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USING SIX SIGMA FOR PROCESS IMPROVEMENT IN HEALTHCARE
Is 99% Good Enough?
Three hospital campuses
Six Sigma In Healthcare
380 acute care beds
110 long-term careBowling Green
Scottsville
Franklin
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
Six Sigma In Healthcare
What is Six Sigma?
Measure Measure of Quality:of Quality:Expresses how close a process or service comes to Expresses how close a process or service comes to meeting its customers’ expectation.meeting its customers’ expectation.
Method Method for Continuous Improvement:for Continuous Improvement:
Uses a rigid framework to approach process Uses a rigid framework to approach process improvement.improvement.
MindsetMindset for Culture Change:for Culture Change:When successful, Six Sigma fundamentally changes When successful, Six Sigma fundamentally changes the culture and operating philosophy of the company. the culture and operating philosophy of the company. It becomes “the way to do our job”. It becomes “the way to do our job”.
Six Sigma In Healthcare
Z or Sigma Level
Sigma Level Defect Rate Defects per Million
2 30.8% 308,5373 6.7% 66,8074 0.62% 6,2105 0.0233% 2336 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 ambulance’s arrival on the scene is 4.3 sigma.
Is 99% Good Enough?
Six Sigma In Healthcare
99% Good (3.8 Sigma) 99.99966% Good (6 Sigma)
200,000 wrong drug 68 wrong prescriptionsprescriptions 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 droppedat birth each day every 2 months
Six Sigma In Healthcare
What Makes Six Sigma Different?
•Methodology is robust
• Process is measured using the customer’s 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
Six Sigma In Healthcare
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
Six Sigma In Healthcare
Strategic Alignmentto Driving Results & Leverage Resources
Organizational Dashboard for Success
Six Sigma In Healthcare
• Customer Satisfaction
• Quality of Service
• Efficiency
Measured by Press Ganey Scores
Measured by Timeliness (a rolled “z” score)
Measured by Operating Margin(cost per unit produced at departmental level)
Action Plan
Six Sigma In Healthcare
– 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
Functional Structure
Six Sigma In Healthcare
PR
ES
IDEN
T A
ND
CEO
Hospital CEO &
Sponsor
EVP &Sponsor
EVP &Sponsor
Press Ganey Score & Target
Timeliness Z Score & Target
Cost Efficiency & Target
MasterBlack Belts
MasterBlack Belts
Brown BeltsBrown Belts
Cha
mpi
ons
& S
pons
ors
Cha
mpi
ons
& S
pons
ors
Green BeltsGreen Belts
Change AgentsChange Agents
Project Profile: Radiology Staffing Efficiency
Six Sigma In Healthcare
Baseline: .3 SigmaDPMM = 382,000
Critical X: Staff Schedule
Controlled Process:1.15 Sigma
DPMM = 125,000
Operational Problem: LaborCosts Too High in Radiology
Defect: Occurs any Time Staffing Exceeds Labor Resources RequiredFor Exam Volume
Improvements: •Staff Used CAP &
Work-out™ to Redesign Schedule
•14 Positions Eliminated•1st Yr. Savings $860,000
Six Sigma In Healthcare
Financial Returns
50%
60%
70%
80%
90%
100%
Radiology Cost Per Procedure
Senior Management’s Involvement
Six Sigma In Healthcare
•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”
Key Learnings
Six Sigma In Healthcare
•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