Program Materials

CS&E Educational Program Readings…

…on Variation and Quality

James, Brent C. (1992). Good enough? Standards and Measurement in Continuous Quality Improvement. National Quality of Care Forum – Bridging the Gap between Theory and Practice [monograph]. Hospital Research and Educational Trust (American Hospital Association); 3-27.

Start here for a basic introduction to continuous quality improvement’s underlying principles and concepts, expressed from a healthcare perspective by one of its leaders.

• Motivation for

your learning during CS&E program

• An integrated overview of interaction of standards, variation, resistance to change and their effect on costs

Benneyan JC, Lloyd RC, Plsek PE. (2003). Statistical process control as a tool for research and healthcare improvement. Quality & Safety in Health Care 12; 458-464.

Read this article next to begin understanding the benefits of SPC for identifying, measuring and controlling variation

• Five examples that cover a broad range of healthcare situations
• Article clearly and concisely written by practitioners of SPC in healthcare

Wheeler, Donald J. (2000). Understanding Variation: The Key to Managing Chaos. Knoxville, TN: SPC Press.

Read this book next to broaden your understanding of the underlying principles, applications and benefits of SPC

• An excellent, short, easy-to-read, highly understandable and effective introduction to the "messiness" of variation and how to conquer it
• Good, everyday examples from the business world

Carey, Raymond G. and Lloyd, Robert C. (2001). Measuring Quality Improvement in Healthcare: A Guide to Statistical Process Control Applications. New York: Quality Resources.

When you’re ready for more on SPC, read this book. Read Chapter 4 first, then the latter half of Chapter 5 (start on p. 63), then skim through Chapter 6 ("Control Chart Case Studies") and read in detail the cases that interest you…then read the rest of the book.

• Good introductory text on SPC with examples and case studies from healthcare

…on Teams and Quality

Scholtes, Peter R., Joiner, Brian L., Streibel, Barbara J. (2003) The Team Handbook. 3rd ed. Madison, WI.

There is more science than art in creating highly effective teams, and this book is the best at explaining it while introducing the methodology and tools of quality improvement (Use in parallel with first two readings above.).

• How to design, launch, develop and facilitate a high-performance Team
• Can be read straight through, or used as a "just-in-time" reference to learn about a specific topic as you encounter the need
• If you’re a team lead, this is your bible (All team members should have a copy, too.)

…on Methodology and Tools for Quality Improvement

Tague, Nancy R. (2005) The Quality Toolbox. 2nd ed. Milwaukee, WI. ASQ Quality Press.

Use as your reference-of-choice as your team travels the "Plan-Do-Check-Act" road to quality improvement.

• Explains in detail the quality improvement process (PDCA)
• Explains and illustrates just about every quality improvement tool and technique (gives description, when to use, procedure, example, considerations, variations)
• Shows which tools and techniques are best suited for each phase of PDCA
• If you’re a team lead, this is your other bible (All team members should have a copy, too.)

…on Change

Scholtes, Peter R., Joiner, Brian L., Streibel, Barbara J. (2003) The Team Handbook. 3rd ed. Madison, WI.

Read Chapter 1, pages 5-39, 40 and pages 5-65 to 5-69 for a local, "front-line" applied approach to change management.

[For more practical advice and direction on managing the change required of all quality improvement efforts, read Managerial Breakthrough (not included in CS&E materials) by one of the masters, Joseph Juran (1964, McGraw-Hill) – especially Chapters 3 and 9.]

…on "the Big Picture" and Quality

Conrad, Douglas A. (1991). Editorial. Frontiers of Health Services Management, 7:4, 1.

Sahney, Vinod K. and Warden, Gail L. (1991). The quest for quality and productivity in health services. Frontiers of Health Services Management, 7:4, 2-40.

Conrad, Douglas A. (1991) The commentaries: A summary. Frontiers of Health Services Management. 7:4, 41.

James, Brent. (1991) TQM and clinical medicine. Frontiers of Health Services Management. 7:4, 42-46.

Berwick, Donald M. (1991). Blazing the trail of quality: The HFHS quality management process. Frontiers of Health Services Management, 7:4, 47-50.

Wolford, Rodney, G. (1991). A CEO’s perspective of TQM. Frontiers of Health Services Management, 7:4, 51-54.

Sahney, Vinod K. and Warden, Gail L. (1991). Reply. Frontiers of Health Services Management, 7:4, 55-56.

This issue of Frontiers of Health Services Management:

• Presents a brief summary of the concepts and principles of Total Quality Management (TQM) from the teachings of Deming, Juran and Crosby
• Details the motivation and sequence of activities of implementing TQM at Henry Ford Health System (started in October 1988)
• Describes why TQM will ultimately fail in many healthcare organizations (including MD Anderson)
• Is all written by the corporate vice president (Sahney) and the president/CEO (Warden) of HFHS
• Gives the commentaries of three "leading lights" of healthcare: Brent James, Donald Berwick (calls the Sahney-Warden article a "classic") and Rodney Wolford (CEO of Alliant Health System, which began TQM in 1986) along with the authors’ reply

James, Brent C. (1989). Quality Management for Health Care Delivery [monograph]. Hospital Research and Educational Trust (American Hospital Association), 1-72.

Read after series of articles above.

• Translates and adapts the concepts and principles of continuous quality improvement into the world of healthcare
• Discusses how low quality results in various wastes, causing high costs, whether in administrative or support processes or in clinical processes
• Gives models and methods for how to think about, measure and improve healthcare quality

Committee on Quality of Health Care in America. Institute of Medicine. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: National Academy Press.

…Other Readings on Healthcare and Quality

James, Brent C. (1994). Exploring Outcomes Management. National Quality of Care Forum – Bridging the Gap between Theory and Practice [monograph]. Hospital Research and Educational Trust (American Hospital Association); 3-41.

• Moves from the need for outcomes measurement for medical research, accountability and continuous improvement to the conceptual framework for outcomes management, representing healthcare as a complex, interdependent system composed of numerous interlinked processes
• Provides practical guidance on designing and building an outcomes measurement and management system, from two perspectives: bottom-up and top-down
• Bottom-up: "…the roots of care delivery, where real clinicians make clinical decisions and deliver treatments to real patients; frontline workers need real-time data regarding each process’s outputs and operation, so that they can make appropriate operational corrections"
• Should be required reading before designing / specifying a knowledge management system, decision-support system, balanced scorecard system, dashboard system or an electronic medical record system

Berwick, Donald M., James, Brent C. and Coye, Molly J. (2003). Connections between quality improvement and measurement. Medical Care; 41(1) suppl, I-30 through I-38.

• High-level, conceptual models for beginning to understand the theoretical cause-and-effect linkages between measurement of quality and improvement of quality
• Two pathways posited: "Selection" and "Change"
• The Change pathway expository serves as excellent introduction to change management: critical success factors and barriers

James, Brent C. (1993). Implementing practice guidelines through clinical quality improvement. Frontiers of Health Services Management, 10:1, 3-31.

James, Brent C. (2002) Quality improvement opportunities in healthcare — making it easy to do it right. Journal of Managed Care Pharmacy, 8, 5, September/October.

A survey of published research quantifying the ill-health of healthcare, combined with an analysis of why and what might be done about it.