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  • There is a strategy to get out of the maze. What is it? The strategy we will use to get to Six Sigma is the Breakthrough Strategy. It’s also important that we stick to the strategy and not change midstream. Different organizations might have different strategies. Some organizations might use Six Sigma as their culture change while others use Six Sigma to support a culture change
  • Suggest that each organization that begins this process looks at their quality journey. It is a visual for where they have been and when years pass and Six Sigma continues, they will see the difference between previous quality and now.
  • In a few minutes, Dr. Ettinger and our own Barbara Feldman, will describe in more detail the Virtua “Star” initiative and the role and tools GE has brought to the program. Before they come back and do that, I would like to just briefly share with you sort of an “Executive Overview” of 6 Sigma, including some of the keys we see to successfully implementing 6 Sigma methodology…As well as why we are HERE, and why we believe we can add value as a partner in healthcare. What is Six Sigma? In a nutshell, Six Sigma is, most uniquely, a STATISTICAL quality methodology. This is the “heart and soul” of Six Sigma and I’ll describe this in more detail in a moment. But, Six Sigma is not JUST statistics. It is also quality improvement process and tools , which ensure the implementation and control activities that deliver real change and improvements in the company. Barbara will discuss the GE tools we are delivering to Virtua. And, probably most importantly, Six Sigma is a pervasive, single-minded, company-wide culture…and nothing short of it. Jack Welch has called 6 Sigma the most important initiative GE has ever undertaken…And, that is a significant statement when you take into consideration the revolutionary changes that Jack has led at GE over the past 20 years. Let me explain some of these points a little more clearly.
  • Product Vectors - GE’s term for their “Programs of Excellence” GE Medical - technology, IT, CAP/WorkOut/Six Sigma/LEAN GE Power GE Capital GE Construction/Engineering Innovation - GE is committed to aggressive new product development and to being a market leader in health care. Ability and interest to think outside the box Leadership development - long track record of systematic cultivation of leaders and systems and structures for identifying, mentoring and rewarding/retaining outstanding leaders Focus on results - A business-results mind set that is in their DNA
  • Both processes are flawed and will produce dissatisfied customers. Knowing if the problem is with the accuracy (the Mean) or the scatter (expressed as Sigma) helps us choose improvements that are more likely to succeed. We can also track exactly how much out process has improved!
  • First, Six Sigma is a statistical Quality Methodology. Of course, “Sigma” is just another word for standard deviation…And this begins to give you a feel for what is at the heart of Six Sigma. These implies that we UNDERSTAND variation…and our quality performance in these terms. The focus of Six Sigma is on Statistical process control…of EVERY process, including processes beyond manufacturing…like Services, Sourcing, Order to Remittance, Delivery & Installation, Customer Service, and even Sales an d Marketing. The essence of Six Sigma statistical analysis centers squarely on reducing and eliminating ERRORS. I can’t think of a more direct, and objective approach to Quality improvement than that. And, in the FINAL analysis…Six Sigma is essentially about “moving the mean…and reducing the standard deviation”. That is the lens through which we fundamentally view Quality improvement, from a Six Sigma perspective. In summary, Six Sigma is FIRST a rigorous, MEASUREMENT-based approach to Quality.
  • Let’s put Six Sigma into perspective…
  • This is the Foundations training plan for Six Sigma DMAIC.
  • ( Keep her notes below- review text colors, titles position) Provide an overview of the model and relate back to the previous learning regarding the difficulty in implementing successful change. Use this slide and next as an overview of where we (this session) are going.
