SIX SIGMA in Healthcare

Six Sigma In Healthcare
By Trevor Coons
Brigham Young University Marriott Business School
What Will Be Covered

Six Sigma defined in context of healthcare Brainstorming Exercises Nuts and Bolts How It Works Real World Examples Exercises Summary Reading List
Six Sigma Defined In Context of Healthcare

Statistically
Sigma or is a character used in statistics to represent standard deviation. Six Sigma denote a process that is so in control that only 3.4 parts are defective for every million produced.

As A Tool

With Six Sigma Motorola company was able to Eliminate waste Improve quality Reduce cost Reduce lead time

Coming To Healthcare Quality improvement plan Controlling variance is essential Increases accountability Builds off of current processes
Brainstorming Exercises
How could Six Sigma help? First, come up with ideas how Six Sigma could improve healthcare as a whole Next ,think about how Six Sigma principals could help your company Lastly, think of ways that being able to create strong measures could help you in your job
Brainstorming Exercises
How could Six Sigma help? Scenario 1 You are the manager over Lab and Imaging You seem to be plagued by complaints about taking too long Scenario 2 You are an Emergency Department Manger A slue of seemingly indeterminable delays are frequently putting you on diversion
Nuts and Bolts

All or Nothing vs. Contingency
All or Nothing means that the company either fully commits to Six Sigma or else it shouldnt bother
- It offers greater rewards - But it comes at the cost of greater risk
Contingency
- Allows a company to tailor its own solutions - If done half-hazard, it can cause more harm than good
Nuts and Bolts

All or Nothing
Six Sigma Organization

Champion
Works with Black belts Appropriates resources Heavily trained Full time job cost savings Basic training Part time and work in groups
Black belt
Green belt
Nuts and Bolts

All or Nothing
Organization- Champion
Works with the black belts
Meets frequently with Black belts Identifies potential Black belts to train
Appropriates scarce resources

They have to balance internal and external concerns Has final say on major projects and process changes
Nuts and Bolts

All or Nothing
Organization- Black belts

Heavily trained
Costs thousands of dollars and several month to train Is a specialist in quality management tools
Full time job cost savings

Key to Six Sigma Projects vary in duration and scope
Nuts and Bolts

All or Nothing
Organization- Green belts

Basic training
Trained in basic quality tools
Part time and often work in groups

Depending on the company
They can do Black belt work Or green belts can be relegated lower priority projects
Nuts and Bolts

All or Nothing
Six Sigma Process DMAIC

Scope of the project Define Critical-to-quality factors Create performance baseline Measure Collect comparable data Use data to identify underlying problem Analyze Implement process that will correct the problem Improve Monitor process
To best understand each of these steps, well follow a case example of North Shore University Hospital as they apply these steps.
(The bullets in blue.)
Control
Nuts and Bolts

All or Nothing
Process-DMAIC
Define
In specific terms explain what's wrong Critical-to-quality factors
ED and PACU are diversion, Total Turnaround Time (TAT) taking too long, created a high-level process map
Measure
Create baseline Collect data
Target TAT set to 120 min. and upper specification limit set to 150 min., defect defined as a TAT over 150 min., collected information on 195 patients
Nuts and Bolts

All or Nothing
Process-DMAIC
Analyze
Use data to identify underlying problem
Created a Control Impact Matrix, performed hypothesis testing on what they could control, found the underling problem was employees lacked proficiency with the hospitals bed tracking system (BTS).
Improve
Implement process that will correct the problem
Improved communication within the staff by: documenting communication and reformatting admission RNs beepers. Retraining employees on BTS and providing laminated instructions cards
Nuts and Bolts

All or Nothing
Process-DMAIC
Control
Monitoring the process
TAT continued to be monitored on a monthly basis
Results
Went from a slightly over one sigma process to a 3.1 sigma process Cut standard deviation from 170 minutes to 48 minutes The average TAT went from 226 minutes to 69 minutes
Nuts and Bolts

Contingency
Advice for Implementing on Contingency Manage expectations Manage for the correct outcomes Pick manageable problems Engage the customer Measure the right thing
How It Works
Project types Patient Satisfaction Safety Efficiency Outcomes Many Others
How It Works
Performance Variables Patient Satisfaction Service Level Service Cost Clinical Excellence
How It Works
Physician Engagement Why it is essential Why so hard to get
Think differently Increases burdens
How to gain
Real World Examples

