Harnessing the Potential of Six Sigma in Healthcare

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Harnessing the Potential of Six Sigma in Healthcare

  1. 1. James G. Springfield, FACHE President and CEO Harnessing the Potential of Six Sigma in Healthcare March 30, 2006
  2. 2. Rio Grande Valley
  3. 3. <ul><li>Valley Baptist Medical Center - Harlingen </li></ul><ul><ul><li>611 Licensed Beds </li></ul></ul><ul><ul><li>Lead Level 3 Trauma Center </li></ul></ul><ul><ul><li>State of the Art Children’s Center </li></ul></ul><ul><ul><li># 1 Rated Orthopedics Service </li></ul></ul><ul><ul><li>Heart & Vascular Institute </li></ul></ul><ul><ul><li>Teaching facility for the Regional Academic Health Center of The University of Texas Health Science Center at San Antonio </li></ul></ul><ul><li>Valley Baptist Medical Center – Brownsville </li></ul><ul><ul><li>243 Licensed Beds </li></ul></ul><ul><ul><li>Level 3 Trauma Center </li></ul></ul><ul><ul><li>State of the Art Imaging Center </li></ul></ul><ul><ul><li>Center of Diabetes Management </li></ul></ul><ul><li>Other Entities </li></ul><ul><ul><li>Golden Palms Retirement and Healthcare Center </li></ul></ul><ul><ul><li>Valley Baptist Health Plans </li></ul></ul><ul><ul><li>Advanced Medical Supply (DME) </li></ul></ul><ul><ul><li>Valley Baptist Ambulatory Surgery Center </li></ul></ul><ul><ul><li>Clinical Pastoral Education Center </li></ul></ul><ul><ul><li>Licensed Vocational Nurse School </li></ul></ul><ul><ul><li>Family Practice Residency Program </li></ul></ul><ul><ul><li>Internal Medicine Residency Program </li></ul></ul><ul><ul><li>Home Health & Hospice </li></ul></ul><ul><ul><li>Rehabilitation & Wellness </li></ul></ul><ul><ul><li>Behavioral Health Services </li></ul></ul>Valley Baptist Health System
  4. 4. <ul><li>Strategic Initiatives </li></ul><ul><ul><li>Integration </li></ul></ul><ul><ul><li>Simplicity </li></ul></ul><ul><ul><li>Six Sigma Quality </li></ul></ul><ul><ul><li>Relentless Service </li></ul></ul><ul><ul><li>Expansion of Services & Regionalization </li></ul></ul><ul><li>Values </li></ul><ul><ul><li>Disciplined </li></ul></ul><ul><ul><li>Entrepreneurial </li></ul></ul><ul><ul><li>Performance Oriented </li></ul></ul><ul><ul><li>Accountable </li></ul></ul>Valley Baptist Health System
  5. 5. Valley Baptist Health System Operating Calendar September October December January February May April March July August June November 1 st Quarter 2 nd Quarter 3 rd Quarter 4 th Quarter Execute Initiatives: Mgmt. Mtg. Marching Orders Performance Reviews Board Retreat QOR Aug. Board Meeting (Present budget) QOR QOR QOR Talent Review / Succession, HR Planning Initiatives Dev. & Review + Sr. Mgmt. & Review and Key Mgmt. Retreat Performance Stds. Set Budget = Work product req. = Processes link Sr. Mgmt. Mtg Key Mgmt. Retreat Guidance VBHS Confidential & Proprietary Information VBHS Values VB Survey II Strategic Planning Integration Simplicity Service Expansion & Regionalization Relentless Service Six Sigma Quality VB Survey I
  6. 6. <ul><li>A comprehensive and flexible program for achieving, sustaining and maximizing business success that: </li></ul><ul><ul><li>Is a management methodology with three perspectives: </li></ul></ul><ul><ul><ul><li>A Measure of Quality </li></ul></ul></ul><ul><ul><ul><li>A Process for Continuous Improvement </li></ul></ul></ul><ul><ul><ul><li>An Enabler for Cultural Change </li></ul></ul></ul><ul><ul><li>Is uniquely driven by a clear focus on the “Voice of the Customer” </li></ul></ul><ul><ul><li>Is founded in a rigorous use of facts, data and statistical analysis </li></ul></ul><ul><ul><li>Provides for diligent attention on managing, improving and reinventing business processes </li></ul></ul>What is Six Sigma?