  • Adrienne's Presentation

    1. 1. Adrienne Elberfeld Six Sigma Master Black Belt Virtua Health Marlton, NJ Six Sigma... Getting Real about Results in Healthcare
    2. 2. Virtua Facilities
    3. 3. Virtua Locations
    4. 4. Virtua Health <ul><li>Four hospital system in Southern New Jersey </li></ul><ul><li>Two Long Term Care Facilities </li></ul><ul><li>Two Home Health Agencies </li></ul><ul><li>Two Free Standing Surgical Centers </li></ul><ul><li>Ambulatory Care - Camden </li></ul><ul><li>Fitness Center </li></ul><ul><li>7000 employees + 1700 physicians </li></ul><ul><li>7,000 deliveries </li></ul><ul><li>$600 million in revenues </li></ul><ul><li>STAR Culture </li></ul>
    5. 5. <ul><li>Dramatically improve patient satisfaction scores. </li></ul><ul><li>Advance Virtua’s POE development. </li></ul><ul><li>Continue implementation of medical staff development plan. </li></ul><ul><li>Continue to improve and sustain global clinical quality and patient safety metrics. </li></ul><ul><li>Continue rigor in cost expense management, revenue enhancement and reduced length of stay. </li></ul><ul><li>Recognize and continuously develop best people and monitor employee satisfaction. </li></ul><ul><li>Begin facilities planning and development of ambulatory sites and regional medical centers. </li></ul>Virtua Imperatives 2005
    6. 6. The “STAR”… PERFORMANCE EXCELLENCE Clinical Quality & Safety Caring Culture Best People Excellent Service Resource Stewardship Outstanding Patient Experience Achieve Vision and Receive Recognition MISSION AND VALUES STRATEGIC INITIATIVES
    7. 7. The STAR Initiative <ul><li>An organization wide cultural transformation initiative that will assure that Virtua fulfills its covenant with the community, achieves its vision, and is highly successful over the long-term. </li></ul><ul><li>Three Objectives: </li></ul><ul><ul><li>1) Focus the work on creating an outstanding experience for patients </li></ul></ul><ul><ul><li>2) Become a high performing organization </li></ul></ul><ul><ul><li>3) Be recognized for our excellence </li></ul></ul>We Know Where We Want to Go, How Are We Going to Get There?
    8. 8. Current State: STAR Commitment Desired State: STAR Performance It’s Great to Have a Philosophy . . . But We Need a Strategy !! Six Sigma is our strategy on our journey through the maze
    9. 9. The Tool Chest <ul><li>Paths to Change </li></ul><ul><li>Strategic Decision </li></ul><ul><li>Operational issue Requiring a Decision </li></ul><ul><li>“ Wisdom of the Group” Problem </li></ul><ul><li>Analytical Problem </li></ul>Change Acceleration WorkOut Six Sigma
    10. 10. VIRTUA’S QUALITY JOURNEY WJ: Quality Circles: early - late 1980s MH: Morbidity and Mortality Reviews, Quality Audits WJ : Quality Assurance: mid 1980’s MH: Quality Assurance: mid 1970’s to mid 1980’s WJ: Quality Assessment: late 1980’s MH: Quality Assessment mid to late 80’s (Leadership explores Total Quality Management Concepts with VHA 1988 - 1990) WJ: Total Quality Management: early 1990s MH: Total Quality Management 1990 - 1995 WJ: Re-engineering / Patient Centered Care: mid 1990’s MH: Metric Focused Quality Improvement (AQP) / Patient Focused Care: mid 1990’s Virtua Health : Quality Management, Six Sigma, Workout: 2000 and beyond April 2001
    11. 11. What is Six Sigma?… <ul><li>Methodology for achieving goals and objectives </li></ul><ul><li>Quantitative technique for problem solving </li></ul><ul><li>Comprehensive improvement process </li></ul>Tools For Driving Sustainable Change
