Make Your Clinics Flow With Synchrony

Synchrony is the ability of a healthcare process to control the pace of the physician process and the pace of the patient process such that the physician and patient are ready for each other at the same time, without waste or delay. When a process achieves synchrony, the patient does not wait for the doctor, nor does the doctor wait for the patient. Dr. Dennis Han is an ophthalmologist specializing in diseases of the retina at the Medical College of Wisconsin and Froedtert Memorial Hospital; Aneesh Suneja is an engineer and lean consultant who worked with Dr. Han to transform his practice. With the help of Suneja, Han’s patients experienced an 85% reduction in non-value added wait times, and a corresponding 97% “top box” rating on patient satisfaction surveys (“strongly agree to recommend this doctor’s office to others”). Financially, his practice saw a 25% year-over-year increase in relative value units (RVU) production and a 41% increase in payments due to increased physician availability. If you are a physician, clinic manager, administrator, technician, or provider of health services in a clinic setting, you can use the guidelines described in this book to effect a transformation as well.

Synchrony is the ability of a healthcare process to control the pace of the physician process and the pace of the patient process such that the physician and patient are ready for each other at the same time, without waste or delay. When a process achieves synchrony, the patient does not wait for the doctor, nor does the doctor wait for the patient. Dr. Dennis Han is an ophthalmologist specializing in diseases of the retina at the Medical College of Wisconsin and Froedtert Memorial Hospital; Aneesh Suneja is an engineer and lean consultant who worked with Dr. Han to transform his practice. With the help of Suneja, Han’s patients experienced an 85% reduction in non-value added wait times, and a corresponding 97% “top box” rating on patient satisfaction surveys (“strongly agree to recommend this doctor’s office to others”). Financially, his practice saw a 25% year-over-year increase in relative value units (RVU) production and a 41% increase in payments due to increased physician availability. If you are a physician, clinic manager, administrator, technician, or provider of health services in a clinic setting, you can use the guidelines described in this book to effect a transformation as well. "Thank you, doctor Dennis Han, MD, and co-author Aneesh Suneja, MBA, for this marvelous work that applies Lean principles in healthcare settings. The focus on physician medical clinics is a brave venture into this complex, hectic world that has traditionally been dominated by physicians with a predominant emphasis on patient volume, and subsequent billing volume, versus caring for their customers... This important work is essential for just about all existing physician clinics." Dale Farris Healthcare quality improvement specialist with 25 years experience. "Lean principles have opened up more slots for patient care allowing better clinic and staff utilization, and have increased patient throughput while reducing employee overhead and burnout. There is a joy on the faces of the staff when they get to leave the office earlier than expected because lean principles have been deployed." Jose Martinez, MD Practicing physician and beneficiary of the “Synchrony” "Physician office managers and their medical staffs would be the primary targets for this book. However, I also see it being applicable to the higher educational setting...[such as in colleges and institutions teaching healthcare improvement.]" Jim Bente Vice President, Planning and Institutional Effectiveness, College of duPage Adjunct Faculty, Carnegie Mellon University

This practical, how-to book clearly and succinctly takes the reader through six proven "success steps" for implementing lean in any healthcare environment: 1. Create physician flow 2. Support physician value-added time 3. Visually communicate patient status 4. Standardize everyone's work 5. Lay out the clinic for minimal motion 6. Change the care delivery model Why go through such a transformation? Because it works. Tell a doctor that he can see the same number of patients, offering the same high quality and personal care, and have an extra 90 minutes at the end of his clinic day -- and that means something. Tell the staff that they can look forward to actually ending on time, with satisfied patients, no backlog, and having focused their attention completely on quality patient care -- and they will listen. These Lean principles and success steps work in clinics ranging from orthopedics to neurology to cardiac care -- the specialty doesn't matter. They work in small practices and large hospital settings. Lean methodology provides the tools to address the frustrations patients and doctors alike experience in the clinic process. Included throughout the book is a case study showing the lean transformation undertaken at the Orthopedic Center at Children's Hospital of Wisconsin, with numerous quotes and insights from those actually involved. This transformation resulted in patient wait times being reduced by more than 70 percent, the clinic being able to see 25 percent more patients in less space, patient satisfaction scores sometimes reaching 100 percent, and staff satisfaction scores improving by more than 25 percent.