  7. 7. What is Six Sigma? <ul><li>Integrated part of management system </li></ul><ul><li>Fact & data based decision making </li></ul><ul><li>Knowledge transfer, learning process </li></ul><ul><li>Value added focus on defect removal </li></ul><ul><li>Utilization of technology tools </li></ul><ul><li>A lasting infrastructure </li></ul><ul><li>Not a cost reduction program </li></ul><ul><li>Not a training program </li></ul><ul><li>Not a statistics program </li></ul><ul><li>Not a quality program </li></ul><ul><li>Not a quick fix </li></ul>Six Sigma Advantage, Inc.
  8. 8. <ul><li>Six Sigma is a statistical measure that expresses how close a service process comes to its quality goal </li></ul><ul><li>Six Sigma refers to a process that produces only 3.4 defects per million opportunities </li></ul>What is Six Sigma? 3.4 233 6,210 66,807 308,537 DPMO 99.9997% 99.9767% 99.3790% 93.3193% 69.1463% Yield 6 5 4 3 2 Sigma
  9. 9. DMAIC Methodology
  10. 10. How did we begin implementing Six Sigma? <ul><li>CEO Commitment </li></ul><ul><ul><li>Vision </li></ul></ul><ul><ul><li>Leadership </li></ul></ul><ul><ul><li>Resources (time, money, people) </li></ul></ul><ul><li>Partnership with General Electric Medical Systems </li></ul><ul><ul><li>Guidance </li></ul></ul><ul><ul><li>Expert Knowledge </li></ul></ul><ul><ul><li>Training – Six Sigma, CAP, Work-Out™ </li></ul></ul><ul><ul><li>Project Mentoring </li></ul></ul><ul><ul><li>Transition Assistance </li></ul></ul>
  11. 11. Roles at VBHS <ul><li>Master Black Belt – 6 Sigma mentor and educator </li></ul><ul><li>Black Belt – 6 Sigma trained specialist who works on 6 Sigma improvement initiatives on a full time basis </li></ul><ul><li>Green Belt – 6 Sigma trained specialist who uses the Six Sigma methodology to solve problems as a function of their normal work </li></ul><ul><li>Yellow Belt – Physicians and Executives trained in basic 6 Sigma methods who assist with problem solving, initiative sponsorship and solution implementation </li></ul><ul><li>Sponsor – Executive with responsibility to identify 6 Sigma initiatives, assign resources and remove barriers </li></ul><ul><li>Change Agent - Expert in the application of CAP and Work-Out™ tools </li></ul>
  12. 12. Six Sigma Practitioners at VBHS <ul><li>Master Black Belts (5) </li></ul><ul><ul><li>3 Certified </li></ul></ul><ul><ul><li>2 Seeking Certification </li></ul></ul><ul><li>Black Belts (4) </li></ul><ul><ul><li>3 Harlingen </li></ul></ul><ul><ul><li>1 Brownsville </li></ul></ul><ul><li>Green Belts (61) </li></ul><ul><ul><li>31 Certified </li></ul></ul><ul><ul><li>30 Seeking Certification </li></ul></ul><ul><li>Yellow Belts (34) </li></ul><ul><ul><li>15 Executives </li></ul></ul><ul><ul><li>19 Physicians </li></ul></ul><ul><li>Master Change Agents (2) </li></ul><ul><li>Change Agents (237) </li></ul><ul><ul><li>190 Harlingen </li></ul></ul><ul><ul><li>47 Brownsville </li></ul></ul><ul><li>Future </li></ul><ul><ul><li>All Executives will be trained to Yellow Belt level </li></ul></ul><ul><ul><li>All Directors and Managers to Green Belt certification </li></ul></ul>
  13. 13. Physician Yellow Belts <ul><li>Jose Ayala, DPM </li></ul><ul><li>Maria T. Camacho, MD </li></ul><ul><li>Miguel Cintron, MD </li></ul><ul><li>Chandler E. Deal, MD </li></ul><ul><li>Luis Gaitan, MD </li></ul><ul><li>Alfredo Garcia, MD </li></ul><ul><li>Giovanna Ghafoori, MD </li></ul><ul><li>Khadim Hussain, MD </li></ul><ul><li>Garner Klein, MD </li></ul><ul><li>Robert A. Lozano, MD </li></ul><ul><li>Raul Maldonado, DPM </li></ul><ul><li>Juan Mancillas, MD </li></ul><ul><li>Carlos Medina, MD </li></ul><ul><li>John A. Partin, MD </li></ul><ul><li>Eric Six, MD </li></ul><ul><li>Adela S. Valdez, MD </li></ul><ul><li>Daniel F. Villarreal, MD </li></ul><ul><li>Gerald Witson, DDS </li></ul><ul><li>Robert T. Wright, DO </li></ul>
