Six Sigma InHealthcare

By Trevor CoonsBrigham 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 σ 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.

Six Sigma Defined In Context of Healthcare

As A ToolWith Six Sigma Motorola company was able to

• Eliminate waste

• Improve quality

• Reduce cost

• Reduce lead time

Six Sigma Defined In Context of Healthcare

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 ExercisesHow 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 shouldn’t 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 BoltsAll or Nothing

• Six Sigma Organization

Nuts and BoltsAll 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 BoltsAll 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 BoltsAll 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

To best understand each of these steps, we’ll follow a case example of North Shore University Hospital as they apply these steps.(The bullets in blue.)

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 RN’s 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 BoltsContingency

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 ExamplesOrganization Project Outcome Achievement

Charleston Area Medical Center

Supply chain for surgical supplies

Lower inventory, Improved supplier relations

Saved: $163,410 immediately $841,540 future

CommonwealthHealth Corporation

Radiology Decreased time between dictation and signature, Improved wait times and staff scheduling

$800,000 savings, 25% better throughput and eliminated 14 positions

Froedtert Memorial Lutheran Hospital

ICU lab times Reduced turnaround times Cut turnaround times from 52 to 23 minutes

Mount Carmel Hospital

Medicare+ Choice Plan reimbursement

Redefined coding working-aged Medicare recipients

Profit $857,000

Wellmark Inc. Physician addition to managed care network

Reduced time for adding physicians to medical plan

Savings: $3 million per year

Scottsdale Healthcare

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

Profits: $600,000

ExercisesYou are trying to figure out what Sigma level your at• You take meticulous notes of what’s going on in your unit

and observe 195 turnovers • 130 of those observations were defects • Calculate defects per million

opportunities (DPMO)

(Hint)

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

Sigma DPMO

1 691,462

2 308,538

3 66,807

4 6,210

5 233

6 3.4

Exercises

Activities to use in your meeting• Managers go on a quality waste walk• Discuss training you’d 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 Surgeon’s 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

• “Healthcare’s 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

• “What’s 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. 4 th edition. New York: Prentice Hall, 2010.