combining lean six sigma and baldrige to create a process-oriented organization
TRANSCRIPT
Combining Lean Six Sigma and Baldrige to Create
a Process-Oriented Organization
Nancy Pratt, Sr. Vice President, Clinical EffectivenessPatricia Atkins, Director, Lean Six Sigma
Sharp HealthCareSan Diego, CA
Contact Information: [email protected]
Baldrige Core Values and Concepts
• Visionary Leadership• Patient-Focused Excellence• Organizational and Personal Learning• Valuing Staff and Partners• Agility• Focus on the Future• Managing for Innovation• Management by Fact• Social Responsibility and Community Health
Core Competency
Strategically important capabilities that provide an advantage in your marketplace…
they frequently are challenging for competitors to imitate and they provide a
sustainable advantage.
Work Systems – Key Work Processes
Screening
Admission Registration
Assessment/Diagnosis
Treatment
Discharge/Education
Emergency CareHome CareHospice CareInpatient CareLong-term CareMental Health CareOutpatient CarePrimary/Specialty RehabilitationUrgent Care
Enterprise Work Systems
Key Health Care Work Processes
Screening
Admission Registration
Assessment/Diagnosis
Treatment
Discharge/Education
Emergency CareHome CareHospice CareInpatient CareLong-term CareMental Health CareOutpatient CarePrimary/Specialty RehabilitationUrgent Care
Enterprise Work Systems
Key Health Care Work Processes
Each work system is comprised of each key work process.
Enterprise Work Systems
Seven Step Process
Strategic Planning & Deployment
Performance MeasurementLinkage and Alignment
Data Analysis, PrioritizationDashboards, Report CardsComparative Data SelectionAnnual Targets and Goals
Performance Measurement
Performance ImprovementSystem
Process Management
Screening Admission /Registration
Assessmentand
Diagnosis
Treatmentand
Management
Discharge
Level 1: Key Processes
Level 2 Processes
Level 3 Processes
Breakdown Work Systems to Key Processes that are
Actionable
Criteria Weight
Alignment with strategy 9
Resource availability 9
Data Complexity 1
Scope / Change Management Complexity 3
Sharp’s Project Prioritization
SIPOC (forward) andCOPIS (backward)
SUP P L I ER S
CU S T O M E R S
OutputsInputs Process
What customers require of our process
What we require of our suppliers In-process
Metrics
Requirements and Feedback
Requirements and Feedback
Performance MeasurementTranslating Voice of the Customer to Process Requirements Using Customer Needs Mapping
Voice of theCustomer
Real Issue Efficiency Cost Timeliness Accuracy Friendliness Convenience Access Communication Other
1st, 2nd, 3rd Level Needs
Critical to Quality (CTQ) Requirements:SpecificMeasurableAccurateRealisticTimely
Process Key Requirements Process MeasuresScreening Safe, Timely Blood sugar (7.1-20), Cholesterol (7.1-21),
Cancer screening (7.1-18 and 7.1-19), Glucose levels (7.1-1)
Admission/ Registration
Safe, Timely Patient satisfaction (7.2-5), Accredited (7.6-10), Privacy (7.6-7), Door to Doctor (7.5-18)
Assessment and Diagnosis
Safe, Evidence-based, Efficient, Timely
Patient satisfaction (7.2-9), Skin care (7.1-10), Stroke care (7.1-16), LVF (7.5-13), CAP O2 (7.5-14)
Treatment Safe, Evidence-based, Efficient, Timely, Patient-centered, Equitable
Glycemic control (7.1-2, 7.1-3), AMI Beta Blockers (7.1-4), CAP antibiotics (7.1-5), Cancer (7.1-8), Treatment measures (7.1-9 to 17)
Discharge/ Education
Safe, Patient-centered, Timely
AHRQ Patient Safety (7.1-15), AMI mortality (7.1-6), Bariatric program (7.1-9) Smoking cessation (7.5-12)
Key Health Care Processes
Process Key Requirements Process MeasuresRevenue Cycle Timely, Accurate EBITDA (7.3-4), Days in AR (7.3-2), Billing Cost
(7.3-3), Payment (7.3-6)
Strategic Planning
Timely, Accurate Net Revenue (7.3-1), Market Share (7.3-8 through 14), Growth (7.6-1 and 7.6-2)
Key Suppliers and Partners
Efficient, AccurateTimely, Satisfaction
Provider Survey (7.5-3)Denials (7.5-9)
Supply Chain Management
Timely, AccurateEfficient, Safe
Pharmacy Turnaround (7.5-20), Sales Outstanding (7.5-5), Automated Orders (7.5-7)
Work Force Management
Timely, AccurateCustomer-centeredSafe
Retention (7.4-12), EOS (7.4-1 to 5), Nursing satisfaction (7.4-6), Perf appraisal (7.4-11), Overall turnover (7.4-13), Vacancy (7.4-14)
Knowledge Management
TimelySafe Accurate
Internal promotion (7.4-10), Training expenditure (7.4-15), Out of network (7.5-10), Critical Values (7.5-16)
Key Business & Support Processes
Performance Improvement Processes
Process ManagementStrategic Planning & Deployment Process
• Scorecard• Dashboard• Strategic Plan
Workforce and Leadership Development
Process Design and Improvement
Individual Improvement
Process Improvement
Team Improvement
TeamResource
Management
Knowledge
Man
agem
ent Change M
anagement
DMAIC 12-Step Processto Discover the Best Solution
12. Spread the improvement
11. Control the process
6. Analyze cause and effects
5. Measure the process
4. Define the right metrics and targets
3. Define and understand the process
2. Define the customer(s) and their needs
1. Define context of problem/processand select a project
D
MM
A
C
10. Fully implement
9. Select a solution and pilot it
8. Identify and manage risks
7. Identify the ideal state and possible solutions, apply innovative tools
I
Leading Change
Changing Systems & Structures
CurrentState
TransitionState
ImprovedState
Creating A Shared Need
Shaping A Vision
Mobilizing Commitment
Making Change Last
Monitoring Progress
Change Acceleration Process (CAP)to Process People Through Change
Share Out
Scan
Share In
C.A.P.
