Lean Six Sigma in Healthcare

Today and Tomorrow

K.Kanimozhi,M.Sc(N), M.Sc(Psy)Sister Tutor

College of nursingJIPMER, Puducherry

Saturday,19.04.2012

What the organization wants•Available and prompt care

•Better patient outcomes

•Increased patient satisfaction

•Improved financial viability

•Improved publicly reported information

•Higher employee involvement and satisfaction

Quality

care

What do our Patients need?

• Favorable patient outcomes• Patient safety• Implement new procedures

and capabilities• Slow rising healthcare costs

Quality

care

The high cost of poor quality• Along with human suffering, treating medical errors

such as hospital-acquired infections come with a high

financial cost.

• Roughly 1 in 10 Americans will acquire an infection as

a result of their hospital stay, and this stay will be

lengthened in order to provide appropriate treatment.

Change is imperative!

How to improve quality of care?

Hospitals must also redesign processes and address the human side of change.

Technology alone isn’t the answer…

Kano Model

Noriaki Kano

– Professor at Tokyo Rika University

– Developed foundation for “Attractive Quality

Creation” commonly referred to as the “Kano

Model”

(or)

– Satisfaction model

Key Elements

• Identify the Voice of the Customer

• Translate Voice of the Customer into Critical to

Quality Characteristics (CTQs)

• Rank the CTQs into three categories:

– Dissatisfier - Must be’s – Cost of Entry

– Satisfier – More is better – Competitive

– Delighter – Latent Need – Differentiator

Kano Model

DelightersExcited Quality

DissatisfierMust-be

Expected Quality

“Didn’t know I wanted it but I

like it.”

“Cannot increase my satisfaction, but

can decrease.”

Dissatisfaction

Satisfaction

Service Performance

Service Performance

SatisfierOne DimensionalDesired Quality

QUALITY OF CARE

STANDARDS(BENCHMARK)

METHODOLOGY (PROCESS)

LEAN SIX SIGMA

What is Lean Six Sigma?How does it apply in Healthcare?

What is Lean?

• Originated within Toyota in 1950’s• Its use focuses on elimination of Waste• Enhancing ‘Value-Added’ operations• A method to reduce complexity and

improve process flow

• We Spend 75-95% of Our Time Doing Things

That Increase Our Costs and Create No Value

for the Customer!

• Wastes make the organization slow,

inefficient and uncompetitive

Lean in healthcare In healthcare, Lean is about shortening

the time between the patient entering and

leaving a care facility by eliminating all

non-value added time, motion, and steps.

Lean in Healthcare

Includes a variety of improvement tools:•8 kinds of waste•Flowcharting or process mapping

•5 ‘s’

8 Kinds of waste

INVENTORY unneeded

stock or supplies

MOTION movement

of staff

OVER PRODUCTION unnecessary

tests (procedure >

demand)

OVER PROCESSING filling out

extra paperwork

TRANSPORTATION

movement of patients or equipment

REWORK/ CORRECTION

(DEFECTS) paperwork, med errors,

error in reporting or

surgery

WAITING delays in

diagnosis and treatment (universal

waste)

UNUSED CREATIVITY

People knowledge and skills that are not utilized by

the organisation.

The continuous movement of products, services and information from end to end through the process

Define value from the customer’s perspective

customer signals the need

The complete elimination of waste so all activities create value for the customer

2 Map the

Value Stream

3Establish

Flow

4Implement

Pull

5Work to

Perfection

1Specify Value

Map all of the steps…value added & non-value added

What are your customers willing to pay for?

Lean Thinking Process

The 5 steps to Lean Thinking …

How does the customer view my process?What does the customer look at to measure

performance?

Time to Park Car

Registration

Walk to Procedure

Area

Procedure Time

Time to drive to facility

Hospital’s Viewof “Registration”

Patient’s Viewof “Registration”

FLOWCHARTING OR PROCESS MAPPING

Lobby Time

5S Workplace Organization

Before 5S

S1: Sort

Needed

Create Visual Workplace-S2: Set In Order-S3: Shine -S4: Simplify & standardize (Red Tagged)

Remove fromWorkplace

Discard aftera defined time

Not Needed

After 5S

-S5: Sustain A place for everything and everything in its place

Nurses station before 5S

Sort and Set in Order

Shine (Clean)

After - Sustain

BEFORE AFTER

Storeroom before & after color coding

Rehab Standard Room Layout

Standardized room layout will aid staff as they care for patients and reduce room turnaround time

What is a Lean Hospital?

It all works together without waste

Physicians

Cath LabSurgery

HousekeepingED

Radiology

Lab

Staff

Pharmacy

Food Service

Nursing Units

Advantages of Lean Six Sigma• Improved patient care, safety, and

satisfaction• Improved quality• Increased revenue • Better employee satisfaction• Improving patient outcomes• Transforming the economy with science and technology

Six Sigma in Healthcare: A prescription for change?

Where did Six Sigma Come From?

• Initially developed at Motorola

in the 1980s to improve

processes, meet customer

expectations and maintain

market leadership• It is a true management

system

What is Six Sigma?

• seeks to identify and remove the causes of

defects and errors in manufacturing and/or

service delivery and business processes.

Defect: Failing to deliver

what the customer wants

What does Six Sigma mean?The term “Sigma” is a measurement of how

far a given process deviates from perfection –

a measure of the number of “defects”.

