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Hardwiring Excellence Chapter Tools. Chapter 2: Healthcare Flywheel. The Healthcare Flywheel. Chapter 3: Principle 1: Commit to Excellence. The Five Pillars. Hardwiring Excellence Chapter Highlights - Download as Word Doc .doc), PDF File .pdf), Text File .txt) or read online. Chapter Summaries of the book. I designed this presentation of Quint Studer's advice at the request of an HR professional who needed to present the information to managers.

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Downloads PDF Hardwiring Excellence: Purpose, Worthwhile Work, Making a Difference, PDF Downloads Hardwiring Excellence: Purpose. A "textbook with passion", Hardwiring Excellence offers a road map and practical how-to guide for creating and sustaining a culture of service and operational. author of Hardwiring Excellence: Purpose, Worthwhile Work, Making a Difference (Fire Starter. Publishing, , ISBN: , $).

Studies from other industries and foreign countries were not included.

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Selection Articles were included for review if they met the following five criteria: they appeared in a peer-reviewed journal; they described a specific intervention or activity prescribed by the transformation strategy; the intervention was not classified as a pilot study; they provided quantitative data describing the effect size or statistical significance; and they were not review articles. Peer-reviewed status was determined using publication information available in Ulrich's Periodicals Directory and the publication's website.

These liberal criteria allowed for the inclusion of almost any study design, analytic strategy, outcome of interest, or type of health service organization. However, it served to exclude informational, tutorial, or advocacy pieces, news reports, and general success stories without sufficient data to critically judge the information presented. From each included article we abstracted a description of the intervention, the setting, study design, dependent variables, and key reported findings.

The goal of this article was not to critique the interventions themselves, so the level of information extracted was not to the depth of very rigorous systematic comparative reviews such as a Cochrane EPOC review. Readers wishing to critically examine the interventions in greater detail are referred to the original publications. Data abstraction Both authors reviewed the included studies and arrived at a consensus on the abstracted information.

Setting included type of health service organization and if the article described an intervention within a hospital, the particular department in which the study occurred was noted. Studies included in the review are summarized in Table S1; Additional File 1. Six Sigma 'Six Sigma is an organized and systematic method for strategic process improvements and new product and service development that relies on statistical methods and the scientific method to make dramatic reductions in customer defined defect rates' [ 18 ].

Motorola receives the credit for creating Six Sigma [ 19 ], but the methodology and concepts are clearly rooted in the quality improvement tradition promoted by Deming's TQM principles and the works of Juran [ 20 , 21 ].

Examining the methodology and philosophical underpinnings of Six Sigma are not an objective of this review, as Six Sigma's approach of problem identification, measurement, statistical analysis, improvement, and controls plans is well covered by numerous publications.

The nine studies included in this review described the results of Six Sigma programs on surgery turnaround time [ 22 ], clinic appointment access [ 23 ], hand hygiene compliance [ 24 ], antibiotic prophylaxis in surgery [ 25 ], scheduling radiology procedures [ 26 ], catheter-related bloodstream infections [ 27 ], meeting Centers for Medicare and Medicaid Services CMS cardiac indictors [ 28 ], nosocomial urinary tract infections [ 29 ], and operating room OR throughput [ 30 ]. While each study addressed a very different problem, they shared numerous common features.

Bush and colleagues' report [ 23 ] on patient access was concerned with obstetrics and gynecological appointments at an outpatient clinic, while the remaining studies were set in various hospital departments. None were conducted by outside evaluators or researchers. While none of the studies were randomized trials, all included pre-intervention measurements. Also importantly, each reported their respective Six Sigma interventions were effective.

Parker and colleagues' [ 25 ] examination of an intervention to improve antibiotic prophylaxis during surgery reported statistically significant increases in the proportion of surgery patients receiving timely prophylaxis. However, methodological issues question these conclusions. Pre-intervention data were collected through retrospective chart review and post-intervention data were captured electronically during the procedure.

Without a comparison group experiencing the same change in data collection, it is not possible to definitely exclude the change in measurement as responsible for the reported effect size. Additionally, while this study had the most sophisticated analysis of all the studies included on Six Sigma, the statistical inferences are biased.

The authors compared pre- and post-intervention data using the X2 statistic which requires independent observations. The data violated this assumption because individuals anesthesiologists contributed multiple observations. Even if the observations were independent, the selected univariate statistic could not account for any residual confounding bias. Finally, single setting interventions are obviously susceptible to limitations in generalizability to other settings.

Data Integration

The one group pre-test post-test design was also utilized by the studies on surgery case turnaround time [ 22 ], radiology scheduling [ 26 ], catheter-related blood stream infections [ 27 ], urinary tract infections [ 29 ], and OR throughput [ 30 ]. All of these studies reported positive results: patient-out to patient-in time was decreased [ 22 ], the variation in the number of telephone calls required to schedule procedures was reduced [ 26 ], there were less infections [ 27 , 29 ], and delays were reduced [ 30 ].