Identify & VerifyBest Practice,
Promising Practice,Lesson Learned
Collect Best Practice/Lesson
and Communicate
Evaluate for Applicability
Apply the Best Practices
Monitor Progress
Sharp’s Best PracticeSharing Model
Lean Six Sigma Deployment Time Line
Phase I Phase 3 Phase 4
Demo Projects
Small Scale Black Belt Training
Phase 2
High Visibility Projects
Site visit Exec Team Coalition
Share Results and Vision
Large Scale Black/Green Belt Training and Beyond
Engage Entire Leadership Commitment
Develop ‘Talking Points’
and Tool Kit
Winter 2003 Summer 2003 Fall 2003 Winter 2004 Spring 2004 Summer 2004
Critical Success Factors Deployment of Performance Improvement
Processes
• Executive commitment, Clear strategy• Initial priority: Financial ROI• Expert training & mentoring• Cross functional team of Black Belts• Rigorous structure• Accountability for results• Communication plan• Alignment with rewards
Diabetes Initiative
Inpatient Diabetes Mean Blood Glucose Level
150155160165170175180
2003 2004 2005 2006 2007(YTD)
Blo
od G
luco
se L
evel
Average Hospitalized Blood Sugar LevelGoal
Better
No Benchmark Exists
Benchmarking DiabetesPerformance
Medical ICU Diabetes Average Blood Glucose Levels
140155170185200215
2003 2004 2005 2006 2007YTD
Blo
od G
luco
se L
evel
SCVMC (no data pre-2005) SGHSMH Best Practice (AACE)
Better
SCHHC has no dedicated MICU
Ambulatory Care
SRS/SMP Publicly Reported Measures - Cervical Cancer Screening
50%60%70%80%90%
100%
SRS SMP
% C
om
pli
ant
2003 20042005 2006IHA 90th Percentile Better
P
Evidence-Based Medicine Performance
Sharp Grossmont Hospital Stroke Care Results
50%
60%
70%
80%
90%
100%
'05 '06 '07Q1 '07Q2 '05 '06 '07Q1 '07Q2 '05 '06 '07Q1 '07Q2JC Stroke CertifiedHospitals Benchmark
Better
t-PA Administered Lipid Profile
A-Fib Pts Receiving Anticoagulation Therapy
R
Core MeasuresFigure 7.1-4 AMI - Beta Blockers at DC
0%20%40%60%80%
100%
SMH SGH SCHHC SCVMCPerc
ent C
ompl
ianc
e
FY2004 FY2005FY2006 FY2007-Q1FY2007-Q2 FY2007-Q3National Top 10%
BetterR
(Includes Routine Discharges only; Excludes day before DC orders)Action:Increase use of Potential Discharge ‘PD’ program to anticipate discharge needs prior to discharge order written
SMH Discharge Project ‘Discharge Order Written’ to ‘Discharge’ Time
When PD Flag is used there is a significant decrease in ‘Discharge Order Written’ to ‘Discharged’ Time
0
0.5
1
1.5
2
2.5
3
3.5
Dec '06 Jan '07
p=.05
Target = 2 hrs
3.0
2.4
Case Cart ReadyCase Carts with Complete Supplies / Instruments
46%
58%66%
81%86%90%
0%10%20%30%40%50%60%70%80%90%
100%
Carts w/ CompleteSupplies
Carts w/ CompleteInstruments
Baseline
Remeasure
Post-SPD Move
Goal = 95%
Good
Call Center7.5-21 Patient Financial Services - Call Center Stats
00:0003:0106:0309:0412:0615:07
Min
: Se
cond
0510152025
% C
alls
Aba
ndon
ed
Speed to Answer (ASA) Best Practice % Abandoned% Calls Abandoned Goal - Speed to AnswerBest Practice - ASA
Better
April 2006 – January 2007
Total Estimated Savings $4,340,498Revenue Enhancement (PPO Transfers) 278,263
$4,618,761Program Expenses to Date $ 725,500
Savings & Revenue Less Expenses $3,893,261
Return on Investment to Date: $1: 5.3
Reducing Out of Network Costs
SMH Physician Engagement with Cerner EMR and CPOE
Exclusions: a) MDs who had <30 orders in Feb, 2008b) Orders put into a ‘planned’ state (not ‘initiated’)
C
D
M
AI
Lean Six Sigma
C
D
M
AI
Lean Six Sigma
C
D
M
AI
Lean Six Sigma
Number of Physicians and the Percent of Orders Entered via CPOE
0
50
100
150
200
0% 0.1-50% >51%
Feb '08
Mar 1-14th