Companion Website to Chapter 14, “Holding the Gains”, from Healthcare

Operations Management, authored by Daniel B. McLaughlin and Julie M. Hays,

and published by Health Administration Press, 2008

This set of web pages are the companion to Chapter 14—Holding the Gains in

Healthcare Operations Management. It contains links to a specialized diagnostic tool to

diagnose and select the best tool for operations improvement and a scoring sheet to

determine an organization’s level of operations excellence.

This book presents an integrated approach to achieving operational excellence. First,

strategy execution and change management systems need to be well developed. The

Balanced Scorecard and formal project management techniques are effective methods to

use in these key organizational challenges.

Quantitative tools can now be applied, such as state-of-the-art data collection and

analysis tools and problem-solving and decision-making techniques. Processes and

scheduling systems can be improved with Six Sigma, Lean, and simulation. Supply chain

techniques can maximize value and minimize costs in operations.

This final chapter of the book addresses the challenge in maintaining healthcare

operations excellence over the long term—holding the gains. High energy is usually

present when a new initiative is introduced, at the start of a large project, or at the

beginning of an effort to solve a problem. However, as time passes, new priorities

emerge, team members change, and operations can drift back to unsatisfactory levels.

A strategy for holding the gains must be developed at the beginning of any operations

improvement effort. Human resources planning, managerial accounting, and control

systems are essential to maintaining the gains. Although this book does not focus on

human resources or finance, these functions are necessary to sustaining the improvements

achieved. Staff from these support departments should be engaged at the beginning of

operations improvement activities and invited to be part of project teams if possible.

Here is a breakdown of the main topics of Chapter 14:

• HR planning

• Managerial accounting

• Control systems

• An algorithm to select the most effective operations improvement tools

• The future

Using the Best Tools for Operations Improvements

A specialized set of diagnostic web pages is available here. These pages will assist the

reader in diagnosing an operations issue and selecting the most effective of the many

operations improvement tools contained in Healthcare Operations Management.

Operational Excellence
The authors have developed a scoring system for operational excellence. Readers who are

practitioners are encouraged to download the score sheet and determine the level of their

organizational unit (or the organization as a whole). The scale has five levels by which

the reader can gauge progress toward comprehensive operational excellence in

healthcare. Download the score sheet here.

Level 1
There are no organized operations monitoring or improvement efforts at level 1. Quality

efforts are aimed at compliance and data submission to regulatory agencies.

Level 2
At level 2, the organization has begun to use operations data for decision making. There

are pockets of process improvement activities in which process mapping and PDCA or

rapid prototyping are used. Evidence-based medicine (EBM) guidelines are used in some

clinical activities.

Level 3
Senior management has identified operations improvement efforts as a priority by level 3.

The organization conducts operations improvement experiments, uses a disciplined

project management methodology, and maintains a comprehensive Balanced Scorecard.

Some pay-for-performance bonuses are received, and the organization obtains above-

average scores on publicly reported quality measures.

Level 4
A level 4 organization engages in multiple process improvement efforts, using a

combination of project management, Six Sigma, Lean, and simulation tools. It has trained

a significant number of employees in the advanced use of these tools, and these

individuals lead process improvement projects. EBM guidelines are used

comprehensively, and all pay-for-performance bonuses are achieved.

Level 5
Operational excellence is the primary strategic objective of an organization at level 5.

Operations improvement efforts are underway in all departments, led by departmental

staff who have been trained in advanced tools. The organization uses real-time simulation

to control patient flow and operations. This organization develops and publishes new
EBM guidelines and best practices for administrative operations, and it scores in the top 5

percent of any national ranking of quality and operational excellence.

The author invites readers’ comments, recommended readings, website

suggestions, and any other material to be added to this webpage for this chapter or any

other chapters. Please click here to send an e-mail. Be sure to include “Healthcare

Operations Management” in the subject line.

Downloadable Resources
PowerPoint
A PowerPoint presentation of the key points of Chapter 14 is available here:

Chapter 14.ppt