However, the limitations on these conclusions are very similar, and they are considered en mass, because they share so many limitations in common.

The single group pre-test post-test design means factors outside the actual intervention cannot be excluded as reasons for the results. In particular, Adams and colleagues'[ 22 ], Volland's [ 26 ], Hansen's [ 29 ], and Fairbanks'[ 30 ] studies were all implemented with other improvement activities occurring concurrently in the organization. The individuals participating in these studies may have been exposed to other quality initiatives or messages.

All five studies are also similar in that they did not engage any statistical tests for all outcomes, so no inferences can be made. Nor was there adjustment for potential confounding bias in any study.

Finally, these interventions were specific to their respective protocols and environments, and may not be able to be replicated anywhere else.

Additionally, the results may not be sustainable; this concern was evident in both the catheter-related infection article [ 27 ], and the urinary tract infection article [ 29 ].

Although neither were analyzed as an interrupted time series design, the authors nonetheless presented multiple post intervention observations that indicated multiple periods where rates returned to pre-invention levels. Two of the Six Sigma studies also employing a single group pre-test post-test design are slightly different than the above and are worth noting separately.

Eldridge and colleagues' study [ 24 ] on hand hygiene reported significant increases in compliance, and Elberfeld and colleagues' study [ 28 ] reported improvements in meeting CMS performance standards. Because both of these studies employ a nationally recognizable clinical guideline or standard, and were implemented across multiple sites, they are stronger than the other Six Sigma studies in terms of external validity.

In spite of this strength, they still both share many of the same limitations and concerns, as noted above. In the case of the hand hygiene study [ 24 ], the authors do not specify what statistical method they employed. However, the unit of analysis was an observation of behavior and not an individual, so observations are again not independent, and the unspecified test would have to account for that correlation.

Again like the above studies, this study design cannot exclude any historical event as a plausible alternative hypothesis. The story is again similar for the Elberfeld and colleagues' article [ 28 ] as indicators of appropriate patient care improved, but no comparison group was referenced, and statistical analysis was nonexistent.

In terms of strength of study designs, Bush and his colleagues' [ 23 ] study deserves special attention, since it was the only one of the nine to include a control group.

Patients in the treatment clinic had to wait 30 fewer days for an outpatient obstetrics visit, patient time in the clinic decreased, gross revenue increased, and both initial and return visits increased. They compared similar measures collected during the same study period from an internal medicine outpatient clinic.

The inclusion of the comparison group, which had no changes, strengthens the conclusion the intervention was the necessary and sufficient condition for the changes in outcomes.

P.D.F D.O.W.N.L.O.A.D Hardwiring Excellence: Purpose, Worthwhile Work, Making a Difference

None of the other studies included a design which addressed the threat from outside events being responsible for any of their results. While benefiting from the stronger design, this study presented only descriptive statistics. No inferential statistics or multivariate analyses were conducted. Communication Boards 4. Your boss. Employee Forums 3.

Manage Up levels Employee of Quarter. Aimed at teaching innovative ways to help healthcare administrators improve the workplace for patients and employees while pushing those around them to excel and grow in a positive direction. Flag for inappropriate content. Related titles. The Unwinding: An Inner History of the New America. The Innovators: Jump to Page. Search inside document.

Leonardo Bassani. Yousuf Zahid.

Cecilia Robles. Holley Jacobs. Mic P. Iulia Tomescu.

Hardwiring Excellence

Popular in Labour. The first shows the growth in baby boomers. The second shows rising costs, and the third, decreasing number of caregivers. In short, the "perfect storm" is brewing in healthcare.

He then promises that the book is about solutions as opposed to feeding a national crisis. Mr Studer opens the book with a dedication to Firestarters. Firestarters are individuals who make a difference in the lives of others. Mr Studer wrote the book as a tribute to the thousands of difference-makers committed to transforming healthcare through compassion, imagination, and often, sheer determination.Kaluzny, — Embed Size px.

Lacking in the articles reviewed here, and maybe in their larger respective evaluations, is the extent to which such transformations are sustainable, and the extent to which the knowledge, attitudes, and skills developed from the transformation are retained and transferred to other problems and parts of the healthcare organization.

Bethi Follow.

Academy of Managment Review — Spiros Stathakis. At the core of the journey, he says, is a sense of purpose, worthwhile work and making a difference. The first shows the growth in baby boomers. All of these studies reported positive results: patient-out to patient-in time was decreased [ 22 ], the variation in the number of telephone calls required to schedule procedures was reduced [ 26 ], there were less infections [ 27 , 29 ], and delays were reduced [ 30 ].

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