5th Annual
WCBF Six Sigma in Healthcare Conference
Keynote Address
March 29, 2007
Las Vegas, Nevada
Implementing Six Sigma...
– Formed with the merger of Clarkson Hospital and UNMC’s
University Hospital in 1997
– 690 Beds
– Tertiary/Quaternary Acad...
•Increasing quality expectations
•Declining Reimbursement
•Increasing demand
•Increasing costs
•Increasing competition
•Wo...
Don’t bother if…
(1) Senior Leadership not truly committed
(2) Not willing to dedicate resources
(3) Not willing to adopt ...
The Chicken is supportive. The pig is committed.
•Board Involvement
•Consistency of Message
•Address the Naysayers
•Role in Project Selection & Belt Life Cycle
•Hold Spons...
•December 2002: Initial training with GE Healthcare
•Today: Full-time Manager, 2 MBBs, and 6 BBs as part of
Quality Improv...
Matt
Operations
Manager,
Dialysis
Six Sigma
Master
Black Belt
Selection
Development
Re-Entry
Six Sigma
Black Belt
Dec ’02-...
Lean Thinking
•Critical to most project successes to date
•Incorporated into all renovation & design work
Crew Resource Ma...
Most attractive
employer
Highest quality
customer service
& care
Most attractive
place to practice
medicine
Enhanced clini...
Billing Satisfaction Surveys
Improvements Made
 Simplified Itemized Statements. Itemized Statements sent automatically.
...
6Six Sigma
D M A I C
5 North Medication Admin Timeliness Project
“The Power of Removing the Bin”
• DMAIC-Lean Projects Initiated to-date: 52
– 11 New Projects Currently Being Scoped
• WorkOuts completed to-date: 168
– 2...
50%
60%
70%
80%
90%
100%
NMC is a good
place to work
Proudly
recommend for
healthcare
I amproud to
work for NMC
2001 2002 ...
18,000
20,000
22,000
24,000
2002 2003 2004 2005 2006
Discharges
0.21
0.22
0.23
0.24
0.25
MarketShare
# of Discharges % Mar...
Days of Cash on Hand
* Actual based on 5 months annualized.
0
10
20
30
40
50
60
70
80
90
100
110
120
Sep-
01
Jan-
02
May-
...
0
15,000
30,000
45,000
60,000
2002 2003 2004 2005 2006 *2007
Budget Actual
Seven-fold increase since 2002
Net Income
(in t...
Alignment and focus of projects on most important
Issues. Project selection is a learned skill
Learning to move faster
Bit...
Implementing Six Sigma in Healthcare Successes & Challenges
Implementing Six Sigma in Healthcare Successes & Challenges
Implementing Six Sigma in Healthcare Successes & Challenges
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Implementing Six Sigma in Healthcare Successes & Challenges

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  • Exercise How inefficient would you estimate your organization to be? 5%, 10%, 20%? If your organization generates $100 million in revenue annually…
  • Just breakfast first (large); breakfast shrinks and Chicken & then pig fade in; tombstone on click
  • Our Priorities do not focus solely on financial results The success we have achieved as an organization has come from leadership doing three very important things: (1) Defining what is important (2) The critical role that Acceptance (the “A” side) plays in continuous and sustained improvement (3) Holding individuals accountable to what is important There is logic in placing The most attractive place to practice medicine and most attractive employer at the top of the diagram. The positive effects from being successful with them translates into success in the rest. All of this is linked to creating a culture of accountability. Without a culture of accountability we won’t have the outcomes we desire.
  • Toyota Slice; Animate for presentation; static for handout
  • Before Lean Avg time to obtain results for a CBC: 35min Prelim results after implementation: 26min
  • Will add graphs (i.e. market share; good results)
  • Implementing Six Sigma in Healthcare Successes & Challenges

