Six Sigma In Healthcare

1. Six Sigma InHealthcare By Trevor Coons Brigham Young University Marriott Business School

2. 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

3. Six Sigma Defined In Context of Healthcare Statistically • Sigma or σ is a character used in statisticsto represent standard deviation. • Six Sigma denote a process that is so in control that only 3.4 parts are defective for every million produced.

4. Six Sigma Defined In Context of Healthcare As A Tool With Six Sigma Motorola company was able to • Eliminate waste • Improve quality • Reduce cost • Reduce lead time

5. Six Sigma Defined In Context of Healthcare Coming To Healthcare • Quality improvement plan • Controlling variance is essential • Increases accountability • Builds off of current processes

6. 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

7. 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

8. 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

9. Nuts and BoltsAll or Nothing • Six Sigma Organization

10. 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

11. 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

12. 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

13. 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.)

14. 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

15. 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

16. 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

17. 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

18. How It Works Project types • Patient Satisfaction • Safety • Efficiency • Outcomes • Many Others

19. How It Works Performance Variables • Patient Satisfaction • Service Level • Service Cost • Clinical Excellence

20. How It Works Physician Engagement • Why it is essential • Why so hard to get • Think differently • Increases burdens • How to gain

21. Real World Examples

22. Exercises You 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

23. 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

24. Summary • Six Sigma defined in context of healthcare • Brainstorming Exercises • Nuts and Bolts • How It Works • Real World Examples • Exercises

25. 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

26. 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. 4th edition. New York: Prentice Hall, 2010.