lean six sigma in healthcare · • lean/six sigma is relatively new to healthcare ... six sigma...

Lean Six Sigma in Healthcare

Lynne Hall RN, BSN

October 17, 2012

Learn. Act. Improve. Spread. Keep the Drum Beat Going. 2

Objectives

• Name several tools used in Lean Six Sigma

• Define the DMAIIC process

• Understand a “real world” example of simple LSS project

2


Introduction

• Lean/Six Sigma is relatively new to Healthcare

• Healthcare provides an excellent venue for Lean/Six Sigma

– Opportunities to improve processes

– Financial aspects – bottom line

– Able to sustain the gain

– Works well with other process improvement cycles

– Includes frontline staff input and help with data collection

3


Lean Six Sigma Overview

• GHA has adapted a Lean Six Sigma approach for Healthcare

• Not just a new way to look at process improvement

– Incorporates PDSA Cycle

– Uses DMAIIC process improvement

– Looks at

• Customer Requirements (could be department, units, floors)

• Organizational Culture

• Implementation Strategy

• Rewards and Recognition

4

Learn. Act. Improve. Spread. Keep the Drum Beat Going. © 2012 Institute of Industrial Engineers 1-5

SIPOC Project charter Voice of the Patient Process map

Measurement plan FMEA Ishikawa diagram Statistical process control Capacity analysis Pareto analysis

Lean process design FMEA Correlation studies Statistical process control Design of experiments Simulation techniques

Daily control plan Statistical process control Simulation techniques

Lean Six Sigma Process

Correlation of variables Confidence intervals Hypothesis testing Regression analysis ANOVA

Recognize the problem exists

Form Quality Improvement Teams

Define the Problem

Develop Performance

Measures

Analyze problem/

process

Determine Root Cause

Select and Implement Solution

Evaluate Solution

Ensure Permanence

Continuous

Improvement

PDCA

Define

Measure

Analyze

Improve

Control

Recognize the problem exists

Form quality improvement teams

Define the problem

Develop performance

measures

Analyze problem/

process

Determine root cause

Select and implement solution

Evaluate solution

Ensure permanence

Continuous

improvement

PDSA

Define

Measure

Analyze

Improve Implement

Control

Lean Six Sigma



• Recognize That Variation Exists

• Identify What the Customer Wants and Needs

• Use a Problem-Solving Methodology

• Follow the DMAIC Model

• Monitor the Process

• Update Best Practices and Lessons Learned

• Celebrate Success

• Sustain the gain!!

1-6



• Six Sigma incorporates more tools that help define and

improve the process

– Spaghetti Diagrams

– DMAIC Process

– Statistical Tools

– Value Stream Mapping

– Waste, Non-Value Added

– Speed, Cycle Time

– Standardization

– And so much more!!

7


Six Sigma Project

CMS charged Hospital Engagement Networks (HEN) with

reducing Early Elective Deliveries (EED)

• Using a Lean Six Sigma Approach the GA HEN

• Decreased EED by 90%

• Saved over 1 million dollars!!

8


Six Sigma Project (DMAIIC)

• Define – CMS defined the problem to be addressed – Decrease

Early Elective Deliveries

– High risk for infant born between 37 and 39 weeks

– Action Group developed with partners to discuss plan of action to

decrease the overall rate of EED’s and charter developed

– Looked at baseline data 2009 and 2010 (65% and 57% respectively)

– Held an in-person meeting with hospitals to be engaged in reducing

EED’s

9



• Measure – Looked at possible measures to help reduce EED

– Meeting with small group of hospitals and measures were decided on

using JC-PC-01 (process) and 5 minute Apgar Scores (outcome)

– Starting in May 2012 telnet meetings were held every 3 weeks

– Education included

• Hard stops

• Bundles

• Physician and staff buy-in

• Community education

• Staff empowerment

• Hospital highlights

11



• Analyze –Initial data collection revealed a correlation between

physician buy-in, staff empowerment, and success in decrease

of EED

– Hospitals who were successful in reducing EED’s had “hard” stops in

place

– Physicians who wanted to induce or schedule a cesarean section and did

not have a pre-determined medical condition for the patient were sent to

peer review or the staff had the power to say no

– Data also revealed a need for community education as well

– By decreasing EED’s waste is cut out

12



• Improve/Implement – “hard stops”, induction bundles, and

policies and procedures were put into place

– Improvement in reduction of EED’s was noticed

– Education continued on Physician Buy-in, staff empowerment, and

community education

– Hospitals continued to submit data

– Resource page was developed on the GA HEN website with best

practice policies and procedures to share from hospital to hospital

13



• Control – we are currently in the control phase in sustaining the

gain the hospitals have made

– Continued with data submissions

– Encouraged hospitals to submit data to monitor continued progress

– Hospitals shared their journey to zero

– Run charts developed globally and hospital specific

14


Six Sigma Project (Data Results)

15


Six Sigma Project (Data Results)

16


The Results 3

• According to Managed Care Magazine it costs around $41,000

for a late preterm NICU visit

• The incidents went from 147 incidents in March 2012 to just

34 in August 2012

• That’s a decrease of 113 incidents

• If even a ¼ of the babies went to NICU, we saved Georgia

Healthcare $1,158,250

OVER 1 MILLION Dollars!!


Conclusion

• This was a simple six sigma design

– Defined the process

– Measured baseline data

– Analyzed the data

– Implemented and Improved the new process

– Now sustaining the gain

• Six Sigma in Healthcare does not have to be complicated AND

the financial and practical gains are well worth it

18

Questions??

19

lean six sigma in healthcare · • lean/six sigma is relatively new to healthcare ... six sigma...

Documents