USING SIX SIGMA FOR PROCESS IMPROVEMENT IN HEALTHCARE

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USING SIX SIGMA FOR PROCESS IMPROVEMENT IN
HEALTHCARE
Is 99 Good Enough?
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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
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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.
• Mindset for Culture Change
• When successful, Six Sigma fundamentally changes
  the culture and operating philosophy of the
  company. It becomes the way to do our job.

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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 ambulances arrival
on the scene is 4.3 sigma.
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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
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What Makes Six Sigma Different?

• Process is measured using the customers
  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

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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

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Strategic Alignment to Driving Results
Leverage Resources
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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)
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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

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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
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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
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Financial Returns
Radiology Cost Per Procedure
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Senior Managements 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

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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