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Six Sigma A Case Study

Six sigma application to decrease utility costs and improve engineering system reliability in a healthcare setting Dr LH Hiranandani Hospital, Mumbai is a 130 bed multi speciality tertiary and quaternary care hospital. It is the first hospital in the city of Mumbai and the western region of India to have received the prestigious National Accreditation for Hospitals and Healthcare Providers (NABH). Among other specialties, the hospital has energy efficient structure design to achieve day light harvesting and to reduce HVAC load, rain water harvesting system and integrated building management system (IBMS). The Need
"The first phase of Six Sigm a m e thodology starte d with de ciding and de fining the m e trics to be im prove d" - A njan Roy Pre side nt & C EO , Q itsUSA

The hospital is in the process of expanding from current 130 beds to additional 71 beds to cater to its growing patient base by constructing and adding additional six floors of 90,000 sq feet space. The senior management of the hospital felt that it would be crucial to control and reduce its utility costs with the current expansion plan to meet its strategic objectives that included providing ultimate patient services. Therefore, it was decided to implement the Six Sigma methodology in its engineering operations and maintenance services to control and contain the operations and maintenance budget.
Project Objectives Utility C onsumption Engineering System Reliability FWS= Flushing water supply Metrics Water and Power C onsumption Engineering complaints DWS= Drinking water supply, Units KL and KWH No. of complaints KWH=Kilowatt-hour, KPI FWS/PO, DWS/PO, KWH/PO No. of complaints /day PO= Patient Occupancy

Approach The six sigma DMAIC methodology was used for achieving the desired improvement in engineering system reliability and utility costs. Phase-I: Defining the Opportunity for Improvement The first phase of Six Sigma methodology started with deciding and defining the metrics to be improved. The engineering team of the hospital decided to improve the power consumption and water consumption (both flushing and drinking). In terms of engineering system reliability, the team decided to reduce the no. of engineering complaints received per day. Metrics and Key Performance Indicators The table shows the various metrics and their associated key performance indicators that were targeted for improvement. Traditionally, utility consumption has been reported in terms of per square feet of consumption. However, the team felt that it would be more appropriate to

measure and monitor the metrics in terms of per patient consumption. Opportunity Statement for Improvement Benchmarks for each of the metrics were established based on historical data. Table 1 shows the benchmarks established for power, water (flushing and water) and gas consumption. The data shown in the table are reflective of average consumption per patient per month. The table also shows the average number of engineering complaints received per day. Table-I: Benchmarks for utility consumption and engineering system reliability based on twelve months data (March'08-Feb'09)
Table 1 KPI KWH/PO FWS/PO DWS/PO No. of engineering complaints Monthly Average 104 1.12 0.93 19 STDEV 12.1 0.3 0.2 5

Phase-II: Measure: Monitoring and Measuring Day to Day Performance The second phase of Six Sigma involved mapping out the processes and then monitoring and measuring the performance indicators in a predefined and planned manner. Each of the above key performance indicators were tracked by the Six Sigma engineering project team on a daily basis. Utility Consumption Monitoring The Key Performance Indicators for utility consumption were monitored for stability using statistical process control (SPC) charts. Individual control charts (Average and Moving Range) were used on a daily basis. The control limits for the charts were established using historical process data. The team monitored the process performance using these charts on a daily basis. Monitoring of Engineering System Reliability Monitoring and measurement of engineering system reliability was done by monitoring the number of complaints received on a daily basis. Further the number of complaints receive on a monthly basis were stratified into various types of system complaints. The Table 2 shows the stratification of total number of engineering complaints in the month of March'09 into various types of complaints.
Table 2 TRADEWISE ELEC TRIC AL HVAC PLUMBING C ARPENTRY GAS OPERATION PAINTING TOTAL 263 52 96 35 34 47

