In a nutshell, this presentation should tell the story of how “it” used to be, why “it” had to change and how we changed “it” at SFMC with brief examples of results and lessons learned. The “it” we are talking about is Performance Improvement in Patient Care Outcomes. In the past, MDs kind of did their own thing, based on their culture of independence and learning from expert physicians. Traditionally, hospitals provide performance data from quality management department – but rarely pushed for practice changes and MDs changed practice as their experience & knowledge sources provided evidence for change. There has been a critical shift in the Healthcare environment due to public awareness of quality and safety issues and regulatory and payor response. Due to this critical shift, the old order of PI has had to change. Hospitals are challenged to improve performance and to engage and enable Physicians to change theirs.
Who we are and why we were looking for change...
How it used to be... The traditional physician culture creates roadblocks to collaboration and rapid improvement...
In addition, the healthcare culture is steeped in the old way of doing business – Just a few years ago, benchmarking to mediocrity was the norm. Like most HC systems of the old order, we had a very solid set of beliefs that were barriers to true performance improvement.
The IOM report “To Err is Human” was the stimulus for a critical shift. The old order of hospital and MD “quality management” was put on trial and judged guilty of being ineffective! What to do now...
Initial skepticism was fueled somewhat by our learning from manufacturing. However, the bigger skepticism came from our own history with performance improvement.... Flavor of the Month... Bottom up rather than top down... No commitment from the top...
Initial pressure came from CAT contract and invitation to learn 6 Sigma Management System to create significant change in outcomes by improving processes.
We adopted 6 Sigma as a framework for Transformation change. It would not be a program or a department – no flavor of the month.. Deployment was about developing new competencies in problem solving and about aligning improvement efforts with strategy. Not additional work, but the WAY we would do our work.
Transforming how people think about and do their work
Scientific Approach Data required Rigorous application of methodology Sophisticated knowledge and use of data Successful projects – results sustained over time Listen and respond to concerns
Choose a physician champion who has early adopter characteristics Respected as a Physician Good at communicating Willing to standup when needed (has courage) Good social skills and relationships Primary care background a bonus Be sure you have a physician champion who can Make the case for the change Show potential gaps in performance Constantly communicated your message in multiple ways to multiple groups Recognize that when you talk with one physician you have talked to one physician You need to pay him for his time You need to keep him informed You have to have clear alignment and support ( no waffling when a heavy producer starts to squawk)
QQ is committed to working jointly with clinicians, employers, payers and patients to effect lasting positive changes in healthcare. Not really here to talk about QQ initiative as much as the EBS project….
Local – every facility and every md is important to this community and can make a difference Respect – We all have different vantages points that will add value, their involvement is essential to success Process - 6 sigma mantra… it’s not people it’s process Environment --Md’s often trapped in the system Opportunity - input Talents – “the product I produce is not as good as I would like it to be, but I am good” Expertise – leverage and articulate what is good about them SBAR – clear direction and an end point.
Achieving Physician Buy-in for
Leveraging 6 Sigma Management System
OSF Saint Francis Medical Center
Tim C. Miller, M.D.
Vice President, CMO & Director of Academic Affairs
6 Sigma Black Belt
WCBF’s 7 th Annual Lean, Six Sigma and Process Improvement in Healthcare Summit
Improvement Methodologies Methodology Wars IHI Collaboratives 6 Sigma Lean & Kaizan TQM/CQI EBM Nursing Research KEEP IT SIMPLE!
6 Sigma The Unifying Framework for Improvement Adequate Human Resources Living Our Values Every Day OSF Mission Improve Capacity Improved Patient Safety Improved Service Improved Cost and Reimbursement Community Safety Quality Service Value 6 Sigma
Operations First Demonstrate use of 6 Sigma to address MD complaints with operations! Target key operations processes that frustrate physicians to demonstrate the improvement power of 6 Sigma Y = f (x)
Strategy: Best Quality September 5, 2007; Page D1
6 Sigma Relationship to EBM 6 Sigma doesn’t create clinical evidence – it helps us use it consistently 6 Sigma Targets Reducing Variation And Elimination Of Errors to Reliably Deliver Quality Care In A Safe Environment Y = f (x)
Coordinate New Projects with Clinical/Academic Strategies
TAL (Teaching, Administration and Leadership) video
Engaging Physicians I heard that you are a certified 6 Sigma Black Belt Zombie. Is that true? He didn’t seem dangerous, Dr. Smith. I’m an assertive and innovative professional, experienced in lean, six sigma and process improvement in healthcare. I just sat through a 3-hour project review meeting.
How did we get them there? “ W e are going to ask you to do some tough things …”
Articulate the Burning Platform What will make you uncomfortable enough that you will want to be a part of the change? In the future, everybody will have 15 minutes of quality health care. State Ranking on Quality Dimension