USING SIX SIGMA FOR PROCESS IMPROVEMENT IN HEALTHCARE

Is 99% Good Enough?

Three hospital campuses

Six Sigma In Healthcare

380 acute care beds

110 long-term careBowling Green

Scottsville

Franklin

Full range acute & tertiary • Open Heart Surgery• Cancer Treatment• Neonatal Intensive Care• Psychiatric Services• Home Health• Emergency Medical Services• Managed Care• Primary Care Walk-in Clinics• OP Rehab Center• Physician Practices• Free Clinic • Long Term Acute Care Hospital• Health and Wellness Center

Six Sigma In Healthcare

What is Six Sigma?

Measure Measure of Quality:of Quality:Expresses how close a process or service comes to Expresses how close a process or service comes to meeting its customers’ expectation.meeting its customers’ expectation.

Method Method for Continuous Improvement:for Continuous Improvement:

Uses a rigid framework to approach process Uses a rigid framework to approach process improvement.improvement.

MindsetMindset for Culture Change:for Culture Change:When successful, Six Sigma fundamentally changes When successful, Six Sigma fundamentally changes the culture and operating philosophy of the company. the culture and operating philosophy of the company. It becomes “the way to do our job”. It becomes “the way to do our job”.

Six Sigma In Healthcare

Z or Sigma Level

Sigma Level Defect Rate Defects per Million

2 30.8% 308,5373 6.7% 66,8074 0.62% 6,2105 0.0233% 2336 0.00034% 3.4

By using the Sigma level to express how good a process is, we are able to compare dissimilar processes. Example: Radiology report turnaround time is at 2 sigma while an ambulance’s arrival on the scene is 4.3 sigma.

Is 99% Good Enough?

Six Sigma In Healthcare

99% Good (3.8 Sigma) 99.99966% Good (6 Sigma)

200,000 wrong drug 68 wrong prescriptionsprescriptions each year each year

5,000 incorrect surgical 1.7 incorrect surgical operations each week operations each week

50 newborn babies dropped One newborn baby droppedat birth each day every 2 months

Six Sigma In Healthcare

What Makes Six Sigma Different?

•Methodology is robust

• Process is measured using the customer’s specification rather than internally established thresholds

•Analysis is data driven

•Improvements are statistically valid

•Improvements are tested and proven

•Processes are controlled

•Project framework is rigid

Six Sigma In Healthcare

Culture change

• Traditional Beliefs:– Quality costs money– Inspection and rework

can capture defects– Quality of output is

enough– Control the worst case

and the average– 99% defect free is good

enough– Documentation can

control quality

• Six Sigma Beliefs:– Poor quality is extremely

expensive– Defects must be

prevented– Quality must be built into

the process (Sony TVs)– Variability is the enemy– Need to achieve 3.4

defects per million– Mistake proof to sustain

quality

Six Sigma In Healthcare

Strategic Alignmentto Driving Results & Leverage Resources

Organizational Dashboard for Success

Six Sigma In Healthcare

• Customer Satisfaction

• Quality of Service

• Efficiency

Measured by Press Ganey Scores

Measured by Timeliness (a rolled “z” score)

Measured by Operating Margin(cost per unit produced at departmental level)

Action Plan

Six Sigma In Healthcare

– Customer Service/Satisfaction Reduced Wait Times Meeting Service Expectations

– Delivered Quality of Care Reduced Medical Errors Increased Safety Use of Appropriate Technology

– At Lower Cost Increased Productivity Decreased Cost

Functional Structure

Six Sigma In Healthcare

PR

ES

IDEN

T A

ND

CEO

Hospital CEO &

Sponsor

EVP &Sponsor

EVP &Sponsor

Press Ganey Score & Target

Timeliness Z Score & Target

Cost Efficiency & Target

MasterBlack Belts

MasterBlack Belts

Brown BeltsBrown Belts

Cha

mpi

ons

& S

pons

ors

Cha

mpi

ons

& S

pons

ors

Green BeltsGreen Belts

Change AgentsChange Agents

Project Profile: Radiology Staffing Efficiency

Six Sigma In Healthcare

Baseline: .3 SigmaDPMM = 382,000

Critical X: Staff Schedule

Controlled Process:1.15 Sigma

DPMM = 125,000

Operational Problem: LaborCosts Too High in Radiology

Defect: Occurs any Time Staffing Exceeds Labor Resources RequiredFor Exam Volume

Improvements: •Staff Used CAP &

Work-out™ to Redesign Schedule

•14 Positions Eliminated•1st Yr. Savings $860,000

Six Sigma In Healthcare

Financial Returns

50%

60%

70%

80%

90%

100%

Radiology Cost Per Procedure

Senior Management’s Involvement

Six Sigma In Healthcare

•Created Vision Statement•Identified CTQs•Attended CAP/Workout Training•Attended Greenbelt Training provided by GE•“Shadowed” Greenbelt Projects•Participate in Formal Reviews by Greenbelts•Driven from “top-down”

Key Learnings

Six Sigma In Healthcare

•Commitment is Critical•Ideally From the Top•Watch for & Address the “Holdouts”

•People Selection•Best & Brightest

•Project Selection•Tied to Strategic Objectives

•Financial Results & Validation•Challenging, Challenging, Challenging

•Culture Change vs. Quality Tool