combining lean six sigma and baldrige to create a process-oriented organization

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Combining Lean Six Sigma and Baldrige to Create a Process-Oriented Organization Nancy Pratt, Sr. Vice President, Clinical Effectiveness Patricia Atkins, Director, Lean Six Sigma Sharp HealthCare San Diego, CA Contact Information: 1-888-Sharp08 [email protected]

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Page 1: Combining Lean Six Sigma and Baldrige to Create a Process-Oriented Organization

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]

Page 2: Combining Lean Six Sigma and Baldrige to Create a Process-Oriented Organization

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

Page 3: Combining Lean Six Sigma and Baldrige to Create a Process-Oriented Organization

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.

Page 4: Combining Lean Six Sigma and Baldrige to Create a Process-Oriented Organization
Page 5: Combining Lean Six Sigma and Baldrige to Create a Process-Oriented Organization

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.

Page 6: Combining Lean Six Sigma and Baldrige to Create a Process-Oriented Organization

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

Page 7: Combining Lean Six Sigma and Baldrige to Create a Process-Oriented Organization

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

Page 8: Combining Lean Six Sigma and Baldrige to Create a Process-Oriented Organization

Criteria Weight

Alignment with strategy 9

Resource availability 9

Data Complexity 1

Scope / Change Management Complexity 3

Sharp’s Project Prioritization

Page 9: Combining Lean Six Sigma and Baldrige to Create a Process-Oriented Organization

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

Page 10: Combining Lean Six Sigma and Baldrige to Create a Process-Oriented Organization

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

Page 11: Combining Lean Six Sigma and Baldrige to Create a Process-Oriented Organization

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

Page 12: Combining Lean Six Sigma and Baldrige to Create a Process-Oriented Organization

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

Page 13: Combining Lean Six Sigma and Baldrige to Create a Process-Oriented Organization

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

Page 14: Combining Lean Six Sigma and Baldrige to Create a Process-Oriented Organization

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

Page 15: Combining Lean Six Sigma and Baldrige to Create a Process-Oriented Organization

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

Page 16: Combining Lean Six Sigma and Baldrige to Create a Process-Oriented Organization

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

Page 17: Combining Lean Six Sigma and Baldrige to Create a Process-Oriented Organization

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

Page 18: Combining Lean Six Sigma and Baldrige to Create a Process-Oriented Organization

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

Page 19: Combining Lean Six Sigma and Baldrige to Create a Process-Oriented Organization

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

Page 20: Combining Lean Six Sigma and Baldrige to Create a Process-Oriented Organization

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

Page 21: Combining Lean Six Sigma and Baldrige to Create a Process-Oriented Organization

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

Page 22: Combining Lean Six Sigma and Baldrige to Create a Process-Oriented Organization

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

Page 23: Combining Lean Six Sigma and Baldrige to Create a Process-Oriented Organization

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

Page 24: Combining Lean Six Sigma and Baldrige to Create a Process-Oriented Organization

(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

Page 25: Combining Lean Six Sigma and Baldrige to Create a Process-Oriented Organization

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

Page 26: Combining Lean Six Sigma and Baldrige to Create a Process-Oriented Organization

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

Page 27: Combining Lean Six Sigma and Baldrige to Create a Process-Oriented Organization

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

Page 28: Combining Lean Six Sigma and Baldrige to Create a Process-Oriented Organization

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