  14. 14. Six Sigma Physician Council Members <ul><li>Miguel Cintron, MD </li></ul><ul><li>Lisa Dix-Emperador, MD </li></ul><ul><li>Luis Gaitan, MD </li></ul><ul><li>Giovanna Ghafoori, MD </li></ul><ul><li>Tomas A. Gonzalez, MD </li></ul><ul><li>Christopher Hansen, MD </li></ul><ul><li>Khadim Hussain, MD </li></ul><ul><li>Garner Klein, MD </li></ul><ul><li>Bruce Leibert, MD </li></ul><ul><li>Juan J. Mancillas, MD </li></ul><ul><li>Clay W. Ross, MD </li></ul><ul><li>Michael Simpson, MD </li></ul><ul><li>Eric Six, MD </li></ul><ul><li>Adela S. Valdez, MD </li></ul><ul><li>Gerald Whitson, MD </li></ul><ul><li>Robert Wright, MD </li></ul>
  15. 15. VBHS Timeline <ul><li>May 2002 </li></ul><ul><ul><li>Engagement with GEMS </li></ul></ul><ul><ul><li>Wave 1: 6 initiatives </li></ul></ul><ul><ul><li>Green Belts trained </li></ul></ul><ul><li>March 2003 </li></ul><ul><ul><li>Wave 2: 6 initiatives </li></ul></ul><ul><ul><li>3 Full Time Black Belts appointed </li></ul></ul><ul><li>April 2003 </li></ul><ul><ul><li>3 Full Time Master Black Belts appointed and trained </li></ul></ul><ul><li>June 2003 </li></ul><ul><ul><li>Wave 3: 8 initiatives </li></ul></ul><ul><ul><li>Green Belts trained </li></ul></ul><ul><ul><li>2 Master Change Agents trained </li></ul></ul><ul><li>March 2004 </li></ul><ul><ul><li>Wave 4: 15 initiatives </li></ul></ul><ul><ul><li>Green Belts trained </li></ul></ul><ul><li>July 2005 </li></ul><ul><ul><li>Wave 5/1: 13 initiatives </li></ul></ul><ul><ul><li>Green Belts trained </li></ul></ul><ul><li>September 2005 </li></ul><ul><ul><li>Wave 6/2/1: 14 initiatives; Wave 6 at VBMC-H, Wave 2 at VBMC-B, Wave 1 at System </li></ul></ul><ul><ul><li>Green Belts trained </li></ul></ul>
  16. 16. 72 Completed Training and Translation Initiatives <ul><li>Wave 1 </li></ul><ul><ul><li>ED Wait Times </li></ul></ul><ul><ul><li>Diabetes Management </li></ul></ul><ul><ul><li>Pharmacy Order Verification </li></ul></ul><ul><ul><li>OR Turnaround Time </li></ul></ul><ul><ul><li>Staff Scheduling </li></ul></ul><ul><ul><li>Nursing Order Activation </li></ul></ul><ul><li>Wave 2 </li></ul><ul><ul><li>ED Wait Times </li></ul></ul><ul><ul><li>Laboratory Turnaround </li></ul></ul><ul><ul><li>Admissions Process </li></ul></ul><ul><ul><li>OR Turnaround Time </li></ul></ul><ul><ul><li>Radiology Turnaround </li></ul></ul><ul><ul><li>Discharge Process </li></ul></ul><ul><li>Wave 3 </li></ul><ul><ul><li>ED Wait Times </li></ul></ul><ul><ul><li>Surgery Patient Preparation & PATT </li></ul></ul><ul><ul><li>DRG Assurance of Accuracy </li></ul></ul><ul><ul><li>RN Admissions Assessment </li></ul></ul><ul><ul><li>Patient Registration Accuracy </li></ul></ul><ul><ul><li>Outpatient Service Redesign </li></ul></ul><ul><ul><li>Performance Management </li></ul></ul><ul><ul><li>RN New Hire Process </li></ul></ul>
  17. 17. <ul><li>Timely Utilization of Ancillary Services in the ED </li></ul><ul><li>Inpatient Floor to Floor Transfers </li></ul><ul><li>Event Response </li></ul><ul><li>Golden Palms MDS Coding Accuracy </li></ul><ul><li>CHF </li></ul><ul><li>Stroke Care </li></ul><ul><li>AMI </li></ul><ul><li>Forms Management </li></ul><ul><li>Pain Management </li></ul><ul><li>STO Turnaround Time </li></ul><ul><li>Patient Identification </li></ul><ul><li>Outpatient Services Integration </li></ul><ul><li>Timely & Safe Medication Turnaround </li></ul><ul><li>Abbreviations </li></ul><ul><li>Pathology Process Flow Improvement </li></ul>Wave 4 Initiatives
  18. 18. <ul><li>VBMC-Harlingen </li></ul><ul><li>Wave 5 </li></ul><ul><li>ED Registration & Accuracy </li></ul><ul><li>Pneumonia Core Measures </li></ul><ul><li>Interdisciplinary Communication </li></ul><ul><li>VBMC-H Accessibility </li></ul><ul><li>Ancillary Departments Results Availability </li></ul><ul><li>Physician Pay for Performance </li></ul><ul><li>ED Charges </li></ul><ul><li>VBMC-Brownsville </li></ul><ul><li>Wave 1 </li></ul><ul><li>Emergency Department Hold Time </li></ul><ul><li>Me dical Records / Transcription Turnaround Process </li></ul><ul><li>ICU Care Management Process </li></ul><ul><li>Outpatient Registration Turnaround Time </li></ul><ul><li>Length of Stay Planning & Mgmt Process </li></ul><ul><li>Radiology Turnaround Time </li></ul>Wave 5/1 Initiatives