Six Sigma correlates to just 3.4 defects per

million opportunities.

The fundamental objective is focusing on

process improvement and variation

reduction.

23

456

308,537

66,807

6,2102333.4

ZB DPMO

Target CustomerSpecificatio

n

3s 3s 6.6% Defects

BEFORE

w i d e v a r i a n c e

Six Sigma illustrated

No Defects 6sAFTER

slim variance

Target CustomerSpecificatio

n

6s

Patients don’t feel the averages, they feel the variability

GoalSix 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 Level

Statistically...DPMO

~93.3% “Good”

99.99966% “Good”

How good are we today?

The Classical View of Quality

“99% Good” (Z = 3.8s)

The Six Sigma View of Quality

“99.99966% Good” (Z = 6s)

One hour without electricity every 34 years

68 wrong drug prescriptions each year

No electricity for almost 7 hours each month

200,000 wrong drug prescriptions each year

5,000 incorrect surgical operations per week

1.7 incorrect surgical operations per week

One minute of unsafe drinking water every seven months

Unsafe drinking water almost 15 minutes each day

How good do we need to be?

99% just isn’t good enough

By applying Six Sigma tools:

To reduce variation

Hypothesis testing Regression

CTQ Tree

Design of ExperimentsVOC

How do we do it?

Key roles and responsibilities

Team Members: Individuals who receive specific Six Sigma training and who support projects in their areas

Champions/Sponsors: Trained business leaders who lead the deployment of Six Sigma in a significant business area

Black Belts: Fully-trained Six Sigma experts who lead improvement teams, work projects across the business and mentor Green Belts

Green Belts: Fully-trained individuals who apply Six Sigma skills to projects in their job areas

Master Black Belts: Fully-trained quality leaders responsible for Six Sigma strategy, training, mentoring, deployment and results

• use of two Six Sigma sub-methodologies:

DMAIC and DMADV.

Six Sigma DMAIC process

• is an improvement system for existing

processes falling below specification and

looking for incremental improvement.

How do we do it?

Define CTQs

Statistical Problem

Practical Problem

Statistical Solution

Practical Solution

Steps in six sigma -The DMAIC Methodology

...measure your target metricand know your measure is good...

…look for root causes andgenerate a prioritized listing of them.

... determine and confirm theoptimal solution ...

…be sure the problem doesn’t come back… sustain it

and relate it to the customer.., ... define the problem, clarify

Six Sigma DMADV process

• is an improvement system used to develop new

processes or products at Six Sigma quality levels.

• Both Six Sigma processes are executed by Six Sigma

Green Belts and Six Sigma Black Belts, and are

overseen by Six Sigma Master Black Belts.

DEFINE

MEASURE

ANALYZE

DESIGN

VERIFY

Sources of Variation

= +Yeast

+ ++ + …

Y= f(X1, X2, X3, …)

Equipments Methods PeopleMaterial

Sample fishbone diagram – poor x-ray quality

PatientSatisfaction

Physician –Staff

Satisfaction

Community Relaationship

FinancialViability

Projects and Work-Outs

Becoming a Better Healthcare Provider

HospitalManagement Processes

Tools

Outcome

Per

form

ance

Exc

elle

nce

PatientSafety

The Ultimate Goal

•Improving process/safety for medication administration

•Reduction in Blood Stream Infections in ICU

•Reducing ventilator acquired pneumonia

•Emergency Department Patient Wait Time

•Reduction in Lost Films

•Staff Recruitment and Retention

•Physician (Professional Fee) Billing Accuracy

•Quality of Care and Satisfaction of Families in Newborn ICU

Healthcare Project Examples

• According to the Six Sigma Academy, Black Belts save companies approximately $230,000 per project and can complete four to 6 projects per year.

• The average black Belt salary is $ 80,000 in the United States

LEANElimination of wastes

SIX SIGMAReduction of

variation

Questions

?

THANK U

For more information contact:Carolyn Pexton925-275-0726

Carolyn.Pexton@med.ge.com

And visit the iSixSigma healthcare portal

www.healthcare.isixsigma.com

References• Walder, D., (1993). Kano’s model for understanding customer-defined

quality. Center For Quality of Management Journal, 39, 65 – 69.

• Jacobs, R., (1997). Evaluating customer satisfaction with media products

and services. European Media Management Journal, 32, 11 – 18.

• Ungvari, S., (1999). Adding the third dimension to auqlity. Triz Journal, 40,

31 – 35.

• Sauerwein, E., Bailom, F., Matzler, K., & Hinterhuber, H. (1996). The kano

model: How to delight your customers. International Working Seminar on

Production Economics, 19, 313 - 327

• Zultner, R.E. & Mazur, G. H. ( 2006). The Kano Model: Recent

Developments. The eighteenth symposium on Quality Function

Deployment.

Additional Information on LSS

• www.isixsigma.com• American Society for Quality (www.asq.org)• Books:

– What is Lean Six Sigma? George, Rowlands, and Kastle

– The Six Sigma Way Fieldbook Pande, Newman, & Cavanagh

• Lean Six Sigma hospital systems:– Virginia Mason – Seattle, WA– ThedaCare – Appleton, WI

• IUPUI – Laboratory for Enterprise Excellence• Toast Kaizen video, Bruce Hamilton, GBMP