effective application of six sigma for enhanced customer satisfaction
TRANSCRIPT
NewYork-PresbyterianThe University Hospital of Columbia and Cornell
Six Sigma in Service & Transactional EnvironmentsSix Sigma in Service & Transactional Environments
22ndnd Annual Summit Annual Summit
Mary O. Cramer
Master Black Belt
NewYork- Presbyterian Hospital
EFFECTIVE APPLICATION OF EFFECTIVE APPLICATION OF SIX SIGMA FOR ENHANCED CUSTOMER SIX SIGMA FOR ENHANCED CUSTOMER
SATISFACTIONSATISFACTION
2
OBJECTIVESOBJECTIVES
Prioritizing Six Sigma Projects Associated with Service
Practical Application of Six Sigma to Service Improvement Projects
Critical Success Factors & Lessons Learned
NewYork-PresbyterianThe University Hospital of Columbia and Cornell
NewYorkPresbyterian NewYorkPresbyterian Healthcare SystemHealthcare System
OverviewOverview
4
Market Share: 1 of Every 4 Inpatient Discharges in the New York Metropolitan Area.
Largest Non-public Employer In New York City (27,500 FTEs); and Over 50,000 FTEs Total.
Membership in 4 States (NY, NJ, CT and TX).
Strong Medical College Partnerships With Weill Cornell Medical College and Columbia University College Of Physicians And Surgeons
System Overview
NewYork-PresbyterianThe University Hospital of Columbia and Cornell
NewYork-Presbyterian Hospital
6
Key Statistics
Outpatient Statistics
Outpatient Visits: 1,444,076 Emergency Visits: 180,308 Ambulatory Surgeries: 64,776
Inpatient Statistics
Certified Beds 2,344 Discharges: 105,666 Inpatient Days: 725,159 Deliveries: 12,425
Other
Total Revenues: $2.4 Billion Employees: 14,738 Physicians: 5,083
Updated: June 2, 2005
7
Quality-Driven Health Care System
Clinical Excellence
Finest Health Care Practitioners
Patient-Centered Systems
Cutting Edge Medicine
Scientific Research/Education
Fiscal Discipline
Strategic Vision: Strategic Vision:
8
Institutional ObjectivesInstitutional Objectives
8
Improve Quality and Outcomes• Clinical Quality, Efficiency & Service
Increase Volume and Access
Enhance Operating Efficiency
Improve Cost-Effectiveness
Become “Employer of Choice”
9
AccomplishmentsAccomplishments
Improved Operating Performance
• Increased Patient Revenues and Margin
• Reduced Bad Debt
• Enhanced Fundraising
• Development of Service Lines and Cross-campus Collaborations
• Established Strategic Relationships With Key Vendors
10
AccomplishmentsAccomplishments
Enhanced QualityEnhanced Quality
• Increased Reputation and National RankingIncreased Reputation and National Ranking
• Improved Patient SatisfactionImproved Patient Satisfaction
• Recruitment of Premier PhysiciansRecruitment of Premier Physicians
• Stronger Residency ProgramsStronger Residency Programs
11
The Health Care LandscapeSignificant Trends
• Constrained Financial Environment
– Expenses Outstripping Revenues
– Shrinking Government Reimbursement
• Limited Workforce
• Labor Expense Rising
• Facilities and Equipment Aging
12
The Health Care LandscapeThe Health Care LandscapeSignificant TrendsSignificant Trends
• Increased Consumer Demand for Highest Quality
• Aging Population; Increasing Prevalence of Chronic
Disease
• Consumers Educated about Outcomes
13
The Health Care LandscapeSignificant Trends
Increasing Regulatory Requirements
• Federal, State, and Local Regulations
• Joint Commission Updated Standards
• Unfunded Mandates
14
What We’ve Heard What We’ve Heard From Our EmployeesFrom Our Employees
Communication
• Accountability
• Decision Making
Cross Department Teamwork/Cooperation
Reduce Bureaucracy
Increase Management Skills
Communication
• Accountability
• Decision Making
Cross Department Teamwork/Cooperation
Reduce Bureaucracy
Increase Management Skills
NIMBLENESSNIMBLENESS
15
Attributes of Patient Satisfaction Most Closely Related to Overall Satisfaction & Likelihood to Recommend:
Priorities:TeamworkTimelinessCommunication
Patients Expect a Superior Product(1,2) (3) (4) (5)
What We’ve Heard What We’ve Heard From Our PatientsFrom Our Patients
16
Focus: Enhanced Loyalty Rationale: Patients Who Rate Their Hospital Experience As Excellent
Are Most Likely To Be Loyal And To Recommend The Hospital To Others.
Patients Or Customers Who Are Currently “4s” Or “Good” Are The Most Likely To Move To “Excellent”.
