performance improvement the lean six sigma way
DESCRIPTION
Charleston Area Medical Center 7,000 employees 800 physicians Highest level newborn & pediatric ICU’s Level 1 Trauma Center WV only free standing women and children’s hospital Annual community benefit more than $115 millionTRANSCRIPT
PERFORMANCE IMPROVEMENT THE LEAN SIX SIGMA WAY
Karen Miller, RN, BSN, MBALean Six Sigma Master Black Belt
Charleston Area Medical Center• 7,000 employees• 800 physicians• Highest level newborn & pediatric ICU’s• Level 1 Trauma Center• WV only free standing women and
children’s hospital• Annual community benefit more than
$115 million
Objectives• Understand how six sigma methodology & lean
pinciples are used for continuous improvement• Learn how using continuous improvement
methodologies affect Value Based Purchasing (VBP) reimbursement
• Learn how the process can prevent readmissions within 30 days for targeted patient population of CHF, Pneumonia, and COPD
• Understand how to link process improvements with financial benefits
What is Six Sigma?Measure of QualityStatistical measure that expresses how close a service comes to its quality goal
Process for Continuous Improvement Follow DMAIC methodology to identify how root cause factors impact outcomes and results
Enabler for Culture ChangeAim to be nearly flawless in executing our key processes with customer focus.
Six Sigma Methodology DMAIC: To improve any existing product or process
Define Measure Analyze Improve Control
Who are the customers and what are their priorities?
How is the process performing and how is it measured?
What are the most important causes of the defects?
How do we remove the causes of the defects?
How can we maintain the improvements?
Six Sigma Methodology ExampleSix Sigma Methodology Example
Example: Angioplasty Balloon Inflation
Define the ProblemDefine the Problem
Doctors are Doctors are expecting 2.5 mm, expecting 2.5 mm, but will allow some but will allow some variation within the variation within the
upper & lower upper & lower specifications. specifications.
10% of patients 10% of patients have a repeat have a repeat
angioplasty within 3 angioplasty within 3 months, which months, which
exceeds the national exceeds the national average of 5% average of 5%
UpperSpecification
Limit
Lower Specification
Limit
Target
2.5 mm
No Less Than
2.25mm
No More Than
2.75mm
Measure to See if Meeting SpecificationsMeasure to See if Meeting Specifications
UpperSpecification
Limit
No Less Than
2.25mm
Lower Specification
Limit
No More Than
2.75mm
Extruded BalloonExtruded BalloonInflation data plotted Inflation data plotted
ininActual MicrometersActual Micrometers
MeasurementsMeasurements
Measure the Data & Determine DefectsMeasure the Data & Determine Defects
Variation in the Variation in the process caused data process caused data
points outside the points outside the specification limits specification limits
(Defects). (Defects).
UpperSpecification
Limit
No Less Than
2.25mm
Lower Specification
Limit
No More Than
2.75mm
DefectDefect
Current inflation rate within spec
limits is 80%
Analyze the Data Using StatisticsAnalyze the Data Using Statistics
Basic StatisticsBasic Statistics
Mean Inflation = 2.50mm
St. Deviation = 0.125mm
UpperSpecification
Limit
Lower Specification
Limit
Mean
2.50mm
Standard Deviation
0.125mm
On Average it’s OK - it’s a Variation issue
Improve the Process by Identifying the Improve the Process by Identifying the Key Variables (Root Causes)Key Variables (Root Causes)
Reducing Variation is Reducing Variation is the Key to Improvingthe Key to ImprovingProcess CapabilityProcess Capability
UpperSpecification
Limit
Lower Specification
Limit
Std Dev
Spec Width
220.5 mm
0.125 mm
2.25mm 2.75mm
2.5mm
0.25mm0.25mm
Improve the Process by Implementing Improve the Process by Implementing Solutions to Control the Key VariablesSolutions to Control the Key Variables
UpperSpecification
Limit
Lower Specification
LimitReducing Variation is Reducing Variation is the Key to Improvingthe Key to ImprovingProcess CapabilityProcess Capability
Std Dev
Spec Width
330.5 mm
0.083 mm
Improve the Process by Implementing Improve the Process by Implementing Solutions to Control the Key VariablesSolutions to Control the Key Variables
UpperSpecification
Limit
Lower Specification
LimitReducing Variation is Reducing Variation is the Key to Improvingthe Key to ImprovingProcess CapabilityProcess Capability
Std Dev
Spec Width
440.5 mm
0.062 mm
Improve the Average and Improve the Average and Reduce the VariationReduce the Variation
UpperSpecification
Limit
Lower Specification
LimitReducing Variation is the Reducing Variation is the
Key to ImprovingKey to ImprovingProcess CapabilityProcess Capability
Std Dev
Spec Width
550.5 mm
0.05 mm
Improve the Process by Implementing Mistake Improve the Process by Implementing Mistake Proofing Solutions to Control the Key VariablesProofing Solutions to Control the Key Variables
UpperSpecification
Limit
Lower Specification
Limit
Reducing Variation is Reducing Variation is Clearly the Key to Clearly the Key to
ImprovingImprovingProcess CapabilityProcess Capability
Std Dev
Spec Width
660.5 mm
0.041 mm
Defect Production is significantly reduced - but by how much?
