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Lean Six Sigma Experiences in two Dutch
hospitals Barcelona April 2007
Jaap van den Heuvel
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Quality management
Quality Control
Quality Planning
Defect rate
Time
Quality Improvement
Lessons learned
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Six Sigma is

• An integrated approach
• Of continuous improvement
• By reducing defect

Patient
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Six Sigma
Evaluation
Patient
The Hidden Hospital
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Six Sigma in Industry

• Motorola, 1987
• IBM, Sony, Samsung, Philips
• Boeing, Bombardier, Lockheed
• Ford, Volvo
• Nokia
• Bank of America, Citibank
• American Express

Six Sigma at General Electric 1995 Jack Welch
1996 Investments 200 million savings
150 million 1997 Investments 400 million
savings 600 million 1998 Investments 450
million savings 1,2 billion 2001 Savings
12 billion (Turnover 200 billion)
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Six Sigma introduces

• A philosophy
• A projectmanagement approach
• Tools and statistical techniques
• An organisational structure
• An improvement culture

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Philosophy show us the data
lt 20 days 94
Average stay 9.9 days
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Project mangement
Six Sigma breakthrough cookbook
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Tools and statistical techniques
Patient

• X Yf(X)
  Y
• Control Chart
• Pareto Chart
• Box Plot
• Cause and Effect Diagram

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Tools and statistical techniques
Patient

• X Yf(X)
  Y
• ANOVA
• Regression Analysis
• Chi-square distribution

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Six Sigma Organisation

• Champions
• Master Black Belt
• Black Belts
• Green Belts
• Yellow Belts

Directie
Champions
Clustermanagers
Master Black Belt
Black Belt
Black Belt
Black Belt
Green Belt
Green Belt
Green Belt
Green Belt
Green Belt
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Implementation of Six Sigma

• Executive training
• Green Belt-training
• Projects
• Black Belt-training
• Appointment of Master Black Belt

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Six Sigma in the Red Cross Hospital
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Results
In 2004 we achieved 2 million euro net earnings
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Lean Six Sigma in the Canisius Wilhelmina Hospital
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What is Lean Manufacturing?

• Analyses whole Processes
• Focuses on Added Value
• Reduces Complexity
• Process speed is the key goal of Lean!!

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Littles Law

• WIP
• Lead Time --------
• ACR

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Case The ER in the Canisius Wilhelmina Hospital
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The Emergency Room

• Long waiting times
• Patients stay too long in the ER
• Not enough treatment rooms
• Workload is too high

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What do you expect the organization demands from
the board??

• Building more treatment rooms?
• More nursing staff?
• More physicians?

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Process capability plot
DMAIC
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Process performance
DMAIC
Avarage Lead Time 2,5 hour
In 50 Lead Time gt 2,5 hour
In 25 Lead Time gt 3,5 hour
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Average Lead Time in the ER
DMAIC
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2
3
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SP
Announcement of the patient
Arrival and registration
First contact with nurse
Call for physician
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20
5
6
7
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SP
SP
Start examination physician
Differential diagnosis known
Start of treatment
Patient leaves the ER
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Totaal 159
SP
Average Lead Time in minutes
Sub Process
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Potential factors of influence
DMAIC
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Relevant factors of influence
DMAIC

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Relevant factors of influence

• X-ray ? 40 min

Blood exam ? 60 min ( gem.)
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Relevant factors of influence

Admission ? 25 min
Second physician ? 50 min
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Most important factors of influence

• First contact nurse ( step 2 3 )
• Blood and X-ray exam ( step 3 4 )
• Arrival physician ( step 4 5 )
• Examination physician ( step 5 6 )
• Waiting for consultant ( step 5 6 )
• Examiniation second physician ( step 5 6)
• Admission ( step 7 8 )

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Define the objective
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Define the objective of the project
DMAIC
Average (in min.) Max (in
min.)
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Improvement actions
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Introducing a Dashboard
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Results in January 2007
Average Lead Time(in min.)
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Effects of a decreased Lead Time

• Less waiting and treatment times
• Decreased Total Treatment Time (Lead
  Time)
• Less rooms needed
• Less personnel needed

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Conclusion

• Combining Six Sigma with Lean principles is very
  powerful
• Lean Six Sigma works even better in Healthcare
  than in Industry

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Questions?