how lean and six sigma can improve healthcare

How Lean and Six Sigma Can

Improve Healthcare Safety and

Predictability, and Reduce Costs

Eddie Pérez-Ruberté, CSSBB

Senior Lean Specialist

BayCare Health System

2 2

Objectives

Illustrate applicability of LSS to healthcare

Present successful examples of LSS

applications in healthcare

Identify a path to incorporate LSS in

healthcare improvement journey

1

2

3

3 3

Benefits of Lean Six Sigma

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Healthcare: The Case for LSS

Cost of Poor Quality

>2.4M

Additional hospital days

due to medical errors

$17B

Excess charges

every year

Health Affairs Study, The $17.1 Billion Problem, 2011

Poor quality | Access challenges | Unsustainable higher costs | Decreased payments

5 5

High Cost – Average Performance

$8,508/person

79 Years

AUS AUT

BLG

CAN

CHL CZE

DEN

EST

FIN

FRA

GER GRC

HGR

ICE

IRL

ISL

ITA

JAP

KOR LUX

MEX

NTH NZE

NOR

POL

PRT

SLO

SVN

SPA

SWE

SWI

TUR

GBR

USA

72

74

76

78

80

82

84

86

$0 $2,000 $4,000 $6,000 $8,000 $10,000

Lif

e E

xp

ec

tan

cy

Total Expense Per Capita (US$)

The U.S. spends more on health care per capita than any of the

other OECD countries; yet it ranks in the bottom 25% of those

countries on life expectancy

The Organization for Economic Co-operation and Development (OECD)

6 6

Can we use LSS in Healthcare?

Arguments against

using Lean Six Sigma

in Healthcare

Arguments for using

Lean Six Sigma in

Healthcare

• Cars don’t bleed out

• Cookbook medicine

• That does not apply here

• Healthcare is different

• A process is a process

• So many opportunities

• No standardization

• Fragmented, inefficient

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And now…

PACU

• PACU Full ~ 2.5 hours/wk

• Suboptimal Patient Care

• Revenue loss

Lean Project

• Process Map

• Ishikawa

• Communication

• Standardization

• > 90% reduction in “PACU

Full” time

OPH

• High costs of cataracts surgery

• High variability in practices

among MDs

• $1,800 loss per case

Lean Project

• Value Stream Map

• Communication

• Standardization

• 32% time savings

• >30% cost reduction by case

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PACU: .

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Situation

A Full PACU means inefficient care and lost revenue

PACU Full

event 16/22

days per month

Patients

recovering

in the OR

$100 / minute Overtime

required

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Background

300+ Beds 16 OR Rooms

40+ Cases / Day 39 PACU Bays

Problem Definition Questions:

• Why is the PACU Full 2.5 – 5 hrs. every week?

• Is it because we do not have enough bays?

• Is it because we do not have enough staff?

• Is it because we do not have adequate staffing?

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Approach

ToC Training Map the Process

Data Collection

The Journey to Improvement Starts Here

Actions for Waste

Reduction Identify Waste

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Define

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Measure Metric – minutes “PACU Full” per week/month

Took baseline over 3 months

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Analyze

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Challenged Focus

Chopping tomatoes for tomorrow’s sandwiches

Gemba

Walk

Bundles

Tomorrow’s

Cases

Low Priority High Priority PACU Full

Expectations ≠ Practice

Flow

When expectations are not effectively

communicated, practices seldom change

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Improve - Patient Flow Algorithm

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Improve - Communications

“In the event there is a PACU full (888)

event, we need everybody to be

engaged working to decompress and

lower PACU census to alleviate the

issue at the earliest as humanly

possible, without sacrificing patient or

staff safety.”

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Improve - Predictive Models

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Improve - Predictive Models

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Improve

Patient

Flow

Algorithm

Communication Cross-

training

Monitors Electronic

Bed

Tracking

Predictive

model

Total

Several Levels of

Improvement

• Improved communications

across departments / units

• Better coordination

• Increased awareness

• Wise use of technology

Effect of Implemented Improvements

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Results - Total Minutes by Month

Increased availability of the PACU

>90%

Reduction in

“PACU Full” time

$60K

Impact on

revenue / month

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Control

Checklists Cross-training

Standardization Communication

Hardwire the improvements

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THE OPHTHALMOLOGIST

WHO COULD NOT SEE

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Situation

0

2

4

6

8

10

12

2011 2012 2013 2014

Costs Medicare

Cost vs Reimbursement of

Cataracts Surgery

Gap

$1,800

2014 Loss per case

2X

Disparity in case

duration by MD

0

1

2

3

4

5

6

7

8

9

10

May Jun Jul

MD1 MD2 MD3 MD4 MD5

Case duration by Physician

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Background

6 OPH + 2 OPT

1 OR Room 13+ Cases / Week

Problem Definition Questions:

• Why do we have different practices among MDs?

• What is best for the patient?

• Where do we have waste?

Retina, Cataracts,

Glaucoma, Cornea, etc.

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Approach

VSM Training Map the Value Stream

Actions for Waste

Reduction

The Journey to Improvement Starts Here

Identify Waste

NVA VA

Increase Value-

Added Ratio

27 27

Define

Let’s

Define

the

problem

This is a waste

of our time!

I already know

the solution…

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Value Stream Map - Current State - Ph1

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Value Stream Map - Current State - Ph2

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Value Stream Map - Current State - Ph3

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Value Stream Map – Current State

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Value Stream Map – Current vs. Future

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Results

32% time

savings

between cases

30% cost

reduction

per case

Kai Zen

Standardization Access

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A Path Forward

IMA

GE

CR

ED

IT: D

RE

AM

AT

ICO

.

Enable Staff

(Knowledge,

Training)

Map the

Process or

Value Stream

Identify Waste

Eliminate Waste Through

Actions, Ownership &

Accountability

Standardization PDCA/PDSA Kaizen

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IMA

GE

CR

ED

IT: D

ILB

ER

T.C

OM

.