  19. 19. <ul><li>Wave 6 (Harlingen) </li></ul><ul><ul><li>Cardiac Catheterization Lab Capacity </li></ul></ul><ul><ul><li>Medication Reconciliation </li></ul></ul><ul><ul><li>On-Time Discharges </li></ul></ul><ul><ul><li>Critical Care Glucose Management </li></ul></ul><ul><ul><li>Coronary Bypass Graft Core Measures </li></ul></ul><ul><li>Wave 2 (Brownsville) </li></ul><ul><ul><li>Wound Care </li></ul></ul><ul><ul><li>Women’s Services Throughput </li></ul></ul><ul><ul><li>Respiratory Care Management </li></ul></ul><ul><ul><li>Surgical Case Time Management </li></ul></ul><ul><ul><li>Critical Care Medication Administration Turnaround Time </li></ul></ul>Wave 6/2/1 Initiatives <ul><li>Wave 1 (System) </li></ul><ul><ul><li>Decision Support Turnaround Time </li></ul></ul><ul><ul><li>Advance Directives </li></ul></ul><ul><ul><li>Family Practice Residency Program Patient Throughput </li></ul></ul><ul><ul><li>Event Response </li></ul></ul>
  20. 20. Translation Initiatives <ul><li>Acute Myocardial Infarction </li></ul><ul><li>Heart Failure Management </li></ul><ul><li>Patient ID (Mother Baby) </li></ul><ul><li>Patient ID (Ancillary Services) </li></ul><ul><li>Surgical Preparation (Inpatient) </li></ul><ul><li>Surgical Preparation (Day Surgery) </li></ul><ul><li>Abbreviations </li></ul><ul><li>Pharmacy Order Verification </li></ul><ul><li>Nursing Activation of Orders </li></ul><ul><li>DRG Assurance of Accuracy </li></ul>
  21. 21. Examples of the VBHS application of Six Sigma
  22. 22. <ul><li>61 minutes </li></ul><ul><li>on average in </li></ul><ul><li>2002 </li></ul>Operating Room (Harlingen) Amount of time it takes to turnaround surgical suites from one case to the next Decreased 34% 40 minutes on average in 2006
  23. 23. <ul><li>110 minutes </li></ul><ul><li>on average in </li></ul><ul><li>2002 </li></ul>Pharmacy (Harlingen) Amount of time it takes the pharmacy to verify a physician order Decreased 80% 22 minutes on average in 2006
  24. 24. <ul><li>Accuracy rate of </li></ul><ul><li>75% in </li></ul><ul><li>2003 </li></ul>Diagnostic Related Group (Harlingen) Code assignment on 16 DRGs Improved 33% Six Sigma performance in 2006
  25. 25. <ul><li>Compliance rate </li></ul><ul><li>96.8% in </li></ul><ul><li>2004 </li></ul>Patient Identification (Harlingen) & (Brownsville) Proper patient identification prior to medical procedures Six Sigma performance in 2006
  26. 26. <ul><li>42 hours on </li></ul><ul><li>average in </li></ul><ul><li>February 2005 </li></ul>Radiology (Brownsville) Amount of time it takes for the final report to be posted in the patient’s chart after the radiological exam is ordered Decreased 64% 15 hours on average in January 2006
  27. 27. <ul><li>566 minutes on </li></ul><ul><li>average in </li></ul><ul><li>March 2005 </li></ul>Emergency Department (Brownsville) Amount of time it takes a patient to leave the ED after the MD order for admission is written Decreased 69% 177 minutes on average in January 2006
  28. 28. <ul><li>33 minutes on </li></ul><ul><li>average in </li></ul><ul><li>2003 </li></ul>Emergency Department (Harlingen) Amount of time it takes to discharge a patient after the doctor has determined the discharge disposition Decreased 30% 23 minutes on average in 2006
  29. 29. <ul><li>226 minutes on </li></ul><ul><li>average in </li></ul><ul><li>2004 </li></ul>Emergency Department (Harlingen) Amount of time it takes a patient to arrive to an inpatient bed from the ED after the doctor has written the admission order Decreased 49% 116 minutes on average in 2006
