Six Sigma In Healthcare

By Trevor Coons
Brigham Young University Marriott Business School

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

Six Sigma Defined In Context of Healthcare

Statistically
Sigma or 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.

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

Six Sigma Defined In Context of Healthcare

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

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

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

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

Nuts and Bolts

All or Nothing

Six Sigma Organization

Champion

Works with Black belts Appropriates resources Heavily trained Full time job cost savings Basic training Part time and work in groups

Black belt

Green belt

Nuts and Bolts

All 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

Nuts and Bolts

All 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

Nuts and Bolts

All 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

Nuts and Bolts

All or Nothing

Six Sigma Process DMAIC

Scope of the project Define Critical-to-quality factors Create performance baseline Measure Collect comparable data Use data to identify underlying problem Analyze Implement process that will correct the problem Improve Monitor process

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.)

Control

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

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

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

Nuts and Bolts

Contingency

Advice for Implementing on Contingency Manage expectations Manage for the correct outcomes Pick manageable problems Engage the customer Measure the right thing

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

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

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

How to gain

Real World Examples

Organization Charleston Area Medical Center Commonwealth Health Corporation Froedtert Memorial Lutheran Hospital Project Supply chain for surgical supplies Radiology ICU lab times
Medicare+ Choice Plan reimbursement
Physician addition to managed care network

Outcome
Lower inventory, Improved supplier relations Decreased time between dictation and signature, Improved wait times and staff scheduling

Achievement
Saved: $163,410 immediately $841,540 future $800,000 savings, 25% better throughput and eliminated 14 positions

Reduced turnaround times Cut turnaround times from 52 to 23 minutes

Redefined coding workingaged Medicare recipients

Mount Carmel Hospital

Wellmark Inc.

Profit $857,000

Reduced time for adding Savings: $3 million physicians to medical plan per year Profits: $600,000

Scottsdale Healthcare

Over crowded ED Improved transfer time from ED to inpatient hospital bed

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 Sigma DPMO 691,462 130 of those observations were defects 1 2 308,538 Calculate defects per million 3 66,807 4 6,210 opportunities (DPMO) 5 233 (Hint)
6 3.4

(Defects/ (Opportunities* Occurrences) ) X 1,000,000

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

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

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. 50:4 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

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 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. 46:6 2007. 789-796 Managing Quality-Integrating the Supply Chain. Foster, S. Thomas. 4th edition. New York: Prentice Hall, 2010.