    12. 12. Solid tools but…. <ul><li>Quality tool </li></ul><ul><li>Vague goals </li></ul><ul><li>No standard metrics </li></ul><ul><li>Open-ended, unstructured </li></ul><ul><li>Department-based </li></ul><ul><li>Focus on product quality </li></ul>Real results that matter to customers…. <ul><li>Business tool </li></ul><ul><li>Clear goals/deliverables </li></ul><ul><li>Clear, consistent metrics </li></ul><ul><li>Rigorous timeline </li></ul><ul><li>Business-based </li></ul><ul><li>Focus on customer </li></ul>Six Sigma builds on Lessons Learned from prior approaches TQM Six Sigma What Makes Six Sigma Different? Adapted with permission from Hamadi Said, US Mint Philadelphia, PA
    13. 13. The Nature of Variation . . . So how does this principle translate into the real world? Mean is Centered ( it is On Target), but there is Large Variation (Big Sigma!) Accurate but not Precise Mean is not Centered ( it is Off Target); the Variation is Small Precise but not Accurate
    14. 14. Six Sigma is… A Quantitative Methodology <ul><li>Sigma = Standard Deviation </li></ul><ul><li>Goal: Eliminate Defects </li></ul>“ Move the Mean…Reduce Variability” 1  2  3  Target Customer Spec 3   6.6% Defects Today 3  6  Target No Defects! Desired State 6  2 308,537 3 66,807 4 6,210 5 233 6 3.4  DPMO Y= f(X 1 +X 2 +X 3 +…..X n ) 1 
    15. 15. Why Six Sigma as a Tool?… A Health System The Size of Virtua Fills ~400,000 New In-Patient Medication Orders Per Year… Six Sigma Can Make a Difference in Healthcare Error Rates at 2  to 6  2 123,415 69.1% 3 26,723 93.3% 4 2,484 99.4% 5 93 99.98% 6 1.4 99.99966%  Script Errors / Yr % Correct … Six Sigma Means 1-2 Incorrect Orders Per Year
    16. 16. Overall Approach Practical Problem Statistical Problem Statistical Solution Practical Solution What is Six Sigma?
    17. 17. DMAIC: To improve any existing product or process Six Sigma Methodologies 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? What is Six Sigma? Define Measure Analyze Improve Control
    18. 18. What measurements will the process owner use to confirm sustained improvements? What system and structure changes support sustained gains? Define Project Scoping Operations Plan Strategic Plan Control Improve Analyze Measure What is the right operational area for a project? What is the right process result to address? What does the customer expect? How is the current process performing? What are the most important factors driving the process results? What changes will deliver the desired process result? How well did the changes improve the process? Project Conclusion The DMAIC Process
    19. 19. Define DEFINE PHASE: Focus on the Y Y = f (x) Project Funnel “ How do my customers look at me?”
    20. 20. Measure Define Phase: Focus on the Y Y = f (x) Measure Phase: Focus on the Y Project Funnel “ What do I want to improve?” “ What’s the best way to measure?” “ Can I trust the output data?”
    21. 21. Analyze X 1 X 2 X 3 X 4 X 5 X 6 X 7 X 8 X 9 X 10 X 11 X 12 X 13 X 14 Define Phase: Focus on the Y X 1 X 2 X 3 X 4 X 5 X 6 X 7 X 8 X 9 X 10 X 11 X 12 X 13 X 14 Y = f Measure Phase: Focus on the Y Analyze Phase: List & prioritize X’s “ How good am I today?” “ How good do I need to be?” “ What factors make a difference?”
    22. 22. Analyze Define Phase: Focus on the Y Measure Phase: Focus on the Y Analyze Phase: Identify vital X’s Y = f + X 1 X 2 X 3 X 4 X 5 X 6 X 7 X 8 X 9 X 10 X 11 X 12 X 13 X 14 X 2 X 7 “ How good am I today?” “ How good do I need to be?” “ What factors make a difference?”
    23. 23. Improve Define Phase: Focus on the Y Measure Phase: Focus on the Y Analyze Phase: Identify vital X’s Improve Phase: Focus on vital X’s + X 2 X 7 X 2 + X 7 Y = f “ What’s at the root of the problem?” “ How can I predict the output?”
    24. 24. Control Y X 7 Define Phase: Focus on the Y Measure Phase: Focus on the Y Improve Phase: Focus on vital X’s Control Phase: Sustain improvements Analyze Phase: Identify vital X’s “ Have I reached my goal?” “ How can I sustain the improvement?”
