USING SIX SIGMA FOR PROCESS IMPROVEMENT IN HEALTHCARE

1. USING SIX SIGMA FOR PROCESS IMPROVEMENT IN HEALTHCARE Is 99% Good Enough?

2. Three hospital campuses 380 acute care beds 110 long-term care • Full range acute & tertiary • Open Heart Surgery • Cancer Treatment • Neonatal Intensive Care • Psychiatric Services • Home Health • Emergency Medical Services • Managed Care • Primary Care Walk-in Clinics • OP Rehab Center • Physician Practices • Free Clinic • Long Term Acute Care Hospital • Health and Wellness Center Bowling Green Scottsville Franklin Six Sigma In Healthcare

3. What is Six Sigma? Measure of Quality: Expresses how close a process or service comes to meeting its customers’ expectation. Method for Continuous Improvement: Uses a rigid framework to approach process improvement. Mindsetfor Culture Change: When successful, Six Sigma fundamentally changes the culture and operating philosophy of the company. It becomes “the way to do our job”. Six Sigma In Healthcare

4. Z or Sigma Level Sigma Level Defect Rate Defects per Million 2 30.8% 308,537 3 6.7% 66,807 4 0.62% 6,210 5 0.0233% 233 6 0.00034% 3.4 By using the Sigma level to express how good a process is, we are able to compare dissimilar processes. Example: Radiology report turnaround time is at 2 sigma while an ambulance’s arrival on the scene is 4.3 sigma. Six Sigma In Healthcare

5. Is 99% Good Enough? 99% Good (3.8 Sigma)99.99966% Good (6 Sigma) 200,000 wrong drug 68 wrong prescriptions prescriptions each year each year 5,000 incorrect surgical 1.7 incorrect surgical operations each week operations each week 50 newborn babies dropped One newborn baby dropped at birth each day every 2 months Six Sigma In Healthcare

6. What Makes Six Sigma Different? • Process is measured using the customer’s specification rather than • internally established thresholds • Analysis is data driven • Improvements are statistically valid • Improvements are tested and proven • Processes are controlled • Project framework is rigid • Methodology is robust Six Sigma In Healthcare

7. Culture change • Traditional Beliefs: • Quality costs money • Inspection and rework can capture defects • Quality of output is enough • Control the worst case and the average • 99% defect free is good enough • Documentation can control quality • Six Sigma Beliefs: • Poor quality is extremely expensive • Defects must be prevented • Quality must be built into the process (Sony TVs) • Variability is the enemy • Need to achieve 3.4 defects per million • Mistake proof to sustain quality Six Sigma In Healthcare

8. Strategic Alignment to Driving Results & Leverage Resources Six Sigma In Healthcare

9. Organizational Dashboard for Success • Customer Satisfaction Measured by Press Ganey Scores • Quality of Service Measured by Timeliness (a rolled “z” score) • Efficiency Measured by Operating Margin (cost per unit produced at departmental level) Six Sigma In Healthcare

10. Action Plan • Customer Service/Satisfaction • Reduced Wait Times • Meeting Service Expectations • Delivered Quality of Care • Reduced Medical Errors • Increased Safety • Use of Appropriate Technology • At Lower Cost • Increased Productivity • Decreased Cost Six Sigma In Healthcare

11. Functional Structure Master Black Belts PRESIDENT AND CEO Hospital CEO & Sponsor Press Ganey Score & Target Brown Belts EVP & Sponsor Champions & Sponsors Timeliness Z Score & Target Green Belts EVP & Sponsor Cost Efficiency & Target Change Agents Six Sigma In Healthcare

12. Project Profile: Radiology Staffing Efficiency Operational Problem: Labor Costs Too High in Radiology Defect: Occurs any Time Staffing Exceeds Labor Resources Required For Exam Volume Baseline: .3 Sigma DPMM = 382,000 Critical X: Staff Schedule • Improvements: • Staff Used CAP & • Work-out™ to • Redesign Schedule • 14 Positions Eliminated • 1st Yr. Savings $860,000 Controlled Process: 1.15 Sigma DPMM = 125,000 Six Sigma In Healthcare

13. Financial Returns Radiology Cost Per Procedure Six Sigma In Healthcare

14. Senior Management’s Involvement • Created Vision Statement • Identified CTQs • Attended CAP/Workout Training • Attended Greenbelt Training provided by GE • “Shadowed” Greenbelt Projects • Participate in Formal Reviews by Greenbelts • Driven from “top-down” Six Sigma In Healthcare

15. Key Learnings • Commitment is Critical • Ideally From the Top • Watch for & Address the “Holdouts” • People Selection • Best & Brightest • Project Selection • Tied to Strategic Objectives • Financial Results & Validation • Challenging, Challenging, Challenging • Culture Change vs. Quality Tool Six Sigma In Healthcare