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Integrating Six Sigma into your Existing Clinical Performance Improvement Activities


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Integrating Six Sigma into your Existing Clinical Performance Improvement Activities

  1. 1. Integrating Six Sigma into your Existing Clinical Performance Improvement Activities Dr. James LaMorgese Chief Medical Officer Sherrie Justice Director, Performance Improvement
  2. 2. Objectives <ul><li>Interpreting Six Sigma under the umbrella of the Baldridge Criteria for process excellence </li></ul><ul><li>Complementing the models of organizational excellence with quality improvement </li></ul><ul><li>Clinical practice project for improving and reducing variation in door to therapy time – “Door to Dilatation” </li></ul><ul><li>Involving multiple departments </li></ul>
  3. 3. St. Luke’s Hospital <ul><li>120 year old Non-Profit Community Hospital in Cedar Rapids, Iowa </li></ul><ul><li>240 - Average daily census </li></ul><ul><li>39,000 ED visits/year </li></ul><ul><li>2500 Births/year </li></ul><ul><li>25+ year Cardio Thoracic Heart Program </li></ul><ul><ul><li>2004 Solucient Top 100 Cardiovascular Hospital </li></ul></ul><ul><li>25+ year CARF accredited Rehab Program </li></ul><ul><li>Surgical Services – 75% Outpatient, 25% Inpatient </li></ul><ul><li>Behavioral Health – Adult/Geriatric, Child/Adolescent </li></ul><ul><li>Home Care/Hospice </li></ul>
  4. 4. Iowa Health System <ul><li>1995 Formed: St. Luke’s and Central Iowa, Des Moines charter members </li></ul><ul><li>Hospital Affiliated/Not full mergers </li></ul><ul><li>Retain Local Boards </li></ul><ul><li>Economies of Scale – purchasing supplies, physician contract negotiation, information technology support. </li></ul>   Waterloo Cedar Rapids   Dubuque Des Moines Sioux City Fort Dodge Quad Cities
  5. 5. Opportunity <ul><li>“ Opportunity is missed by most people because it is dressed in overalls and looks like work” </li></ul><ul><li>Thomas Edison </li></ul>
  6. 6. <ul><li>St. Luke’s Approach to Achieving the Strategic Framework </li></ul>
  7. 7. The Home Front <ul><li>St. Luke’s Hospital had new leadership team – CEO, COO, CFO </li></ul><ul><li>Strategic Plan – Deliver Demonstrably Better Quality </li></ul><ul><li>People critical to this strategy </li></ul><ul><li>Added 2 additional roles </li></ul><ul><ul><li>Director, Center for Quality Management and Clinical Effectiveness </li></ul></ul><ul><ul><li>VP, Organizational Effectiveness </li></ul></ul><ul><li>Resources devoted to physician and staff development </li></ul>
  8. 8. Elements of the Strategic Plan <ul><li>Demonstrably better quality </li></ul><ul><li>Physician workshop of choice </li></ul><ul><li>Partnership with associates </li></ul><ul><li>Strengthen the core </li></ul><ul><li>Regional provider of choice </li></ul>
  9. 9. Breaking Out of the Pack <ul><li>Balanced Scorecard Team </li></ul><ul><li>Baldridge Organization Profile Team </li></ul><ul><li>Clinical Quality Steering Committee </li></ul><ul><li>Communication Team </li></ul><ul><li>Patient Satisfaction Team </li></ul><ul><li>Physician Efficiency Team </li></ul><ul><li>Staff Alignment Team </li></ul><ul><li>Staff Efficiency Team </li></ul>
  10. 10. Performance Improvement Structure Highlights
  11. 11. Interpreting Six Sigma under the umbrella of the Baldrige Criteria for process excellence
  12. 13. St. Luke’s Strategic Plan with the Baldridge Criteria St. Luke’s Strategic Framework Partnership with Associates Partnership with Associates High Middle Ground Top 100 Better Outcomes Strengthen the Core Better Outcomes Workshop of Choice Strengthen the Core Regional Resource
