Lean - Six Sigma Project

1. Lean - Six Sigma Project Project Team • Champions: George Krempel & Paul Gorski • Lead: Greg Horner • Process Owner: Ewa Jaraczewska • Team Members: • Jerry Davis, PT • Teri Kouchoukos, RN • Pat Kralik, PT • Marlene Anderson, RN • Deborah Muhammad, RN Homecare Physical Therapy Attempted Visits Confidential: For Quality Improvement Purposes Only

2. What is Lean - Six Sigma? Lean • Understanding value from the viewpoint of the customer • Identifying Business Value activities that do not add value but are required • Eliminating waste (process steps that do not add value) • Increasing velocity and creating a continuous flow of value added process steps Six Sigma • Reducing process variation and defects. • Reducing process variation yields fewer defects, both of which can create havoc when trying to eliminate waste and create continuous flow. A Lean - Six Sigma project uses the DMAIC process • Define - the project, process and defects • Measure - the process and what it produces • Analyze - the measurements and the process measured • Improve - Design for experiment and implement improvements • Control - the improvements and sustain results Confidential: For Quality Improvement Purposes Only

3. Problem Statement:Attempted Physical Therapy Visits occur when a home visit is scheduled and the physical therapist assigned is unable to complete the visit. From January 2006 to March 2007, attempted visits for Physical Therapy totaled 315 (average 21/mo whereas 8/mo is desired). The financial impact of attempted PT visits are > $34,700 in operating expenses during this period. Who are the Customers? Physical Therapists, Care Coordinators, Dept Mgrs (Bud Var), Patients What is Critical To Customer Satisfaction? Completed Physical Therapy Visit Project Objective: Decrease Homecare Physical Therapy attempted visits 60% to 8 per month  Variation in the definition of an attempted visit Variation in the distribution of scheduled visits among Therapists Why do PT Attempted Visits Occur ? Patients scheduled for PT visits are not appropriate for Physical Therapy RN does not communicate an observation that is significant to PT’s ability to perform a visit • PT does not call patient to confirm before making a visit Confidential: For Quality Improvement Purposes Only

4. Measure and Analyze The project team sought to improve sub processes of the Physical Therapy Visit Process Improve communication sub process 1. Nurse and Therapist communication 2. Therapist assigned Improve scheduling sub process 3. Therapist scheduling Confidential: For Quality Improvement Purposes Only

5. Sub Process ImprovementRN to Therapist Communication Before After Objective: Scheduling Office acts as a communication clearinghouse for significant observations Known Factors: - Paper based system delays document flow. - Multiple RN's assigned to one patient - Multiple PT's assigned to one patient - It is not always known or clear which PT is caring for the patient. Significant observations have the potential to impact ability to complete a scheduled PT visit. - Patient is being discharged - Patient is being hospitalized - Not appropriate for care - Changes in care - Patient homebound status in question - Deletions/additions of services Confidential: For Quality Improvement Purposes Only

6. Keys to Success in Reducing Process Variation • The need to reduce variation in each sub process was identified • Sub process improvements and maps were developed during brainstorming sessions • Sub process improvements were tested by the Homecare staff and then refined by the project team • Sub process improvements were successfully implemented and measured Confidential: For Quality Improvement Purposes Only

7. Project Summary Lean – Six Sigma Objectives Actions Taken Results • Improved communication methods • Improved process flow and throughput Eliminate Waste • Analyzed current state process flow. • Time and work analysis • Implemented operational changes Reduce Process Variation • Sub process maps were developed • Improvements were tested and FMEA’s developed • Implemented cultural changes • Variation reduced to 4.3 (74% improvement from baseline) • Standard Deviation reduced to 2.1 (48% improvement from baseline) Reduce Defects • Implemented pre-visit verification call process • Implemented standardized visit cancellation alert process • Monthly attempted visits reduced to 8.7 (60% improvement from baseline) • Process sigma increased to 3.80 (.34 improvement from baseline) Recover Operating Cost • Project moved through all phases of DMAIC • Control Phase monitoring in place • Project will produce > $19,400.00 in hard cost recovery over a fifteen month period • Implementation costs = $1,200 Confidential: For Quality Improvement Purposes Only

8. Phase I: Baseline Months 1-15 Phase II: Define, Measure, Analyze, Improve Months 16-19 Phase III: Control & Sustain Results Months 20-23 Confidential: For Quality Improvement Purposes Only

9. Summary Project results show stability and sustainability • Attempted visits reduced to 8.7, a 60% improvement from baseline • 74% improvement in process variation • 48% improvement in standard deviation • Process sigma increased to 3.80 Project will produce > $19,400.00 in hard cost recovery Project results are sustainable Confidential: For Quality Improvement Purposes Only