how lean and six sigma can improve healthcare
TRANSCRIPT
How Lean and Six Sigma Can
Improve Healthcare Safety and
Predictability, and Reduce Costs
Eddie Pérez-Ruberté, CSSBB
Senior Lean Specialist
BayCare Health System
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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
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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
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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
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$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)
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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
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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
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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
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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
.