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Six Sigma Class Exercises
Alameda County EMS September 14 & 15, 2005
Group 1: Patient
Voice of the Customer Interpretation Critical to Quality (CTQ)
Get here fast! Quick response Response time*
Know what youre doing Competence Continual training with evaluations
Clean and Confident Professionalism Uniformity: well-groomed, uniform clean & pressed
Listen and Care Compassion Understand patient needs
Make me better Solve the problem Customer satisfaction
Is there a charge? Cost effectiveness Taxes: Effective use of taxpayer dollars
*Problem statement: Over the last six months, we received 25 complaints that we were slow to respond. Project statement: We will reduce complaints of slow response by 50% during the next quarter.
Complaints of Delayed Response
Fire Station Dispatch
People Travel
Appropriate company assigned
Rotating station closures
Call transferred
Dispatch staffing levels
Dispatcher training
Size of apartment complex
Traffic
Inclement weather
Major road construction
Knox boxes
Time of day
Alert devices
Gear on rig
Workout, sleep, shower
Equipment failure
Station layout
Personal protective equipment
Run card
Burnout
Operational readiness
Turnout policy training
District familiarization
Traffic calming devices
VOC Group 1: Patient
Cause and Effect Diagram
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2
Receipt of call to PSAP
Fire/EMScall?
ACCRECDispatch
Take EMDinformaiton
Route call
Turnouttime
Responsetime
Arrival atpatient
Transferred to Police Department
yes
no
VOC Group 1: Patient Response time flowchart
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Group 1: Causes of Delayed Responses
48
35
84
2 0.5
49%
85%
93%97%
99% 100%
0
10
20
30
40
50
60
70
80
90
"Brown outs" Locution failure Traffic calmingdevices
New mapping system Equipment failure Policies/Procedures
Contributing Factors
Perc
enta
ge
All data in the class exercises were made up by the workgroups
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4
Group 2: Medical Director
Voice of the Customer Interpretation Critical to Quality (CTQ)
Increase cardiac arrest survival rate
Competent CPR Witnessed v.fib survival rate up to 30%
Improve advanced airway success rates 95% successful
Quality shortness of breath care
Excellence in assessment; Appropriate treatment and care
Quality cardiac care
Appropriate assessment Appropriate lead interpretation Appropriate treatment Appropriate destination
Data collection analysis and procurement of outcome data from
hospital
Collect data* Accurate and timely Complete documentation and reporting
Data collection system System software, hardware and training to achieve this
*Problem statement: Over the past three months, it has been noted that 50% (PCR/bubble)
paperwork/documentation has been submitted. Project statement: Assess potential causes by process evaluation over 90 day period
Design (user friendly) Behavior Measurement system
PCR not leftat hospital
Responders
Station/Quarters Routing
Transport
Personnel
Equipment
Billing
System Status
Personnel(behavior)
VOC Group 2: Medical DirectorProblem: PCR not left at hospital
Cause and Effect Diagram
Courier
Equipment
Hospital
Available time
Turnaround time
Personnel(Triage)
Patient condition(critical)
Equipment Failure(e.g. CT Scanner)
Call/Dispatch
Personnel
System status
On Scene
QA
Training Competency Fatigue Behavior
Equipment
CAD Clocks Phone Computer
Personnel
Equipment
PatientCondition
ETA to ER
Resources
Patient condition
Available time
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5
CALL
FirstResonders Transport
On scene
Pt.condition
(time)
Transport
Hospital
Pt.condition
(time)
Station
Routing
Billing Q.A.
Complete?
Complete?
Turnaround/complete?(system status)
Available time/complete?
BEHAVIOR
DESIGN
RESOURCES
VOC Group 2: Medical Director Flowchart: Leaving PCRs at Hospital
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Group 2: PCRs Not Left at Hospital
30
2017
10
53 3
1
34%
56%
75%
87%
92%96%
99% 100%
0
10
20
30
40
50
60
70
80
90
100
TransportAgency
Hospital First Responder Enroute Station Dispatch Routing On Scene Time
Contributing Factors
Perc
enta
ge
AAll data in the class exercises were made up by the workgroups
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Group 3: Hospital
Voice of the Customer Interpretation Critical to Quality (CTQ)
Billing information* Reimburse me $ Bring insurance cards
Complete PCR No missing pertinent info (Hx, meds, allergies, treatments)
Time to complete PCR Fax access User friendly PCR
Good patient report Pertinent details Short and concise: MIVT Standardized report outline
Equipment compatibility Smooth transition & interface No time lost changing tubing, pacer pads
Equipment standardization process
Ringdown concise and timely Timely, pertinent info. so we can gather appropriate resources
Early notification with standardized report format (necessary info).