Healthcare organizations and professionals have long needed a straightforward workbook to facilitate the process of root cause analysis (RCA). While other industries employ the RCA tools liberally and train facilitators thoroughly, healthcare has lagged in establishing and resourcing a quality culture. Presently, a growing number of third-party stakeholders are holding access to accreditation and reimbursement pending demonstration of a full response to events outside of expected practice. An increasing number of exceptions to healthcare practice have precipitated a strong response advocating the use of proven quality tools in the industry. In addition, the industry has now expanded its scope beyond the hospital walls to many ancillary healthcare facilities with little experience in implementing quality tools. This book responds to the demand for a RCA workbook written specifically for healthcare, yet still broad in its definition of the industry. This book contains everything that the typical RCA leader in healthcare requires: A text specific to healthcare, but using the broadest definition of the industry to include not only acute care hospitals, but rehabilitation facilities, long-term care facilities, outpatient surgery centers, ambulatory services, and general office practices. A workbook-style format that walks through the process, step-by-step. Straightforward text without “sidebars,” “tables,” and “tips.” Worksheets are provided at the end of the book to reduce reader distraction within the text. A wide range of real-world examples. Format for use by the most naive of users and most basic of processes, as well as a separate section for more advanced users or more complex issues. Templates, both print and electronic, included for the reader’s use. Ready-to-use educational materials with scripting to enable the user to train others and garner support for the use of the techniques. Background text for users in leadership to understand the tools in the larger context of healthcare improvement. Up-to-date information on the latest in the use of RCA in satisfying mandatory reporting requirements and slaying the myth that the process is onerous and fraught with barriers. Background text and tools/process are separated to facilitate the readers’ specific needs. Healthcare leaders can appreciate the current context and requirements without wading through the actual techniques; end-users can begin learning the skills without wading through dense administrative text. Language and tone promoting the use of the tools for improvement of processes that have experienced exceptions, as opposed to assigning blame for errors. Attention to process ownership, training, and resourcing. And, most importantly, thorough description of the improvement process as well as the analysis.

Healthcare leaders around the world are facing tough challenges, including the need to deliver better value for patients and payers, which means improving quality while reducing cost. It might seem impossible to do both, but organizations around the world are proving it's possible, through Lean. Health systems are able to enhance all dimensions of patient care, including both safety and service, while creating more engaging and less frustrating workplaces for healthcare professionals and staff... all leading to improved long-term financial performance. Building on the success of the first two editions of this Shingo Prize-Winning book, Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement, Third Edition explains how to use the Lean philosophy and management system to improve safety, quality, access, and morale while reducing costs. Lean healthcare expert Mark Graban examines the challenges facing today’s health systems, including rising costs, falling reimbursement rates or budget constraints, employee retention, and harm to patients. The new edition of this international bestseller (translated into eight languages) begins with an overview of Lean methods and mindsets. It explains how engaging staff and leaders in Lean practices such as value stream mapping and process observation can help reduce wasted motion for caregivers, prevent delays for patients, and improve the long-term health of your organization. In addition to a new introduction from John Toussaint, this updated edition includes: New and updated material on identifying waste, A3 problem solving, employee idea management, kanban for materials management, and strategy deployment New case studies and examples—including a new 5S case study (Franciscan St. Francis Health) and other case examples highlighting the challenges and successes of an academic medical center and a small urgent access hospital, featuring quotes and stories from executives New examples and updated data throughout, including revised chapters on patient safety and patient flow challenges and the improvements driven by Lean Detailing the mindsets and methods needed for a successful transition to a Lean culture, the book provides the understanding of Lean practices—including value stream mapping, standardized work, error proofing, root cause problem solving, and daily improvement processes—needed to reduce common hospital errors and improve performance in other dimensions. The balanced approach outlined in this book will guide you through the process of improving the quality of care and service while reducing costs in your hospital. *The Lean Certification and Oversight Appeals committee has approved Lean Hospitals as recommended reading for those in pursuit of Lean Bronze Certification from SME, AME, Shingo Prize, and ASQ