Shifting A Score Of “Poor” To “Fair” May Increase The Average Satisfaction Score, But Will Have Little, If Any Impact On Loyalty.
What We’ve Heard What We’ve Heard From Our Patients - Strategy -From Our Patients - Strategy -
17
Importance Of Cultural ChangeImportance Of Cultural Change
Essential To Be Responsive:
• To Patients
• To Employees
• To Payors
Achieving Stated Objectives Requires Changing Skills
• Without Change, Goals Will Not Be Met
Essential To Be Responsive:
• To Patients
• To Employees
• To Payors
Achieving Stated Objectives Requires Changing Skills
• Without Change, Goals Will Not Be Met
18
Driving A Culture Of Performance Excellence
Operational Improvement
Clinical Quality
Leadership & Management Systems
ServiceQuality
19
Performance Excellence
• Commitment to Patient,
Physician & Employee Satisfaction
ServiceService
QualityQuality
• Innovation Practice • Streamlined Clinical & Operational Workflows
EfficiencyEfficiency
20
Tools
Qua
lity,
Ser
vice
Exc
elle
nce,
Eff
icie
ncy
and
Fis
cal D
isci
plin
e
It’s really about CULTURE not about projects!
Quality, Service Excellence, Efficiency, Fiscal Discipline
Six Sigma and Work-OutTM Projects
HospitalManagement Processes
BusinessProcesses
FinancialViability
CommunityRelationships
Physician –Staff
Satisfaction
PatientSatisfaction
PatientSafety
ClinicalCare
Processes
21
Focus On The CustomerFocus On The Customer
CustomerWhat does my customer need
from our process?
How is our process
performance from the customer
perspective?
How does my customer
measure my process?
How would my customer like
for our process to perform?
What can we do better?
How does my customer view my process?
22
Six Sigma Six Sigma Project Selection CriteriaProject Selection Criteria
Criteria ExampleClinical Excellence
Drives Strategic Initiative(s)
Improved patient outcomes, reduced infection rates & appropriate utilization of ancillary services.
Advances stated strategic initiative; e.g. strategic growth, people development, etc..
Regulatory and/or Safety Relevance
Department of Health or JCAHO Requirements
Patient Satisfaction Teamwork, Timeliness, & Communication. Outstanding clinical care, caring environment & facility aesthetics.
Staff Satisfaction Home/work life balance, collegial respect, rewarding career
23
Six Sigma Six Sigma Project Selection CriteriaProject Selection Criteria ( (Cont’d)Cont’d)
Criteria Example
Physician Satisfaction Access to the OR, ease of scheduling, state of the art equipment
Ease of Implementation
Technological change needed, organizational acceptance, project span/scope (across multiple campuses)
Financial Benefits Increased revenue, decreased cost, cost avoidance, implementation support
Time to Complete Time the project will take to complete
Sustainability Systems and structures to support the change; control measures in place
24
Project Selection CriteriaProject Selection Criteria
Project Selection CriteriaOverall Score: 4
3.92.9
4.13.1
4.23.8
4.83.9
4.94.8
0.0
1.0
2.0
3.0
4.0
5.0
6.0
25
Select Projects
Psych ED LOS
Antibiotic Utilization
Attending of Record Accuracy
Medical Records to Ambulatory Care
Outpatient Transplant Room Utilization
Hem/Onc Infusion Center Cycle Time
Outpatient Lab Charge Capture
Transport Response Time for Patient Care Units
Radiology Report Turnaround Time
Craniotomy LOS
ED Throughput
Billing Compliance for Screening Mammograms
Non-Invasive Cancellation Reduction
Housekeeping Turnaround Time
Hip Fracture LOS
CT OR Room Turnaround Time
Patient Wait Times in Radiology
Cath/EP Room Turnaround Time Discharge Instruction Process
Call Bell Response Time
Inpatient Tray Accuracy
Improve AOB Process in Radiology
Information Transfer for Antenatal to L & D
Use of Abbreviations in Medical Records
Isolation Room Throughput
Interdisciplinary Plan of Communication
ICU Throughput
Ambulatory Surgery Wait Time
Nursing Communication Patient Satisfaction
Smoking Cessation Counseling
Pyxis Overrides
Blood Delivery Turnaround Time
Scheduled Induction Wait Time in L&D
Ambulatory Surgery Turnaround Time
Timeliness of Cancer Registry TNM Staging
Radiology Turnaround Time in ED
Medication Delivery Turnaround Time
Accuracy & Timeliness of Pharmacy Charges
26
Overview – Select ProjectsOverview – Select Projects