  13. 14. Conclusions <ul><li>The Baldridge values embedded in the criteria provide an ideal set of performance and quality criteria </li></ul><ul><li>Six Sigma provides an ideal deployment vehicle for leveraging quality and process improvement </li></ul><ul><li>Together, the Baldridge Criteria and robust statistical and analytical tools of Six Sigma can result in quantum improvements in organizations willing to invest </li></ul>
  14. 15. Complementing the models of organizational excellence with quality improvement
  15. 16. St. Luke’s Journey <ul><li>1970 – 1980’s: Internal Focus </li></ul><ul><ul><li>Emphasis on individual competence. Internal trends. </li></ul></ul><ul><li>1990’s: Shift toward process improvement </li></ul><ul><ul><li>Began external benchmarking in key services. </li></ul></ul><ul><li>2000: Benchmarking across the system </li></ul><ul><ul><li>Best practice sharing </li></ul></ul><ul><ul><li>Evidence based practice to decrease variation: resulted in receiving the JCAHO Codman Excellence Award for statewide care of Diabetes. </li></ul></ul><ul><ul><li>IHI strategic partner for the IHS - sets stretch goal, reached through small tests of change </li></ul></ul>
  16. 17. Six sigma as just one of the tools for clinical improvement to patient care and Involving multiple departments at multiple levels See Handout
  17. 19. Who Decides? <ul><li>Administration </li></ul><ul><ul><li>Vice President </li></ul></ul><ul><ul><li>Director </li></ul></ul><ul><ul><li>Manager </li></ul></ul><ul><li>Clinical Quality Steering Committee </li></ul>
  18. 20. How to choose? <ul><li>Impact to the hospital </li></ul><ul><li>Impact to the strategic plan </li></ul><ul><li>Breadth of the project </li></ul><ul><li>Resources needed </li></ul><ul><li>Time required </li></ul>
  19. 21. Clinical Quality Steering Committee <ul><li>Functions: </li></ul><ul><li>Recommends to the Board of Directors a hospitalwide approach to performance improvement and how all levels of the hospital address improvement issues. </li></ul><ul><li>Charters direct care performance improvement action teams </li></ul><ul><li>Ensures the ongoing development and implementation of the clinical processes within the Baldridge strategy. </li></ul>
  20. 22. Clinical practice project for improving and reducing variation in door-to-therapy time - “Door to Dilatation”
  21. 23. Door to Dilatation (D2D) Charter <ul><li>Decrease the variation in the door to dilatation time range for an ST elevated MI patient (STEMI). </li></ul><ul><li>Increase the number/percent of patients whose culprit lesion is dilated within the 90 minute time frame. </li></ul><ul><li>Baseline sigma 2.2 </li></ul>
  22. 24. Measure <ul><li>41% of STEMI patients have their culprit lesion dilated within 90 minutes </li></ul><ul><li>St. Luke’s average time is 103 minutes (April 2003-March 2004) </li></ul>
  23. 25. Measure/Analyze <ul><li>Voice of the customer </li></ul><ul><ul><li>EDP, cardiologists views </li></ul></ul><ul><li>NRMI data </li></ul><ul><li>Concurrent case review </li></ul><ul><li>Literature review - Advisory Board case example(s) </li></ul>
  24. 26. Average Door to Dilatation Time (minutes) for STEMI Patients From NRMI Sept ‘04
  25. 27. Percentage of Defects by Process Slices *Defect- anything that does not meet customer requirement. The lower the number the better.
  26. 28. STEMI Process Times by Shifts Identified from Six Sigma Chart Review (n=44)
  27. 29. Analyze
  28. 30. Rank Order of Solutions to Decrease the ED Time
  29. 31. Lessons Learned <ul><li>Team leadership </li></ul><ul><li>Project scope </li></ul><ul><li>Completion of education </li></ul><ul><ul><li>External assistance </li></ul></ul><ul><li>Influence over the project </li></ul>
  30. 32. Thank You <ul><li>James R. LaMorgese, M.D. </li></ul><ul><li>[email_address] </li></ul><ul><li>319-369-7391 </li></ul><ul><li>Sherrie L. Justice, R.N., M.A. </li></ul><ul><li>[email_address] </li></ul><ul><li>319-369-8367 </li></ul><ul><li>St. Luke’s Hospital </li></ul><ul><li>1026 A Avenue NE </li></ul><ul><li>Cedar Rapids, Iowa 52406-3026 </li></ul>