EXTRACTABLES AND LEACHABLES Learn to address the safety aspects of packaged drug products and medical devices Pharmaceutical drug products and medical devices are expected to be effective and safe to use. This includes minimizing patient, user or product exposure to impurities leached from these items when the drug product is administered or when the medical device is used. Clearly, patient or user exposure to leachables must not adversely impact their health and safety. Furthermore, these impurities must not adversely affect key quality attributes of the drug product or medical device, including its manufacturability, stability, efficacy, appearance, shelf-life and conformance to standards. Extractables and leachables are derived from the drug product’s packaging, manufacturing systems and/or delivery systems or from the medical device’s materials of construction. It is imperative to understand and quantify the release of extractables from these items, the accumulation of leachables in drug products and the release of leachables from medical devices. Once extractables and leachables have been discovered, identified and quantified, their effect on the key product or device quality attributes, including safety, must be systematically and scientifically established according to recognized, rigorous and relevant regulatory and compendial standards and industry-driven best practices. In Extractables and Leachables, the chemical compatibility (including safe use) of drugs (and their containers, delivery devices and manufacturing systems) and medical devices is examined at length, focusing particularly on how trace-level extractables and leachables affect the quality and safety of a medical product and how to assess the magnitude of the effect. This is accomplished by addressing the two critical activities required to develop, register and commercialize safe, effective and affordable clinical therapies; measuring extractables and leachables (chemical characterization) and assessing their impact (for example, toxicological safety risk assessment). Each of these activities is addressed in-depth, based on the existing and developing international regulations and guidelines, current published literature and the author’s extensive personal experience. Written by a key contributor to standards, guidelines, recommended practices and the scientific literature, the book provides “insider” insights beyond those gained by merely reading the relevant texts. Given that the rapidly evolving extractables and leachables landscape, this book provides the most current and crucial information on new and forthcoming regulations and best practices. Extractables and Leachables readers will also find: A thorough summary of regulatory and compendial guidelines and the steps required to meet them A detailed and in-depth review of essential scientific principles and recommended best practices for the design, implementation, interpretation and reporting of chemical characterization studies A practical resource for optimizing the development, registration, and commercialization of safe and effective medical products A helpful tool to maximize product development and successful regulatory outcomes Extractables and Leachables is the essential reference for pharmaceutical scientists, analytical chemists, regulatory affairs professionals, engineers, and toxicologists in areas such as product research and development, product registration and approval, regulatory affairs, analytical science, quality control, and manufacturing.

Predominant health research agendas, usually in line with existing financial incentives for obtaining lucrative research results, tend to focus on therapeutic and pharmacological intervention, prioritizing innovative therapies based on molecular biology and biotechnology approaches. However, commercial interests do not necessarily agree with existing public health priorities. The prevalence of health and biomedical research agendas often neglect not only the less lucrative diseases but also the study of the social and environmental determinants of health and disease, even when addressing these aspects could significantly improve population health at much lower costs. Some examples of absent studies in the health research agendas are the analysis of non-medical factors influencing health outcomes (social determinants of health), the analysis of the relationship between people and their environment (environmental health), or the evaluation of the socio-environmental factors that influence the deterioration of bodies and territories (such as the One Health approach).

This Market-Leading Resource In Holistic Nursing Is Published In Cooperation With The American Holistic Nurses Association (AHNA). Each Chapter Is Revised And Updated By Contributors From The Best-Selling Fifth Edition, As Well As New Thought Leaders From The Field Of Holistic Nursing. Chapters Begin With Nurse Healer Objectives That Are Divided Into Theoretical, Clinical, And Personal Subject Areas, And Then Conclude With Directions For Future Research And Nurse Healer Reflections To Encourage Readers To Delve Deeper Into The Material And Reflect On What They Have Learned In Each Chapter. This Text Is Organized By The Five Core Values Contained Within The Standards Of Holistic Nursing Practice: Core Value 1: Holistic Philosophy, Theories, And Ethics Core Value 2: Holistic Caring Process Core Value 3: Holistic Communication, Therapeutic Environment, And Cultural Diversity Core Value 4: Holistic Education And Research Core Value 5: Holistic Nurse Self-Care A Full Suite Of Online Learning Tools, Including Case Studies, Authors' Podcasts, Nurse Healer Reflections, And Much More, Is Available On The Companion Website.