successfully applying six sigma in a healthcare organization

Successfully Applying Successfully Applying Six Sigma in a Six Sigma in a

Healthcare OrganizationHealthcare Organization

Rick Beaver

VP-Quality

Heritage Valley Health System

Sewickley/Beaver, PA

SSCSSCSix Sigma

Connectionsfor Healthcare

SSCSSCSix Sigma Connectionsfor Healthcare

• Understand Integration of Six Sigma into an Organization for 1st Year Profitability

• Identify Areas of Business Application for Six Sigma

• Discuss Examples of Project Outcomes• Identify Various Options for Six Sigma

Implementation

Presentation Objectives

UnderstandiUnderstanding Six Sigma ng Six Sigma Integration Integration

and and ProfitabilityProfitability

Education and Alignment of Senior

Leadership

Understanding Six Understanding Six Sigma Integration and Sigma Integration and

ProfitabilityProfitability• Identification of Key Stakeholders

– Senior Management Team• For organization success, senior

leadership support is needed• If you want Six Sigma to live beyond one

person, group or project, senior leadership support is needed




Education and Alignment of Senior Leadership

Board Members and Physician Leader Retreat



– Board Members and Physician Leaders• Addresses global needs of the organization• Unified commitment• Common language




Leadership


Operations Leaders and Physicians Provided Awareness

Training



– Operations Leaders and Physicians• Physicians Relate to the Metric Component of Six

Sigma• Sets the awareness of operations and physicians

to understand the path set by the organization• Provides an awareness to operations and

physicians of how students are approaching projects





Leadership


Operations Leaders and Physicians Provided Awareness Training

Project Selection Aligned with Org Goals


ProfitabilityProfitability• Alignment of Projects to Strategic

Imperatives of Organization– Provides a balanced project portfolio– Ensures support of all aspects of the organization

(IT, HR, $, Q, Growth)– Allows incorporation of a specific project set in

the mix– Project selection is a data driven approach, using

FMEA methods and prioritization


Project Selection via Project Selection via FMEAFMEA

Impact on Imperative Finance Quality HR IT GrowthVery High Positive Impact > $750 = 1.00 1.00 1.00 1.00 1.00High Positive Impact $500-$750 = .75 0.75 0.75 0.75 0.75Medium Positive Impact $250-$500 = .50 0.50 0.50 0.50 0.50Low Positive Impact $100-$250 = .25 0.25 0.25 0.25 0.25Very Low Positive Impact < $100 = .10 0.10 0.10 0.10 0.10

ProjectsCardiology Business Deployment 1.00 1.00 0.75 0.75 1.00 4.5

Phys Office EMR 0.75 1.00 0.75 1.00 1.00 4.5

TMC Registration 1.00 1.00 0.50 1.00 0.75 4.25

E/R Business Deployment 0.50 1.00 0.75 0.75 1.00 4

Regional Cancer Center Evaluation 1.00 1.00 0.50 0.50 1.00 4

Improve Customer Satisfaction (needs scoped) 0.10 1.00 1.00 0.50 1.00 3.6

Revenue Capture (1% improvement) 1.00 0.50 0.75 0.75 0.10 3.1

Nursing Overtime 1.00 0.75 1.00 0.10 0.25 3.1

Retail Rx at TMC 0.25 1 1 0.1 0.75 3.1

Reduce FMLA/Missed Days Due to Injury 1.00 0.75 1.00 0.10 0.10 2.95

E.D. Physicians to Private 0.75 0.75 0.50 0.10 0.75 2.85

Human Resources - Payroll 0.25 0.75 0.75 1.00 0.10 2.85

Inventory Management (Fixed & Non) 1.00 0.25 0.50 1.00 0.10 2.85

Family Practice Relocation 0.75 0.75 0.75 0.1 0.5 2.85

Retinal Surgery 0.10 1.00 0.50 0.10 1.00 2.7

Medical Ambulatory Unit 0.25 1 0.75 0.1 0.5 2.6

Robotic Rx 0.25 1 0.25 0.75 0.25 2.5

Child Psychiatry 0.1 1 0.25 0.1 1 2.45

Criterion Value Scores




Leadership




Project Assignment Prior to Class


ProfitabilityProfitability• Project Assignments Prior to Start of Classes


–“If What We Teach Today If What We Teach Today Can’t Be Applied Tomorrow Can’t Be Applied Tomorrow on the Floor, the Training is on the Floor, the Training is Not Fully Effective”Not Fully Effective”

