes through an inbox, a clinician review, a message to a nurse and a call to the patient, and delays at each step can stretch to weeks. Lean process mapping would make those delays visible. But Lean is less suited to problems whose causes lie in patient behavior, language and trust, which do not show up as waste on a process map.

Six Sigma

Six Sigma, developed at Motorola, targets defects and unwanted variation using a five-phase routine known as DMAIC: define, measure, analyze, improve and control. It relies on statistical analysis and trained specialists, often called green belts and black belts. DelliFraine et al. (2010) examined the published hospital and clinic literature on both approaches and found that, although many reported benefits, few used rigorous designs, many lacked statistical testing of results and the overall evidence that these methods improve clinical outcomes was limited. They concluded that more careful evaluation was needed before strong claims could be made.

Where Six Sigma Fits Crestline

Six Sigma's strength is disciplined analysis of well-defined processes with plenty of data, such as laboratory turnaround or billing errors. Crestline has no trained belts, and the DMAIC sequence usually takes months before any change is tried. For a problem with many causes and a slow-moving outcome, that delay would be costly. Six Sigma's statistical tools remain useful, however, especially control charts.

A Question-Led Approach

Associates in Process Improvement built their model around three prompts, covering the goal, how progress will be recognized in data and which ideas deserve a trial. Changes are then tried in Plan-Do-Study-Act cycles, first with one clinician or a handful of patients and only later across a whole clinic. Taylor et al. (2014) systematically reviewed published studies that used PDSA in health care and found that the method was often applied loosely. Only a minority of studies reported a sequence of linked cycles, few used data collected at regular, frequent intervals and many did not report predictions or what was learned from each cycle.

Where the Model Fits Crestline

The Model suits a problem with multiple uncertain causes, because it allows teams to test several ideas quickly and learn which matter. It requires less specialized training than Six Sigma, fits busy clinic teams and aligns with the monthly measures already planned. Its weakness, as Taylor and colleagues show, is that teams often skip the disciplines that make it work.

Comparing the Methods

The table summarizes how each method fits the criteria drawn from Crestline's problem. No method is best in general; the question is which best matches this problem and this organization.

Table 1. Fit of Three Methods With Crestline's Problem

Note. Ratings are the author's judgments based on the reviews cited.

What Each Method Asks of Leaders

Methods also differ in what they demand from leaders. Lean programs typically require executives to spend time where work happens and to protect staff time for problem solving, a commitment that often fades after an initial launch. Six Sigma requires investment in training specialists and in data systems before results appear. The Model for Improvement asks less up front but depends on leaders reviewing run charts regularly and removing barriers teams identify. At Crestline, the medical director has agreed to attend one pilot huddle each month and to review results with the quality manager, a commitment better matched to the Model than to the other two.

Recommendation

Crestline should adopt the Model for Improvement as its overall method and borrow Lean process mapping for the result-handling pathway. To avoid the weaknesses Taylor and colleagues describe, every PDSA cycle will be documented on a one-page form recording the prediction, the data collected and the decision to adapt, adopt or abandon. Process measures will be plotted weekly for tested changes, and control charts drawn from Six Sigma's toolkit will be used for the monthly outcome.

Building the Capability

Two pilot clinics will begin, each with a small team of a physician, a nurse, a medical assistant and a front desk lead. The quality manager will coach them through a half-day training and weekly thirty-minute huddles. A short guide will describe the three questions, the PDSA form and how to read a run chart. Lessons from the pilot teams will shape the training for the remaining clinics.

Conclusion

The evidence for all three methods in health care is weaker than their popularity suggests, which makes fit and disciplined use more important than brand. For a multi-cause, slow-moving problem in a group without dedicated improvement staff, the Model for Improvement, applied carefully and supplemented by Lean mapping and statistical charts, offers the best chance of learning what works.

References

DelliFraine, J. L., Langabeer, J. R., & Nembhard, I. M. (2010). Assessing the evidence of Six Sigma and Lean in the health care industry. Quality Management in Health Care, 19(3), 211-225. https://doi.org/10.1097/QMH.0b013e3181eb140e

Mazzocato, P., Savage, C., Brommels, M., Aronsson, H., & Thor, J. (2010). Lean thinking in healthcare: A realist review of the literature. Quality and Safety in Health Care, 19(5), 376-382. https://doi.org/10.1136/qshc.2009.037986

Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Quality & Safety, 23(4), 290-298. https://doi.org/10.1136/bmjqs-2013-001862