Six Sigma Project Work
Six Sigma Project Work
Six Sigma Project Work
Objectives
Articulate the case for organizational
transformation in healthcare
Learn from case study examples Know the keys to a successful deployment
A Perfect Storm
Patient safety and quality concerns Demographic changes Rapidly changing technologies and treatment Digital transition Workforce issues Financial constraints Rising consumerism Un and Under-insured Leadership challenges
Key Concepts
Critical to Quality (CTQ): Attributes most important to the customer Defect: Failing to deliver what the customer wants Process Capability: What your process can deliver Stable Operations: Ensuring consistent, predictable processes to improve what the
An Enabler for Cultural Change customer view my Patients View How does the
process? What does the customer look at to measure performance?
Registratio n Time to Time to drive to Park Car facility Lobby Time Walk to Procedur Procedure e Time Area
of Registration
DMAIC METHOD:
Define CTQs Practical Problem Statistical Problem Statistical Solution Practical Solution
... define the problem, clarify and relate it to the customer..,
PROCESSES
In simple terms
Listen to the customer
Define their expectations Measure how many times we get it wrong Fix it Prove the fix is real and meaningful Make it stick !!!!!
Large scale improvements require precise coordination and a common cadence to advance smoothly
Customer(s): Customer(s):
Decrease LWBS Decrease LWBS Increase patient satisfaction (Press Ganey #s) Increase patient satisfaction (Press Ganey #s) Reduce ED LOS (Soft Dollars) Reduce ED LOS (Soft Dollars)
PS - - Moving Treat-to-Street patients through the ED PS Moving Treat-to-Street patients through the ED takes too long. PD - - One-third of our patients wait takes too long. PD One-third of our patients wait longer than 60 minutes to be seen by aa physician. longer than 60 minutes to be seen by physician.
Measure
What is the Right Y (CTQ) to Measure? How will it be measured? What is the Right Y (CTQ) to Measure? How will it be measured?
Y = Door to Doc Time. From the time a patient enters through the door until the physician Y = Door to Doc Time. From the time a patient enters through the door until the physician enters the exam room to assess the patient, measured in minutes. enters the exam room to assess the patient, measured in minutes.
We will improve the average ED Throughput Time for Treat and Street Patients by 40%. We will improve the average ED Throughput Time for Treat and Street Patients by 40%. This will reduce the weighted average Door-to-Doc time from 65 minutes to 40 minutes. This will reduce the weighted average Door-to-Doc time from 65 minutes to 40 minutes. We will improve our throughput yield of patients seeing a physician within 60 minutes We will improve our throughput yield of patients seeing a physician within 60 minutes (USL) from 67% current to 80%. This reduction in our defect rate of 13% represents over (USL) from 67% current to 80%. This reduction in our defect rate of 13% represents over 7,500 customers. 7,500 customers.
What are the specification limits? (LSL, USL) What is the Target? What are the specification limits? (LSL, USL) What is the Target?
Based upon our VOC data, we have set aaUSL of 60 minutes and aaTarget Mean of 40 Based upon our VOC data, we have set USL of 60 minutes and Target Mean of 40 minutes. minutes.
