Six Sigma Method for QI & PI

MHS 665

William C. Brannan, MD

Classic Componentsof Quality

0

2

4

6

8

10

12

Outcomes CustomerSatisfaction

Cost ProcessImprovement

Institute of Medicine’s New Components of QI

0 2 4 6 8 10 12

Equity

Efficiency

Timeliness

Patient Centered

Effective

Safety

Relationship of Classic & New Components of Quality

Not one or the otherNot competitiveThey are to complement each otherThey form the matrix or fabric for

Quality Management (QM) in either Quality Assessment (QA) or Quality Improvement (QI)

The Fabric of QI

Safety

Effective

Pt. Centered

Timeliness

Efficiency

Equity

Outcomes Customer Cost Process

Satisfaction Improve

History of Six Sigma

Developed by Motorola & General Motors in mid-1980’s

Data-driven quality methodologySeeks to eliminate variation (and its

associated costs) from a process

Sigma Levels

Sigma Defects Per Million

Opportunities (DPMO)

1 690,000

2 308,537

3 66,807

4 6,210

5 233

6 3.4

Sigma Comparisonof Industries

0

1

10

100

1,000

10,000

100,000

1,000,000

1 2 3 4 5 6

IRS Advice

Acute Back Pain

Post-MI Meds

Mammography

Abx Overuse

IP Med Errors

Airline Baggage

Px Hosp Deaths

Prescriptions

Surg Instr Left

Anesthesia

Airline Fatality

What is Six Sigma?

A process must not produce more than 3.4 defects per million opportunities.

In Healthcare it means not more than 3.4 medication errors in 1 million doses.

Not more than 3.4 foreign bodies left in patient during 1 million surgeries.

Not more than 3.4 no shows per 1 million appointments.

The Six Sigma Cycle

Define Training Implementationobjectives, Designate Black Belts. Develop

set goals Train SS methodology. Projects

Involve organization-

wide projects. Define

Staff advancement Measure

in SS Analyze

Continue training Improve

new staff Control

Continue identifying

new projects

Key Six Sigma Roles

CEO

Champion

Master Black Belts

Black Belts * Experts * Guides

Green Belts

Central Components - Existing

DefineMeasureAnalyzeImproveControl

Central Components - New

DefineMeasureAnalyzeDesignVerify

Define

What is the business case for this project?

Current state map vs future state map.What is the project’s scope?Due date determined.

Measure

What are the metrics for this process?Are they valid and reliable?How will I measure progress?How will I measure success?

Analyze

Can the process be improved?Who will help make the changes?What resources are required?What could cause this change effort to

fail?

Improve

What is the work breakdown structure?What specific activities are necessary to

meet project goals?How will I reintegrate various

subprojects?

Control

How will I control quality, cost, schedule, scope and changes to the plan?

How will I ensure that the business goals of the project were accomplished?

How will I keep the gains I made?

Implementation Step 1

Begin with senior leaders. Train them in the principles and tools.Direct the management infrastructure.Cultivate the environment for innovation

and creativity.Reduce organizational hierarchy.Remove barriers to experimentation and

change.

Implementation Step 2

Develop external quality measures.Communicate with patients, employees,

stakeholders and suppliers.Develop rigorous methods to obtain inputConduct baseline studies of starting point. Identify cultural, policy and procedural

obstacles to change.

Implementation Step 3

Rigorously assess and conduct top-to-bottom training in systems-improvement tools, techniques and philosophies.

Implementation Step 4

Develop a framework for continuous process improvement.

Monitor progress and success.Metrics should focus on strategic goals,

drivers and key business processes.

Implementation Step 5

Managers & staff with intimate process knowledge at all levels of the organization choose processes for improvement.

Improve business performance linked to measurable financial results.

Implementation Step 6

Individual employees and teams, led by Green Belts, conduct Six Sigma projects.

Medical Error Reductions

Reducing patient fallsReducing ADE’s from medicationsReducing ordering & administration

errorsImproving turnaround time for pharmacy

orders

Business Operations

Improving revenue cycleImproving nurse or pharmacy technician

recruitmentImproving employee retentionIncreasing OR throughput

Patient Case Management

Decreasing stroke patient LOSDecreasing CHF LOSReducing lost MRI filmsImproving MRI exam schedulingReducing emergency department

diversions

Patient Satisfaction

Reducing ED wait timesImproving patient satisfaction in ED

WEB SITE

www.isixsigma.com

Six Sigma @ Mission

CEOChampionMaster Black BeltBlack BeltsGreen Belts

DMAIC

Bob BurginBill BrannanTom KnoebberPI ConsultantsCollaborative

Practice TeamFOCUS-PDCA

QI Process @ Mission

V ice-P res id en t o f Q u a lity C h ie f M ed ica l O ffice r

Q u a lity C om m ittee o f S ervice L in e

S ervice L in e

P I D irec to r

O p era tion s L ead ersh ip Team

M ed ica l A d m in is tra tive C om m ittee

B oard Q u a lity C om m ittee