–Students arrive at class day 1 with a specific project and timeline defined–When student leaves class, work starts as soon as they hit the operations floor




Leadership




Project Assignment Prior to Class

Students Aligned with Champions

Black Belt Training


ProfitabilityProfitability• Champion / Student Alignment is

Critical– Both the student AND champion are

responsible for project outcome– Champion ensures use of tools and metrics– Champion helps to break barriers to success– Champion participates in every student

presentation SSCSSCSix Sigma Connectionsfor Healthcare

Champions Support Champions Support Students During ClassStudents During Class


Six Sigma Implementation

Time Line

Feb 1 Aug 20 Aug 22 Sept 30

Project Idea BankDeveloped

1st Wave of

Students Trained

July 03

1st Set Of Projects

Run to Completion

6 Sigma Champion

Training

Nov 1

Oct 4

2002 2003

Leadership Web

Seminars

Board of Directors and Physician Leadership

Training

Physician and Resident Training Program

Developed

Student SelectionSenior Leader

Awareness

Where Can Six Sigma Be Where Can Six Sigma Be Applied in the Organization?Applied in the Organization?

• There are no limitations to its application if Six Sigma is

going to be “a way of doing a way of doing business”business”

Examples of Six Sigma Applications

HR (OT Reduction, FMLA Management, Staff Retention)

Maintenance (Work Order Turn Around Time, Mean Time Between Failure for Clinical Equipment, Clinical Alarms)

ED Design/Construction (Selection of Design/Architectural firms, Selection of fund raising company)

Process Projects to Support ED Pre-Design (Door to Doc, Registration, ED Radiology, Bed Clean

Cycle, Lab Turn-Around-Time)

Examples of Project Outcomes

17:1 Return on $260,000 Investment

Control Chart - HF Discharge Instructions

UCL=44.587

LCL=12.1

CEN=28.344

UCL=56.546

LCL=40.32

CEN=48.433

UCL=99.608

LCL=66.092

CEN=82.85

0

20

40

60

80

100

120

Jul-02

Aug-02

Sep-02

Oct-02

Nov-02

Dec-02

Jan-03

Feb-03

Mar-03

Apr-03

May-03

Jun-03

Jul-03

Aug-03

Sep-03

Oct-03

Nov-03

Dec-03

Jan-04

Feb-04

Mar-04

Apr-04

May-04

Heart Failure Patients Given Education

Baseline Data:Mean = 28.344Sigma Capability = <1.0DPM=723360

First Process Change Data:Mean = 48.433Sigma Capability = <1.5DPM = 481000

PROCESS CHANGE•FMEA completed by two nursing groups Jan-03.•Heart Failure Program nurses education in proper documentation Feb-03. •Education of nursing Apr-03 and Nov-03.•Pilot of Heart Failure Discharge Summary form which included HF specific information May-03.•System wide implementation of new forms Nov-03.•Follow-up with individual nurses regarding their documentation if not in compliance Nov-03.•Informational laminated pocket cards given to all cardiac nurses.•Communicate updates in newsletters and staff meetings - ongoing.