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A Pareto chart for the above data is shown in Figure-3: It can be seen from the above Pareto chart that about 65 per cent of the engineering complaints in March'09 were of plumbing and electrical type. The total number of plumbing and electrical problems was further stratified (second level of stratification) into problems or complaints received from each floor. The Table 3 shows the stratification of plumbing and electrical problems per floor. A Pareto chart for the data is shown in Table 3. The Pareto chart above shows that about 65 of the complaints came from four floors, viz. 2nd floor, ground floor, 4th floor and 1st floor. In other words, almost 65 per cent of the complaints can be reduced by focusing improvement efforts on these four floors only. Maximum complaints i.e. almost 20 per cent of the electrical and plumbing complaints were received from second floor itself.
Table 3 TRADE WISE BASEMENT GROUND 58 13 1ST FL 43 10 2ND FL 68 12 3RD FL 28 13 4TH 5TH 6TH FL FL FL 33 26 30 9 18 5

ELEC TRIC AL 40 PLUMBING 8

Phase-III: Analyse The purpose of this phase of Six Sigma methodology is to analyze the root causes of process deficiencies in an effort to completely eliminate them or at least reduce the effect of the root causes on process parameters. Utility Metrics In the initial phases of the project, the team focused on understanding and investigating the reasons for day -day-variations observed in the performance of the utility metrics as shown by the control charts. The intent was to understand and eliminate all sources that caused unusual variation in day-do- day performance of the key performance indicators showing utility consumption i.e. power, gas and water. A close watch was kept on the Moving Range chart to observe the variation in performance between two consecutive days of operation.

System Reliability The Six Sigma team also investigated and brainstormed various factors and root cause(s) resulting in higher plumbing and electrical complaints coming from ground, first, second and fourth floor. Table 4 shows the various electrical complaints and their root causes identified by the Six Sigma team.
Table 4 Electrical Problems Common complaints C entral Monitor Problem Tube light problem C all Bell Problem Power supply trip Plumbing C omplaints Root Cause (s) Biomedical work Reuse of Blast Misuse by user Overloading

Flush leakage Geyser problem

Algae/SIPON Incorrect thermostat setting

Phase-IV: IMPROVE Once the root causes were identified, then team moved on to the next phase of Six Sigma i.e. improvement phase. The purpose of this phase is to plan and implement various measures to eliminate various root causes of problems identified in the analyse phase. The team successfully achieved the following tasks in this phase of the project: a) Brainstorm various countermeasures to eliminate the root causes. b) Develop an implementation as well as contingency plan to implement the countermeasures. c) Plan and measure the improvement resulting from the implementation of the countermeasures. This phase took almost two months i.e. May-June'09. Benefits Achieved As a result of the implementation in May and June, the team recorded significant improvement in almost all of the utility metrics consumption as well as engineering system reliability in the third

quarter of 2009. The Table 5 shows the results for third quarter performance of 2009 compared to that in 2009. The last column in the table shows the % improvement in third quarter of 2009 performance.
Table 5 KPI KWH/PO FWS/PO DWS/PO No. of engineering complaints per day Q3-08 89.5 0.82 0.78 21 Q3-09 82.7 0.8 0.58 13 % Improvement 7.60% 2.40% 25.60% 38%

It can be seen from the above table that Six Sigma methodology implementation in a short span of six months has led to following improvement at the hospital: a) Engineering complaints has reduced as much as 40 per cent per day. b) Drinking water consumption per patient has decreased as much as 26 per cent. c) Power consumption has decreased by almost 8 per cent per patient per day. d) Flushing water shows a marginal improvement only. The consumption has reduced by about 3 per cent per patient per day. It must be noted that the above improvements i.e. reduction in utility consumption were achieved without any compromise on patient care services and patient satisfaction. As a matter of fact, in October 2009 the hospital has won the Malcolm Baldrige Quality Award (Asia Pacific) for its outstanding quality services to patients. This is the only hospital in India to have won this prestigious award. Phase-V: CONTROL Quality is dynamic and not static and hence Six Sigma pursuit is a journey and not an end result in itself. The hospital management realises that the benefits achieved so far must be sustained by maintaining strict vigilance on the underlying systems and processes. Therefore the team has successfully implemented several process control checks on the day to engineering operations and maintenance tasks. These checks includes detailed procedures, audits, training of operators, training of end users and last but not the least the measurement and monitoring of all the KPI's on process control charts on a daily basis. With inputs from Anil Dhamdhere, Manager, EngineeringHiranandani Hospital
anjan@iflcm.com