    25. 25. DMAIC Training & Project Management Plan Define Project Measure TRAINING REVIEWS R0 The Fundamentals Define & CAP Application R1 Application Analyze Improve R2 Application R3 Application Control & CAP R4 4 weeks 4 weeks 6 weeks 6 weeks 6 weeks
    26. 26. Project Management <ul><li>Master Black Belt role </li></ul><ul><li>Driven by the “R” document cycle </li></ul><ul><li>Tracking software </li></ul><ul><ul><li>Formal Project Management software - (November 2004 implementation of e-project) </li></ul></ul><ul><ul><li>“Good Enough for Now” software </li></ul></ul>
    27. 27. The Work-Out TM Process - An Enabling Technology <ul><li>A 1-2 day session that involves employees to fix the problem </li></ul><ul><li>Concentrated, empowered decision making </li></ul><ul><ul><li>Leadership responds with immediate decision or alternative direction </li></ul></ul><ul><li>Follow up ensures completion of action plans </li></ul>Work-Out TM Is… Key Outcomes Tool That Drives Decisions and Actions for Employees <ul><li>Process to drive improvement </li></ul><ul><li>Opportunity to engage and empower people </li></ul><ul><li>Results-based: </li></ul><ul><ul><li>Decisions </li></ul></ul><ul><ul><li>Accountability </li></ul></ul><ul><ul><li>Follow up </li></ul></ul>
    28. 28. What’s a Work-Out? <ul><li>Addresses an important process </li></ul><ul><li>Facilitated by a STAR coach (130 trained) </li></ul><ul><li>Gives immediate feedback to staff </li></ul><ul><li>Examples: </li></ul><ul><ul><li>Create a new process for Root Cause Analysis </li></ul></ul><ul><ul><li>Create a process to deliver patient satisfaction data to leaders and managers </li></ul></ul><ul><ul><li>Fix night call schedule for residents </li></ul></ul><ul><ul><li>Fix transport process for LTC patients </li></ul></ul><ul><li>Total: 161 so far </li></ul>
    29. 29. The Change Acceleration Process Leading Change Changing Systems and Structures Current State Transition State Improved State Creating A Shared Need Shaping A Vision Mobilizing Commitment Making Change Last Monitoring Progress Simple, Yet Powerful Model to Assure that Change Happens
    30. 30. Summary: Six Sigma Methodologies Six Sigma Change Acceleration Process Effective Results Work-Out ™ Q x A = E The Effectiveness (E) of the result is equal to the Quality (Q) of the solution times the Acceptance (A) of the idea. A Proven Formula For Results
    31. 31. How they work together: Change Acceleration Process Change Acceleration Process Change Acceleration Process Change Acceleration Process Change Acceleration Process Six Sigma project Decisions Implementation Implementation Development WorkOut Detailed Analysis Six Sigma project
    32. 32. What’s Different About Six Sigma? <ul><li>Quantitative: Where is the bang for your buck? </li></ul><ul><li>Accelerates and sustains change </li></ul><ul><li>Applicable to all parts of the system </li></ul><ul><li>Reduce defects----Increase dollars </li></ul>More Than Just Another Flavor of the Month
    33. 33. Six Sigma Personnel <ul><li>Master Black Belt : Full time; advanced training in Six Sigma; leads initiative, consults, teaches, and leads projects. </li></ul><ul><li>Black Belt : Full time; trained in Six Sigma; leads projects and assists green belts. </li></ul><ul><li>Six Sigma Analyst : Full time; trained in Six Sigma and reports directly to campus COO </li></ul><ul><li>Green Belt : Part time; trained in Six Sigma; undertakes one project every nine months. </li></ul><ul><li>STAR Coach : Part time; trained in CAP and Work-Out; leads two projects a year. </li></ul>Accepted Nomenclature Adapted to Virtua
    34. 34. Virtua Health: The Initial Investment <ul><li>Commitment of leadership: CEO and Board </li></ul><ul><li>Executive sponsor </li></ul><ul><li>Project manager </li></ul><ul><li>Training from GE </li></ul><ul><li>Six full time blackbelts </li></ul><ul><li>60 STAR coaches </li></ul><ul><li>Leadership Coalition </li></ul><ul><li>Resources for internal communications </li></ul>$1.4 Million!