    1. 1. 5th Annual WCBF Six Sigma in Healthcare Conference Keynote Address March 29, 2007 Las Vegas, Nevada Implementing Six Sigma in Healthcare Successes & Challenges Glenn Fosdick, FACHE President and Chief Executive Officer
    2. 2. – Formed with the merger of Clarkson Hospital and UNMC’s University Hospital in 1997 – 690 Beds – Tertiary/Quaternary Academic Medical Center • $550 million budget • 22,000 inpatient discharges • 132,000 patient days • 445,000 outpatient visits – Patients from all 50 states, 42 countries – JD Power & Associates Distinguished Hospital for Service Excellence (2005 & 2006) – National reputation in Cancer Care, Transplantation
    3. 3. •Increasing quality expectations •Declining Reimbursement •Increasing demand •Increasing costs •Increasing competition •Workforce shortages •Consumerism •Technology •Physician reimbursement
    4. 4. Don’t bother if… (1) Senior Leadership not truly committed (2) Not willing to dedicate resources (3) Not willing to adopt & integrate other tools & methods (4) Interest is in either a quick fix solution or financial return only
    5. 5. The Chicken is supportive. The pig is committed.
    6. 6. •Board Involvement •Consistency of Message •Address the Naysayers •Role in Project Selection & Belt Life Cycle •Hold Sponsors Accountable •Require leaders to demonstrate application of tools & methods •Recognition
    7. 7. •December 2002: Initial training with GE Healthcare •Today: Full-time Manager, 2 MBBs, and 6 BBs as part of Quality Improvement Function *Limited training of Green Belts *Dedication of Top Talent *Dual Track Program: Leadership Development & QI Professional Tracks •Internal candidates challenging to identify & recruit •“Washouts” have occurred
    8. 8. Matt Operations Manager, Dialysis Six Sigma Master Black Belt Selection Development Re-Entry Six Sigma Black Belt Dec ’02-Aug ‘03 Aug ‘03 – Aug ‘06 Director, Neurological Sciences Aug ’06 – Present “I’m thrilled with Matt’s development as a result of his Six Sigma Assignments. Matt was a talented manager before becoming a BB/MBB, yet his leadership skills grew significantly while serving as a BB/MBB. He has infused our Service line with his ability to make objective, data-driven decisions. Matt’s understanding of how to effectively use data has earned the respect of physicians and enabled him to establish very clear expectations for his staff.” Deb Istas, Executive Director, Neurological Sciences Service Line
    9. 9. Lean Thinking •Critical to most project successes to date •Incorporated into all renovation & design work Crew Resource Management •Team skills & decision making training adopted from aviation •Nearly 1000 OR, ED, Cath Lab, and EP lab staff & physicians trained thus far •Good catches documented: wrong site surgery averted, antibiotics not started, potential mix up of two patients named Smith Balanced Scorecard •Corporate & Director level developed thus far •Drive project identification and monitoring
    10. 10. Most attractive employer Highest quality customer service & care Most attractive place to practice medicine Enhanced clinical quality & patient safety A culture of clinical, operational, & financial accountability QUALITY “A Strategic Separator” Interest Not Limited to Financial Returns
    11. 11. Billing Satisfaction Surveys Improvements Made  Simplified Itemized Statements. Itemized Statements sent automatically.  Completely Revised Patient Liability Statements  Billing Web Pages and Improved Patient Education Materials Billing Website 595 Visits in 2005 (live 8/15/05) 607 Visits from Jan-March 2006 % Positive Responses 72% 77% 86% 87% 89% 91% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100% January 2004 April 2004 July 2005 October 2005 January 2006 April 2006
    12. 12. 6Six Sigma D M A I C 5 North Medication Admin Timeliness Project “The Power of Removing the Bin”
    13. 13. • DMAIC-Lean Projects Initiated to-date: 52 – 11 New Projects Currently Being Scoped • WorkOuts completed to-date: 168 – 27 WorkOuts Underway Project Financial Benefits (through 1/07) Hard $ To-date Soft $ To-date $ 2.5 million $ 5.6 million
    14. 14. 50% 60% 70% 80% 90% 100% NMC is a good place to work Proudly recommend for healthcare I amproud to work for NMC 2001 2002 2004 2006 GoodEmployee Opinion Survey Employee Turnover 25% Reduction from 2003 to 2006 (20.4% to 15.3%)
    15. 15. 18,000 20,000 22,000 24,000 2002 2003 2004 2005 2006 Discharges 0.21 0.22 0.23 0.24 0.25 MarketShare # of Discharges % Market Share Good Market Share & Pt Volume
    16. 16. Days of Cash on Hand * Actual based on 5 months annualized. 0 10 20 30 40 50 60 70 80 90 100 110 120 Sep- 01 Jan- 02 May- 02 Sep- 02 Jan- 03 May- 03 Sep- 03 Jan- 04 May- 04 Sep- 04 Jan- 05 May- 05 Sep- 05 Jan- 06 May- 06 Sep- 06
    17. 17. 0 15,000 30,000 45,000 60,000 2002 2003 2004 2005 2006 *2007 Budget Actual Seven-fold increase since 2002 Net Income (in thousands) * Actual based on 5 months annualized.
    18. 18. Alignment and focus of projects on most important Issues. Project selection is a learned skill Learning to move faster Biting the bullet on difficult people Belts returning to key leadership positions within the Organization Staying on message – this is not “a fad” Convincing the skeptics Commitment to improving the product

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