It has been almost 20 years since the Institute of Medicine
released the seminal report titled, Crossing the Quality Chasm. In
it, the IoM identified six domains of care quality (safe, timely,
effective, efficient, equitable, and patient-centric) and noted a
huge gap between the current state and the desired state. Although
this report received a great deal of attention, sadly there has
been little progress in these areas. In the U.S., healthcare still
has huge disparities, is inefficient, and is fragmented with delays
in care that are often unsafe. Most U.S. citizens are expected to
suffer from a diagnostic error sometime during their lifetime, not
receive a large fraction of recommended care, and pay for one of
the most expensive systems in the world. Much has been written
about quality improvement over the years but many prominent quality
and safety experts. Yet progress has been slow. Some have called on
the healthcare professions to look outside of healthcare to other
industries using examples in nuclear power and airlines for safety,
the hotel and entertainment industry for a 'customer' focus, and
the automotive industry, particularly Toyota for efficiency (Lean).
This book by Dr. Oppenheim on lean healthcare systems engineering
(LHSE) is a fresh approach that brings forth concepts that systems
engineers have used in huge national defense projects. What's
unique in this book is that these powerful system engineering tools
are modified to be able to address smaller sized healthcare
problems that still involve similar problems in fragmentation and
poor communication and coordination. This book is an invaluable
reference for a new powerful process named Lean Healthcare Systems
Engineering (LHSE) for managing workflow and care improvement
projects in all clinical environments. The book applies to
ambulatory clinics and hospitals of all types including operating
rooms, emergency departments, and ancillary departments, clinical
and imaging laboratories, pharmacies, and population health. The
book presents a generic rigorous but not mathematical step-by-step
process of integrated healthcare, systems engineering and Lean. The
book also contains the first major product created with the LHSE
process, namely tabularized summaries of representative projects in
healthcare delivery applications, called Lean Enablers for
Healthcare Projects. Each full-page enabler table lists the
challenges and wastes, powerful improvement goals, risks, and
expected benefits, and some useful descriptions of the healthcare
system of interest. The book provides user-friendly solutions to
major problems in healthcare delivery operations in all clinical
environments, addressing fragmentation, wastes, wrong incentives,
ad-hoc and stove-piped management, lack of optimized processes,
hierarchy gradient, lack of systems thinking, "blaming and shaming
culture", burnout of providers and many others.
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