    35. 35. <ul><li>Need for tools to improve performance and to initiate and sustain change </li></ul><ul><li>Proven track record at GE </li></ul><ul><li>Tell you what you need to hear, not what you want to hear </li></ul><ul><li>Clear commitment to our success and independence </li></ul><ul><li>Complete package </li></ul>Six Sigma: Why partner with GE? The Right Company and Capabilities
    36. 36. What Makes a Good Target for a Six Sigma Project? <ul><li>Addresses an important business objective </li></ul><ul><li>Data driven </li></ul><ul><li>Process Map and Measurable Output </li></ul><ul><li>Foundation team (key staff) is the driver of the project </li></ul><ul><li>Black Belt leads the team as a consultant </li></ul><ul><li>Average time to completion ~6 months </li></ul>Large and Complex Undertaking
    37. 37. Driving the Project ….. Black Belt and Project Team Process Owner and Project Team Define Measure Analyze Improve Control
    38. 38. Evolution of Six Sigma at Virtua Commitment and Flexibility
    39. 39. Cardiac Meds: A PRO/CMS Quality Indicators Project What the Cardiac Meds Team Did … Why They Did It … Project started in 7/02. All PRO indicators were achieved for Q4 ‘02. Project closed out in July ’03; continued success sustained! <ul><li>Gaged current data collection system </li></ul><ul><li>Project requested by physician leadership </li></ul><ul><li>Documentation was more of a problem than the actual delivery of care </li></ul><ul><li>Major progress in achieving physician support for process improvement (including physicians firmly addressing physician outliers!) </li></ul><ul><li>Improve quality and consistency of data </li></ul><ul><li>Created a cardiac discharge instruction sheet </li></ul><ul><li>“ Contained” defects immediately while implementing more sustainable systems and structures to support improvements </li></ul><ul><li>To obtain immediate results to achieve aggressive system targets </li></ul><ul><li>Increase compliance from docs and support accurate data collection </li></ul>Project Results … >90% CHF ACE at DC Results Indicator >95% AMI Beta Blocker at DC >95% AMI Beta Blocker < 24 hrs >95% AMI ASA at Discharge >95% AMA ASA < 24 hrs
    40. 40. Home Care HHRG Case Weight Mix and Coding <ul><li>What the Team Did … </li></ul>Why They Did It … Total Project Benefit Estimate $1,200,000 Medicare Length of Stay <ul><li>Established standards in completion of initial OASIS form </li></ul><ul><li>Enhanced Care Manager role in team </li></ul><ul><li>Implementation of standard operating procedures for both agencies, two bargaining units through use of WorkOuts </li></ul><ul><li>Weekly review of lock days for concurrent review by manager </li></ul><ul><li>Substantial ROI to purchase new computerized system </li></ul><ul><li>On-going sustainable changes in place during training and implementation of new system </li></ul><ul><li>Increase in initial HHRG case weight mix & broader knowledge base of MO questions </li></ul>Overall Case Weight Mix Average = 1.34 Agency OASIS Lock Within 7 Days = 92% Percentage of Agency LUPA’s = 15% <ul><li>Decreased percentage of LUPA’s to 15% </li></ul><ul><li>Surpassed the Medicare threshold for OASIS lock within 7 days </li></ul><ul><li>Decrease in adjustments (refunds) to government </li></ul><ul><li>Decrease in technical denials and increase in cash flow </li></ul>Project Results …
    41. 41. Advantages to Virtua Health <ul><li>Results measured in dollars, quality and service </li></ul><ul><li>Common language </li></ul><ul><li>Breaks down silos </li></ul><ul><li>Physicians like it </li></ul><ul><li>Faster decisions and implementation </li></ul><ul><li>A method to accelerate and sustain change </li></ul><ul><li>Creates clarity and objective measures of success </li></ul>All in all, a Great Return on Investment