27NewYork-PresbyterianThe University Hospital of Columbia and Cornell
Cardiac Cath & Electrophysiology Lab Turnaround Time
Cardiac Cath & Electrophysiology Lab Turnaround Time
28
Reduce turnaround time between patients in the Cardiac Cath and Electrophysiology Lab
Baseline Turnaround Times
Project GoalProject Goal
CUMC
WCMC
Cath Lab 41 min
Cath Lab 31 min EPS Lab 34 min
Cath Lab 52 min
CHONY
29
Patient Delays
Timeliness of Cardiologist Consent process Timeliness of pre-procedure preparations
Lunch Closures Patient Transport/Floor Delays Ancillary Lab Delays Scheduling Delays
Significant Factors
Significant Factors
30
Standardized phone calls Revised pre-procedure packets Implemented patient no-show protocol Shifted to block scheduling for nursing staff lunch times
Night before Inpatient Unit notification for Cath & EPS patients
Auto faxing physician report to inpatient units
“Patient on Deck” Program Consent at time of consult or 45 minutes prior to
procedure
ImprovementsImprovements
31
Campus: CUMC WCMC CHONY
Area: Cath Lab Cath Lab EPS Lab Cath Lab
Baseline Turnaround Time
41 minutes
31 minutes
34 minutes
52 minutes
Current Turnaround Time
27 minutes
23 minutes
30 minutes
27 minutes
Before & After Assessment
Successes
Successes
NewYork-PresbyterianThe University Hospital of Columbia and Cornell
Emergency Department Inpatient Admission Process
Emergency Department Inpatient Admission Process
33
Reduce patient time in ED from bed
assignment to patient exit
Baseline
Project GoalProject Goal
CUMC 179 min
WCMC 64 min
TAP 152 min
CHONY 173 min
Significant Factors Significant Factors
Transportation
Communication
Admitting Department to ED
ED RN to Floor RN
ED MD to Floor MD
ImprovementsImprovements
TransportationEarly Initiation Of Transport
CommunicationProcedures For Nursing Reports
Reorganized And Streamlined Processes
36
SuccessesSuccesses
64
22
179
121
173
100
152
49
0
20
40
60
80
100
120
140
160
180
200
WCMC CUMC CHONY TAP
BeforeAfter
Min
ute
s
37
SummarySummary
Project Benefits
Improved Patient Satisfaction Enhanced Communication Decreased Diversion Hours Decreased Walkouts Estimated $708K Incremental Revenue
NewYork-PresbyterianThe University Hospital of Columbia and Cornell
RADIOLOGY REPORT RADIOLOGY REPORT TURN AROUND TIMETURN AROUND TIME
39
Project Goal
Reduce Turn Around Time of Radiology Reports
74 hrs
49 hrs
NYP/CU
Baseline TAT
NYP/WC
40
Significant Factors
Paperwork Process Flow Communication Process to Referring
Physicians Processing Unresolved Cases
41
Improvements
Forms Distribution Process Radiologist Remote Access Auto Fax Frequency Improved Strategy for Unresolved Cases
42
74
4249
37
0
24
48
72
96
NYP/CU NYP/WC
Before After
Ho
urs
Successes
Statistically Significant Improvement at Both Campuses!Statistically Significant Improvement at Both Campuses!
43
Summary
Project Benefits
Improved Intra-Departmental
Communication Heightened Awareness Regarding
Timeliness of Reports Improved Service to Referring Physicians
NewYork-PresbyterianThe University Hospital of Columbia and Cornell
Outpatient Transplant Clinic
Exam Room Utilization
45
Project Goal
To Increase the Exam Room Utilization in the Transplant Clinics
NYP/CU
NYP/CU
Baseline Utilization Rate
40%
46
Significant Factors
Time of Day Day of Week Room Allocation Scheduling Format Provider Availability
47
Improvements
Clinic Sessions Scheduling Room Assignments Visit Duration Monitoring/Feedback Process
48
SuccessesSuccesses
40%
75%
49%
82%
46%
60%
34%
87%
39%
75%
0%
20%
40%
60%
80%
100%
Total Kidney Heart Lung Liver
Before After
Exa
m R
oo
m U
tiliz
atio
n
Statistically Significant Improvements!Statistically Significant Improvements!
49
Summary
Project Benefits
Reduced Patient Wait Time Improved Patient Access Doubled Patient Volume within Existing
Space Created Capacity for Further Growth Enhanced Patient Centered Care
50
Critical Success Factors
Focus on moving customers from satisfied to highly satisfied/delighted. Strive to enhance loyalty.
Customers expect a superior product; it is service which will delight and differentiate.
Processes which are directly linked to customers’ CTQs are rich improvement opportunities
Six Sigma is effective in identifying those attributes which are critical to quality (CTQs) from the customer’s perspective.