Per
NEWS
NEWS
formance improvement
programs fighting a loss cause
Lean, Six Sigma supplanting CQI, TQM in efficiency, quality arsenal
by Rick Dana Barlow
W
hen budgets hit the rocks, re- volvement from administration, and it em- are key so that people will pay attention,”
gardless of economic climate, ploys a disciplined approach of management Smoker said.
performance improvement pro- with facts and data.” “Lean engages the use of process flow-
grams tend to roll. Robert T. Yokl, pres- charting to determine the bottlenecks in pro-
Back in the 1980s and 1990s, continuous ident and Chief Value cesses and the wastes in the process. Lean
quality improvement (CQI) and total qual- Strategist, Strategic makes significant use of the content experts,
ity management (TQM) ruled the acronym Value Analysis In the process ‘doers’ to assist in defining the
list and dominated discussions about orga- Healthcare, Skippack, current state and the desired state. Lean
nizational change. For the last decade, how- PA, classified CQI may also engage the process upstream and
ever, lean manufacturing and Six Sigma and TQM as umbrella downstream customers to assist in defin-
emerged as popular processes to drive clini- terms representing ing the bottlenecks and the desired state,”
cal and operational change within healthcare more of a philosophy he indicated.
facilities. than a methodology,
Robert T. Yokl
“Historically, CQI
But how do you delineate between these which he felt are their key weaknesses. and TQM by the very
concepts, determine what they can contrib- “Lean Management – a waste eliminator – nature of their name
ute to efficient and effective supply chain and Six Sigma – to reduce variation – have are viewed as quality
management and how to incorporate them defined processes that must be followed ex- initiatives,” said
into day-to-day operations? Healthcare Pur- actly to obtain the desired quality outcomes,” Laura Archer, senior
chasing News reached out to a passel of ex- Yokl noted. “This is why Lean Management vice president, The
perts from hospitals, group purchasing or- and Six Sigma vs. CQI or TQM are ideal Preference Group,
ganizations and consulting firms, all with methodologies for supply chain managers Broadlane Inc., Dal-
considerable experience in performance im- since they will enable supply chain manag- las. “Throughout
Laura Archer
provement initiatives. HPN also posed the ers to eliminate all waste and inefficiencies many organizations
seminal question of why more hospitals in their supply chain. I don’t believe CQI or ‘quality’ is often thought of as someone else’s
aren’t pursuing and implementing these TQM proponents can make this same claim, job or the job of the ‘inspector.’ Quality is of-
performance improvement initiatives if because Lean Management and Six Sigma ten achieved through inspection and control
they’re so important. Each offered an array bring a highly organized approach to qual- instead of data-driven process improvement.
of hurdles – both existing and perceived – ity improvement – not theory.” Lean Six Sigma methodologies are delivered
blocking the strategies that can lead to cost- But James Smoker, MPA, CMRP, who re- across the entire organization as a set of tools
efficient tactics. tired two months ago and methods to improve the overall perfor-
as director, materiel mance of an organization.
Reducing waste streams resource services, “CQI and TQM focus not on the kinds of
At core, the quartet of performance improve- WellSpan Health, waste, but rather on non-value added ac-
ment programs revolves around identifying York, PA, said he tivities,” Archer continued. “In healthcare
and rooting out wasteful quality-draining views them as part of when non-value added activities are ad-
practices, including data-driven variability. a process/perfor- dressed, regulatory or patient safety issues
(See sidebar) mance continuum. frequently arise. Ultimately, the non-value
“Lean and Six Sigma use CQI and TQM “The whole [perfor- added activities become much more diffi-
principles, and all of these programs intend mance improve- cult to remove because they are usually tied
to make businesses more effective and effi- ment/quality man-
James Smoker
to a practice designed to keep people safe
cient,” said Molly agement] focus has to be generated from the or to ensure that regulatory requirements
Ehrlich, CMRP, SSGB, top of the organization chart down. [W. are met. The visual tools and disciplined
implementation man- Edwards] Deming cites constancy of purpose approaches associated with lean manage-
ager, VHA Perfor- – not what’s expected but what’s inspected. ment are proving to be a little more effec-
mance Services, VHA What are the vital few that are really impor- tive in implementation than CQI and TQM,
Inc., Irving, TX. “But I tant and generate results? There’s an expec- which are usually harder to sustain in an
see the main differ- tation from the top that every operating en- organization.”
ences being that Six tity – clinical or support service – is Jeremy Belinski, vice president, strategic
Sigma is more rigor- demonstrating efforts and activity, stream- development, Aspen Healthcare Metrics, a
ous than these others lining business processes, reducing waste MedAssets company, signaled his preference
because it requires in-
Molly Ehrlich
and medical errors. Inspections and rewards for supply chain managers to work with
8 November 2009 • HEALTHCARE PURCHASING NEWS www.hpnonline.com
0911-Performance.pmd 8 10/9/2009, 5:04 PM
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