Sustain the Improvement
UpperSpecification
Limit
Lower Specification
Limit
Spec Standard Sigma DPMO %Width Deviation Level In Spec
0.5 0.125 2 308,538 69.15
66
0.5 0.083 3 66,807 93.32
0.5 0.062 4 6,210 99.38 0.5 0.05 5 233 99.98
0.5 0.041 6 3.4 99.99966
Monitor improvements by capturing data and displaying on graphs or tables to ensure goal continues to be met and investigate defects
Understanding Six SigmaUnderstanding Six Sigma
Business Strategy : An overall strategy that encompasses your hospital’s quality philosophy. It sets the vision for achieving Six Sigma levels of quality in key processes and services.
Tools and Tactics: A set of statistical tools and a disciplined methodology used by specially trained individuals to improve processes by reducing variation and defects.
Goal
Six Sigma refers to a process that produces only 3.4 defects per million opportunities
2 308,5373 66,8074 6,2105 2336 3.4
Sigma DPMO StatisticallyMost U.S. Businesses
3,660 Patients With Misplaced Personal
Items Every Day
340 Patients With Misplaced Personal
Items Every Day
12 Patients With Misplaced Personal
Items Every Day
6 Patients With Misplaced Personal Items Every Month
770 Coding Errors Every Day Require
Correction
72 Coding Errors Every Day Require
Correction
13 Coding Errors Every Week
Require Correction
During The Year, Only 10 Coding Errors
Require Correction
257 Calls Each Day Exceed The Two
Minute On-Hold Time
24 Calls Each Day Exceed The Two
Minute On-Hold Time
5 Calls Each Week Exceed The Two
Minute On-Hold Time
During The Year, 3 Calls Exceed The Two Minute On-Hold Time
66,800
6,210
230
3.4
93.32000%
99.3490%
99.97700%
99.99966%
3
4
5
6
SigmaPatient Billing
Errors Coding
Processing Scheduling Time DPMO % Yield
Sometimes 99% is just not good enough
Processes needs to be Better than you think!Processes needs to be Better than you think!
Lean is…The relentless pursuit of waste
Why Reduce Waste?Make Work: Safer, Faster, Cheaper, Easier
Lean vs. Six Sigma
• Six Sigma = Use of statistical tools to reduce VARIATION in a process.
• Lean = Use of basic change management tools to reduce WASTE in a process.
Types of WasteDefects Medication errors, wrong patients, wrong procedure, redraws, missing or
inaccurate information, no hot water
Over Production Standing orders that outlast patient needs, tests or procedures beyond requirements, duplicate documentation
Waiting Waiting for supplies, instruments, information, test results, instructions, tools, materials, resources
Not Using People’s K/S Under utilization of human resources. Failing to incorporate staff suggestions or ensure internal best practices are shared by all
Transportation Conveying patients, supplies, or materials from one area to another.
Inventory Pharmacy stock, lab supplies, materials & supplies in store rooms, patients in holding areas, discharged patients in beds
Motion Excessive reaching, bending, twisting, walking, etc. while attempting to complete a task
Excess Processing Multiple bed moves, redundant or unnecessary paperwork, multiple approval signatures
Foundational Lean Tools/Concepts5S Workplace Organization
A place for everything and everything in its place1. Sort2. Set in Order3. Shine4. Standardize5. Sustain
Visual ManagementInstantly identify “normal” vs. “abnormal” conditions
StandardizationReliable, repeatable results
Problem SolvingHidden problems now revealed; staff engaged in structured approach to
identify, address, and permanently eliminate root causes or problems.Human Centered Work
Creating a culture for patient centered care, best place to refer patients, best place to work, etc.
1S) Sort: Red Tagging Excess Inventory of Forms
2S) Set in Order & 3S) Shine
4S) Standardize Process
Each form has a number and arrow pointing you which direction to flow to build the chart.
5S) Sustain: Re-order card placed
Prevent excess inventory (waste)Layered audits by management to ensure sustainment
• 17 separate readmission initiatives/projects • Specific patient population data is extracted using
Healthcare Intelligence• Patient specific population discharge call scripts developed• Automated discharge calls• Patient responses to specific questions triggers a call from a
Transitions Coach• Readmissions tracked with reason for admission
Patient Population Management
Award Winning QualityAward Winning Quality
Source Data - Comparion Medical Analytics
Award Winning Quality Award Winning Quality PlusPlus Financial BenefitsFinancial Benefits
Finance Validated Cumulative Savings = $172,826,596FY 2015 Savings = $ 15,971,216
Healthgrades Distinguished Hospital Award: 2014 & 2015
5 Star Ratings: •Coronary Intervention•Neurosurgery•Hip Replacement•Prostate Removal Surgery•COPD•Pneumonia•Stroke•Heart Attack•Heart Failure•Pulmonary Embolism•Sepsis•Esophageal/Stomach Surgeries•Colorectal Surgeries
Questions?