  30. 30. <ul><li>102 minutes on </li></ul><ul><li>average in </li></ul><ul><li>2003 </li></ul>Nursing (Harlingen) Amount of time it takes to complete the Nursing Assessment on inpatients at VBMC-H Decreased 70% 30 minutes on average in 2006
  31. 31. <ul><li>Compliance rate </li></ul><ul><li>73% in </li></ul><ul><li>2004 </li></ul>Nursing (Harlingen) Pain Management assessment and follow up Compliance rate 90% in 2006 Improved 23%
  32. 32. <ul><li>88 minutes on </li></ul><ul><li>average in </li></ul><ul><li>2002 </li></ul>Nursing (Harlingen) Amount of time it takes the nursing department to activate physician orders Decreased 73% 24 minutes on average in 2006
  33. 33. <ul><li>94.6% in </li></ul><ul><li>2004 </li></ul>Evidence Based Medicine (Harlingen) Compliance with the JCAHO’s core measures for Acute Myocardial Infarction Improved 5.4% Six Sigma performance in 2006
  34. 34. <ul><li>81.4% in </li></ul><ul><li>April 2005 </li></ul>Evidence Based Medicine (Brownsville) Compliance with the JCAHO’s core measures for Acute Myocardial Infarction Improved 23% Six Sigma performance in January 2006
  35. 35. <ul><li>58% in </li></ul><ul><li>2004 </li></ul>Evidence Based Medicine (Harlingen) Compliance with the JCAHO’s core measures for Heart Failure Management Improved 72% Six Sigma performance in 2006
  36. 36. Displayed with Permission of Modern Healthcare.  Copyright Crain Communications, Inc., 2005 Modern Healthcare Magazine “Right on the Money” November 14, 2005 <ul><li>Launched October 2003 with 268 hospital participants </li></ul><ul><li>Cash rewards for total of $8.85 million to 123 hospitals the top 20% performers in five clinical areas: </li></ul><ul><ul><li>heart failure, pneumonia, bypass surgery, heart attack and hip and knee replacement. </li></ul></ul><ul><li>Hospitals graded on quality measures, earning a composite quality score in any given focus area. </li></ul>CMS Pay for Performance
  37. 37. <ul><li>53% in </li></ul><ul><li>April 2005 </li></ul>Evidence Based Medicine (Brownsville) Compliance with the JCAHO’s core measures for Heart Failure Management Improved 89% Six Sigma performance in January 2006
  38. 38. Stroke Care (Harlingen) <ul><li>Letter dated September 27, 2005 from Joint Commission’s Executive Vice President, Russell P. Massaro, MD, FACPE: </li></ul><ul><li>The Joint Commission is pleased to award Disease – Specific Certification to your organization’s primary stroke center as a result of the September 2, 2005 review at Valley Baptist Medical Center </li></ul><ul><li>This certification is effective for two years from September 3, 2005, and is indicative of your program’s compliance with consensus-based national standards; effective use of established clinical practice guidelines to manage and optimize care; and performance measurement and improvement activities. </li></ul>
  39. 39. Initiatives Achieving Six Sigma Performance <ul><li>VBMC – Harlingen </li></ul><ul><li>Acute Myocardial Infarction </li></ul><ul><li>Heart Failure Management </li></ul><ul><li>Inpatient Identification Process – Mother Baby Unit </li></ul><ul><li>Inpatient Identification Process – Ancillary Departments </li></ul><ul><li>Surgical Preparation – Day Surgery </li></ul><ul><li>CT turnaround time to ED </li></ul><ul><li>Inappropriate Abbreviations </li></ul><ul><li>VBMC-Brownsville </li></ul><ul><li>Acute Myocardial Infarction </li></ul><ul><li>Heart Failure Management </li></ul><ul><li>Inpatient Identification Process – Mother Baby Unit </li></ul><ul><li>Inpatient Identification Process – Ancillary Departments </li></ul><ul><li>VBHS </li></ul><ul><li>Forms Management </li></ul><ul><li>MDS Accuracy – Golden Palms </li></ul><ul><li>DRG Assurance of Accuracy </li></ul>
  40. 40. Questions? Contact information: [email_address]

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