Six Sigma In Healthcare

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Six Sigma InHealthcare

• By Trevor Coons
• Brigham Young University
• Marriott Business School

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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

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Six Sigma Defined In Context of Healthcare

• Statistically
• Sigma or s 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.

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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

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Six Sigma Defined In Context of Healthcare

• Coming To Healthcare
• Quality improvement plan
• Controlling variance is essential
• Increases accountability
• Builds off of current processes

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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

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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

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Nuts and Bolts

• All or Nothing vs. Contingency
• All or Nothing means that the company either
  fully commits to Six Sigma or else it shouldnt
  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

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Nuts and BoltsAll or Nothing

• Six Sigma Organization

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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

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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

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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

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Nuts and Bolts All or Nothing

• Six Sigma Process DMAIC

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

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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 RNs beepers. Retraining employees on
  BTS and providing laminated instructions cards

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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

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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

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How It Works

• Project types
• Patient Satisfaction
• Safety
• Efficiency
• Outcomes
• Many Others

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How It Works

• Performance Variables
• Patient Satisfaction
• Service Level
• Service Cost
• Clinical Excellence

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How It Works

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

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Real World Examples
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Exercises

• You are trying to figure out what Sigma level
  your at
• You take meticulous notes of whats 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

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Exercises

• Activities to use in your meeting
• Managers go on a quality waste walk
• Discuss training youd like to pursue in your
  company
• Work to reduce reliance on competitive data for
  improvement initiatives
• Discuss how to improve physician engagement

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Summary

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

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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 Surgeons 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. 504 July/August
  2005.226-236
• Healthcares 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

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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. 486
  November/December 2003. 377-391
• Whats 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. 466 2007.
  789-796
• Managing Quality-Integrating the Supply Chain.
  Foster, S. Thomas. 4th edition. New York
  Prentice Hall, 2010.