Control DataMean = 82.85Sigma Capacity = ~2.5DPM = 165676

PROCESS CHANGE•Case managers began to use HF Case Management tool to monitor HF indicators Apr-04

SVH EngineeringWork Order Turn-Around Time

Control Chart

UCL=38.106

LCL=0.0

CEN=18.026 UCL=6.9689

LCL=0.0

CEN=3.2965

0

10

20

30

40

50

60

70

80

Baseline Data (Prior to implementation ofSix Sigma Process Improvements)

Sigma Capability: 2.25DPM: 225,463

Mean: 4.70 Days

Control Phase - Month 1 Data


Mean: 1.05 Days



Mean: 1.22 Days



Mean: 1.08 Days

Maintenance Department

Work Order Turn-Around Time

6σEngineering Six Sigma Team

Control Chart

0%1%2%3%4%5%6%7%8%

0 2 / 09 -

0 2 / 2 2

0 2 / 23 -

0 3 / 0 9

0 3 / 10 -

0 3 / 2 2

0 7 / 13 -

0 7 / 2 6

0 7 / 2 7 -

0 8 / 0 9

0 8 / 10 -

0 8 / 23

0 8 / 2 4 -

0 9 / 06

0 9 / 0 7 -

0 9 / 20

0 9 / 2 1-

10 / 0 4

G o a l2 . 5 %

C e n s u s - 2 4

C e n s u s - 2 5

C e n s u s - 2 3

C e n s u s - 1 9

C e n s u s - 2 0

C e n s u s - 2 1

C e n s u s - 1 9

C e n s u s - 2 4

C e n s u s - 2 1

N u r s i n g : % O T H o u r s P a i d o n 7 W

P a y p e r i o d d a t e s

$ 5 4 , 5 3 6 . 5 8P a i d i n O T $ $A v e r a g e C e n s u s - 1 4 4

$ 2 3 , 8 7 1 . 6 5P a i d i n O T $ $

A v e r a g e C e n s u s - 1 3 1

Cataract Surgery Surgeons Supported Project by:

• Discussing Technique Differences for Eye Anesthesia

• Pre-Scripting Medications

• Eliminated Pre-Admission Testing on Topical Anesthesia Cases

• Common Supplies Accepted

• Types of Ophthalmic Solutions

• Keratomes and Knife Preferences

• Drapes

• Custom Packs

• Lens Supplier

Improved Profit Margin: from –16% to +7%Improved Customer Satisfaction: to Over 90%

44% Variation in Supply Cost

Options for Implementation

• Definitions:– Pilot Scale 1 or 2 Projects– Large Scale 10 to 30+ Projects

• Risks/Benefits of a Pilot Scale Approach– Risks:

• Possible incorrect conclusion of Six Sigma if project/student selection is not well done (i.e., 1 of 2 projects not fully successful)

• Support for the project is not readily available because the organization is not properly informed of the effort

– Benefits: • Short time horizon• Reduced investment up front

Risks/Benefits of a “Large Scale” Approach

• Risks: – Larger investment up front– Involving Board, Senior management and physician

leaders may be problematic in some organizations

• Benefits:– Provides a true evaluation of the six sigma deployment– Mitigates failure due to poor project/student selection– Optimizes financial returns of the deployment– Assures alignment of projects with needs of the

organization – Promotes the long term success of six sigma

Sustaining the Six Sigma Effort for the

Long Term• Incorporate Six Sigma in Internal

MBA or Continuing Education Program– Train the organization; change the culture– A strategy that embraces employee turnover

• Create a structure around Six Sigma– Regular agenda items for operations meetings– Include in monthly newsletters– Poster presentations placed in strategic areas

of the hospital

Are Partnerships with Six Sigma Organizations

Worthwhile?• Partnerships can facilitate deployment and

reduce initial costs • Benefits of leveraging the experience of a

partner:– Project Leader interaction between organizations– Shared learnings– Prevents redundancy

• Example: Partner adopted a project on nursing overtime in their organization for $100,000 annual gain

Summary• Profitability can be achieved in first years

of Six Sigma implementation by:– Achieving organization awareness and support

prior to start of training– Diligent selection of projects and students– Alignment of students with champions– Identification of project set balanced across

company imperatives– Partner with organization experienced in Six

Sigma methodology with demonstrated success


Questions?SSCSSCSix Sigma Six Sigma

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SixSigmaConnections.org

successfully applying six sigma in a healthcare organization

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