    42. 42. <ul><li>Six Sigma should be undertaken with a clear vision of where you want to be </li></ul><ul><li>Introduce Six Sigma as a tool, not a philosophy </li></ul><ul><li>CEO must own it </li></ul><ul><li>Make Six Sigma a system wide effort….Focus on $$$, productivity and patient issues </li></ul><ul><li>Measure, measure measure…Deal with information issues </li></ul><ul><li>Hold people accountable for using Six Sigma to achieve outcomes that are important to the organization </li></ul><ul><li>Invest in resources and make a long term commitment </li></ul><ul><li>Change the systems and structures to support the effort </li></ul>Key Success Factors It Has to Become the Way You Do Your Work
    43. 43. <ul><li>Clear objectives, measurable outcomes and ‘doable’ projects are a must----scope the projects </li></ul><ul><li>It is about the process </li></ul><ul><li>There is plenty of ‘fat’ in healthcare </li></ul><ul><li>Hold people accountable to use the tools to get results----Resistance to change and accountability is high and in high places </li></ul><ul><li>Teach management how to use the tools </li></ul><ul><li>Hit the areas that are ready and fertile--Finance! </li></ul><ul><li>Over communicate by a factor of 1000 </li></ul>Lessons Learned Q X A = E!
    44. 44. Lessons Learned <ul><li>Be flexible and patient </li></ul><ul><li>Deal with the problem of bad data </li></ul><ul><li>Use CAP </li></ul><ul><li>Sponsor Education is critical-teach them how to ask good questions-implementation of Yellow Belt training </li></ul><ul><li>It is all about the customer </li></ul><ul><li>It is a process that shines the light, there is nowhere to hide </li></ul><ul><li>Can help identify future leaders </li></ul><ul><li>Massive staff empowerment </li></ul><ul><li>Common language </li></ul><ul><li>This is constantly evolving…there is always something to improve </li></ul>
    45. 45. Six Sigma: Leadership Development <ul><li>Emerging leaders </li></ul><ul><li>Time limited position </li></ul><ul><li>“Rotating Internship” </li></ul><ul><li>Developing business rigor and results orientation </li></ul><ul><li>“Infecting” the organization with excellence and competence </li></ul>
    46. 46. Leadership Development some success stories <ul><li>Director Patient Billing Services  Black Belt  AVP Home Care  VP Operations </li></ul><ul><li>Director Quality  Master Black Belt  VP Quality </li></ul><ul><li>Nurse Manager Med Surg  Black Belt  Quality Director Home Care  Home Care Director of Nursing </li></ul><ul><li>HR IS  Black Belt  Cardiology Product Line at Marlton </li></ul><ul><li>Nurse Manager Emergency Department  Master Black Belt  Virtua Enterprise Manager </li></ul><ul><li>AVP Community Services  Black Belt  VP Nursing Services </li></ul><ul><li>AVP Operations  Black Belt  Director of Finance </li></ul>
    47. 47. Should You Use Six Sigma? <ul><li>Purpose? </li></ul><ul><ul><li>Vision </li></ul></ul><ul><ul><li>Motivation </li></ul></ul><ul><li>Commitment? </li></ul><ul><ul><li>CEO </li></ul></ul><ul><ul><li>At least 3 years </li></ul></ul><ul><ul><li>Investment </li></ul></ul><ul><li>Capacity? </li></ul><ul><ul><li>Culture </li></ul></ul><ul><ul><li>Accountability </li></ul></ul><ul><ul><li>Skills of the managers </li></ul></ul>Are You Willing to Destroy the Good to Get Better?
    48. 48. Questions
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