Analyze
Value Stream Map Opportunities for Performance Improvements: Value Stream Map Opportunities for Performance Improvements:
Door-to-Doc Subcycle
Front Desk / QR Triage
EKG, Draw Blood, UA, Order X-Ray, administer Pain med 2- RNs 1 Tech
Patient Flow People Flow (RN, E-Info MD, etc.) Flow Other Flow Phone (blood, Call etc.) Patient Wait Time
ED Waiting Room
Treatment
Lab
Tube/bloo d MD
Arr
QR
QR
Triage
Triage
Bed
Bed
MD
6.3 min
11.6 min
23.5 min
22.9 min
Analyze
Statistical Analysis Statistical Analysis
A y it cu
ut in M es M ly th on
s th on M
ks ee W
ts if Sh t n t ie Pa
ys Da A s rn tt e Pa
Patient Attributes
g Re r ra ist
k uic Q g Re
Chart
ion er yp H
an ci si hy P
Registration
te c ia o ss
Satisfaction LWBS
T r ia
e rg ha
ED T
e) c an in (F on si vi In
ge
Bed Available
Nurses
Nurses Physicians
g in ck ra
Software
ce n rie pe Ex il Sk
e nu ve Re
Census
d ee Sp
Env ironment
t os C ls ve Le
y Da of W ee k
I RO
Financial Metrics
Supplies
Associate Attributes
Door-to-Doc
Triage Level
x Fa
y y Ra XRa b La
r pie Co
b La
Ancillary Svcs
ay ift D Sh of e im T k ee fW o ay s D ay id ol H ly er rt ua Q
Seasonality
Methods
Machines
Analyze
What Xs (inputs) are causing most of our variation? What Xs (inputs) are causing most of our variation?
Results for: Historical DOE Door to Doctor Time Results for: Historical DOE Door to Doctor Time Factorial Fit: D2D versus Express Care, X-Ray, Bed Open` Factorial Fit: D2D versus Express Care, X-Ray, Bed Open` Estimated Effects and Coefficients for D2D (coded units) Term Constant Express Care X-Ray Bed Open Express Care*X-Ray Express Care*Bed Open X-Ray*Bed Open Express Care*X-Ray*Bed Open S = 10.1865 R-Sq = 96.87% Effect 35.56 36.06 -37.81 33.69 32.56 14.06 5.19 Coef 87.34 17.78 18.03 -18.91 16.84 16.28 7.03 2.59 SE Coef 2.547 2.547 2.547 2.547 2.547 2.547 2.547 2.547 T 34.30 6.98 7.08 -7.42 6.61 6.39 2.76 1.02 P 0.000 0.000 0.000 0.000 0.000 0.000 0.025 0.338
R-Sq(adj) = 94.12%
Analysis of Variance for D2D (coded units) Source Main Effects 2-Way Interactions 3-Way Interactions Residual Error Pure Error Total DF 3 3 1 8 8 15 Seq SS 15979.9 9571.7 107.6 830.1 830.1 26489.4 Adj SS 15979.9 9571.7 107.6 830.1 830.1 Adj MS 5326.6 3190.6 107.6 103.8 103.8 F 51.33 30.75 1.04 P 0.000 0.000 0.338
Improve
Screen Potential Causes? Screen Potential Causes? Discover Variable Relationships? Discover Variable Relationships? Establish Operating Tolerances? Establish Operating Tolerances?
What Xs (inputs) have we chosen to improve? What Xs (inputs) have we chosen to improve?
1. 1.
1. 1.
Bed Availability Bed Availability The Measure Phase data demonstrated that Door-to-Doctor time increased by two to The Measure Phase data demonstrated that Door-to-Doctor time increased by two to three times when there is no bed open for the patient. three times when there is no bed open for the patient. Ancillary Services Ancillary Services The data further showed that the time it takes to perform an X-Ray or Lab testing is The data further showed that the time it takes to perform an X-Ray or Lab testing is statistically significant in relation to Door-to-Doctor time. statistically significant in relation to Door-to-Doctor time.
3. 3.
Express Care Express Care Lower acuity patients (i.e. Level 33/ /Express Care) wait longer to see aaphysician than Lower acuity patients (i.e. Level Express Care) wait longer to see physician than do higher acuity patients (i.e. Level 1). do higher acuity patients (i.e. Level 1).
Improve
Value Stream Map Key Points / /Opportunities for Improvement: Value Stream Map Key Points Opportunities for Improvement:
Bedside Registration
Triage Front Desk / QR
EKG, Draw Blood, UA, Order X-Ray, administer Pain med 2- RNs 1 Tech
Patient Flow People Flow (RN, MD, etc.) E-Info Flow Patient Wait Time
ED Waiting Room
Impacts: 1 Inc. Patient Satisfaction 2 Red. time by 8.7 minutes 3 Red. variability in process
Improve
What is the mean and median of our process? What is the standard What is the mean and median of our process? What is the standard deviation? deviation?