*Problem statement: Loss of 30% of billable revenue over past four months, resulting in $___ loss. Project statement: Increase billable revenue by 20% (to 90%) over the next six months, resulting
in an increase in revenue of $______.
Lost Revenue
SNF Patient
Patient Prehospital
Nurse left room
Chart AWOL
Staff language barrier
No cards
LanguageBarrier
Altered level of
consciousness
VOC Group: HospitalProblem: Lost revenue
Cause and Effect Diagram
Notavailable
Notbrought
No walletbiopsy
ForgotTo ask
No information
No family
Hospital
Non-compliantpersonnel
Patientacuity
Face sheetincomplete
Staffingpatterns
Patientload
Copier
Location Broken
Transfer of careFor transport
If no go(to hospital)
Didnt pass oninformation
Billing process
Its in the mail
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Do you have insurance?
Locate insurance
documents(bring wallet)
Prehospital field
personnel
Facilitiesclerical staff(Available?
Busy?)
Patient Interview
LOC, Age,Kaiser?
Bystander, family
provides info(Language
barrier)
Inputs (xs)
Cards brought
Copies made
Document oral/verbal info
Clerk makes face sheet
Complete billing info
= $ reimbursement
Process (f)Output (y)
Y = f(x) + f(x) + f(x)...
VOC Group 3: Hospital Factors impacting ability to get billing information
The output is a function of the inputs
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Group 3: Providing Insurance Information
30
20
1512
7 6 52
31%
52%
67%
79%
87%
93%
98%100%
0
10
20
30
40
50
60
70
80
90
100
Cards available Family Historian Communcation EMS asks Copy machine Staff Face sheetcomplete
SNF chart
Contributing Factors
Perc
enta
ge
All data in the class exercises were made up by the workgroups
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Group 4: Local Government
Voice of the Customer Interpretation Critical to Quality (CTQ)
Take too long! Quick response 4-6 minute response time 95% of the time
Cost too much! Fiscally responsible Operate within budget*
You dont care! Professional conduct Appropriate behavior and appearance Dou you know what youre doing? Competent care
Trained (initial and ongoing) Certis & qualifications
*Problem Statement: As local government, our tax base is reduced by 10%. Project Goal: Reduce operating costs by 10%
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Group 4: Local Government Brainstorming solutions (Reducing staffing costs) Mind Map graphic based on the teams outline
Group 4: Expense Reduction
40
20
105 5 5 5 5 5
40%
60%
70%75%
80%85%
90%95%
100%
0
10
20
30
40
50
60
70
80
90
100
Labo
r/Ove
rtime
Sick L
eave
Org C
hart
Fleet
Maint
.
Lost/
Stole
n/Brok
en
Offic
e Was
te
Redu
ndan
t Equ
ip.
Infreq
uentl
y Use
dOt
her
Contributing Factors
Perc
enta
ge
All data in the class exercises were made up by the workgroups
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Group 5: Employees
Voice of the Customer Interpretation Critical to Quality (CTQ)
I want quality training We want reality-based training! Evaluate training methodologies We need equipment thats right for field providers
Equipment that is lightweight, appropriate, current and works
Field test prior to purchase or deployment
I have the paperwork! PCR & forms are time intensive and repetitive Easy to complete and avoid repetition
I dont know what you want* They want clear expectations Clear documentation policy
*Problem statement: Quarterly survey reports show that 80% of employees feel expectations of
performance are unclear. Project statement: During the next survey period we will reduce this measure from 80% to less than
or equal to 20%
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Expectation(Policy)
Send to company officers for comment
Comments(Revisions)?
Finalize(Put in book)
Send out final copy to officers
Revise
Review withindividuals
Resource Person forquestions
Place instandardlocation
Resurvey
yes
no
VOC Group 5: Employees Flowchart: Development and
communication of policies
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Group 5: Poorly Understood Policies
12
10
8
6
33%
61%
83%
100%
0
2
4
6
8
10
12
14
Volume of Policies Complexity of Policy Location of Policy Poor Dissemination
Contributing Factors
Num
ber o
f Occ
urre
nces
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Perc
ent
All data in the class exercises were made up by the workgroups