Organization Charleston Area Medical Center Commonwealth Health Corporation Froedtert Memorial Lutheran Hospital Project Supply chain for surgical supplies Radiology ICU lab times
Medicare+ Choice Plan reimbursement
Physician addition to managed care network
Outcome
Lower inventory, Improved supplier relations Decreased time between dictation and signature, Improved wait times and staff scheduling
Achievement
Saved: $163,410 immediately $841,540 future $800,000 savings, 25% better throughput and eliminated 14 positions
Reduced turnaround times Cut turnaround times from 52 to 23 minutes

Redefined coding workingaged Medicare recipients
Mount Carmel Hospital

Wellmark Inc.
Profit $857,000
Reduced time for adding Savings: $3 million physicians to medical plan per year Profits: $600,000
Scottsdale Healthcare
Over crowded ED Improved transfer time from ED to inpatient hospital bed
Exercises
You are trying to figure out what Sigma level your at You take meticulous notes of whats going on in your unit and observe 195 turnovers Sigma DPMO 691,462 130 of those observations were defects 1 2 308,538 Calculate defects per million 3 66,807 4 6,210 opportunities (DPMO) 5 233 (Hint)
6 3.4
(Defects/ (Opportunities* Occurrences) ) X 1,000,000
Exercises
Activities to use in your meeting
Managers go on a quality waste walk Discuss training youd like to pursue in your company Work to reduce reliance on competitive data for improvement initiatives Discuss how to improve physician engagement
Summary
Six Sigma defined in context of healthcare Brainstorming Exercises Nuts and Bolts How It Works Real World Examples Exercises
Reading List
Crossing the Quality Chasm- A new healthcare system for the 21st century. Institute of medicine. National Academy Press. Washington D.C. 2001 To Err is Human- Building a Safer Health System. Institute of medicine. National Academy Press. Washington D.C. 2000 Gawande, Atul. Better- A Surgeons Notes on Performance. New York: Henry Holt and Company, 2007 Addressing Variation in Hospital Quality: Is Six Sigma the Answer?. Woodard, Tanisha D. Journal of Healthcare Management. 50:4 July/August 2005.226-236 Healthcares Horizon- Form Incremental Improvement to Designing for the Future. Stahl, Richard and Schultz, Bradley and Prexton, Carolyn. Six Sigma Forum Magazine February 2003.17-26. www.ASQ.org Lean-Six Sigma Tools for rapid cycle cost reduction. Caldwell, Chip. Healthcare Financial Management Association. October 2006. 1-2. www.hfma.org
Reading List
Factors critical to the success of Six-Sigma quality program in an Australian hospital. Hilton, Roger and Balla, Margaret and Sohal, Amrik S. Total Quality Management. Vol. 19, No. 9, September 2008. 887-902. Engaging Physicians in Lean Six Sigma. Caldwell, Chip. and Brexler, Jim and Gillem, Tom. Quality Progress. November 2005. 42-46 Faster Turnaround Time. Martocci, Maude, and Pellicone, Angelo. Quality Progress. March 2006: 31-36 (www.asq.org) Integrating Six Sigma with Total Quality Management: A Case Example for Measuring Medication Errors. Revere, Lee and Black, Ken. Journal of Healthcare Management. 48:6 November/December 2003. 377-391 Whats Wrong with Six Sigma?. Goodman, John and Theuerkauf, Jon. Quality Progress. January 2005.37-42 www.ASQ.org Application of the Six Sigma concept in clinical laboratories: a review, Gras, Jeremie M. and Philippe, Marianne. Clin Chem Lab Med. 46:6 2007. 789-796 Managing Quality-Integrating the Supply Chain. Foster, S. Thomas. 4th edition. New York: Prentice Hall, 2010.

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Six Sigma In Healthcare

What Will Be Covered

Six Sigma Defined In Context of Healthcare

Six Sigma Defined In Context of Healthcare

Six Sigma Defined In Context of Healthcare

Nuts and Bolts

Nuts and Bolts

Six Sigma Organization

Nuts and Bolts

Appropriates scarce resources

Nuts and Bolts

Organization- Black belts

Full time job cost savings

Nuts and Bolts

Organization- Green belts

Part time and often work in groups

Nuts and Bolts

Six Sigma Process DMAIC

Nuts and Bolts

Nuts and Bolts

Nuts and Bolts

Nuts and Bolts

Real World Examples

Reduced turnaround times Cut turnaround times from 52 to 23 minutes

Mount Carmel Hospital

Over crowded ED Improved transfer time from ED to inpatient hospital bed

(Defects/ (Opportunities* Occurrences) ) X 1,000,000

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