Mean score Mean score Median Median Standard Deviation Standard Deviation HI/LO HI/LO Range Range Measure Phase Measure Phase 64.3 minutes 64.3 minutes 38.5 minutes 38.5 minutes 44.7 minutes 44.7 minutes 241 / /11 minutes 241 11 minutes 230 minutes 230 minutes Control Phase Control Phase 39.8 minutes 39.8 minutes 34.0 minutes 34.0 minutes 27.7 minutes 27.7 minutes 129 / /44minutes 129 minutes 125 minutes 125 minutes
+ % + % 38.1% 38.1% 11.7% 11.7% 38.0% 38.0% 46.5% (HI; outliers) 46.5% (HI; outliers) 45.7% 45.7%
What is our process capability (Z score, DPMO, Yield %)? What is our process capability (Z score, DPMO, Yield %)?
Z Short-Term Score == Z Short-Term Score DPMO = DPMO = Yield % == Yield % 1.91 2.35 1.91 2.35 333,333 333,333 66.7% 66.7% 0.44 0.44 175,000 175,000 82.5% 82.5% <109,523> <109,523> 15.8% 15.8%
Control
What are our financial results? How were they calculated? What are our financial results? How were they calculated?
Our Financial Impact is $1,120,650 and reflects the improvement in LWBS visits and the Our Financial Impact is $1,120,650 and reflects the improvement in LWBS visits and the corresponding admissions as well as aaconservative (5%) recognition as aaresult of corresponding admissions as well as conservative (5%) recognition as result of throughput improvement. throughput improvement.
What is the plan for monitoring/ auditing the process? What is the Control What is the plan for monitoring/ auditing the process? What is the Control Plan? Plan?
T a rg e t V a lu e s
M e a su re m e n t U p p e r/ L o w e r C o n tro l R e sp o n sib ili ty M e a su re m e n t D e fin itio n M e th o d S p e c L i m its M e th o d F re q u e n c (W h o w ill m e a su re ) A le rt F la g s y Tim e b e g in s w h e n a p a t ie n t c ro s s e s t h e re a c h e s Q u ic k Tw o o u t o f t h re e w e e k s w R e g is tra t io n . Th is tim e is 8 0 % o f p a tie n ts a re n o t s < 6 0 m in u tecso m p le te d w h e n a p h y s ic ia n ; D a s h b o a rd ; b y a p h y s ic ia n w it h in 6 0 D o o r t o D o c to r Timie ld = 8 0 %g re e t s th e p a tie n t a t th e b eM s idu a l - C D R W e b = 6 0 m in u te s a r-R C h aW e e k ly Y e d an e. USL Xb rt M . K e lly -N ic h o ls m in u te s . P a t ie n t le a ve s th e E D a fte r a t le a s t c o m p le tin g th e Q u ic k R e g p ro c e s s b u t b e fo re p h y s ic ia n to m a te d - U S L = 1 .0 % o f D a s h b o a rd ; Au Tw o o u t o f t h re e w e e k s w LW B S % < 1.0% p e rfo rm s e x a m in a tio n . E D Tra c k in g E D vis its Xb a r-R C h aW e e k ly rt M . K e lly -N ic h o ls L W B S % e x c e e d s 1 .0 % . M e tric
Achieving 35% higher take home baby rate with increase in successful implantation at hospital in Northeast
Better patient safety with 91% improvement in post-surgery antibiotic use, delivering annual savings over $1 million at hospital in Southeast
Shorter ED wait times allow 28 more patients per day to be seen, with potential financial impact over $13 million annually at hospital in Southern
Culture Change
Think about it. Are the mission, vision and values of your health system merely bullet points on a web site, or are they clearly understood and activated across the organization? Are people empowered to drive change and accountable for results?