SUCCESS STORY: How Lean Six Sigma Saved $4 Million at UCSD Medical Center

10/2/17
How Lean Six Sigma Saved
$4 Million at UCSD Health
A Lean Six Sigma Success Story
Presented by Lily Angelocci
Process Improvement Specialist,
UC San Diego Department of
Pharmacy

Lily Angelocci
• Department of
Pharmacy, UC San
Diego
• Process Improvement
Specialist
About Our Presenter
2

• UC San Diego Health is one of five academic medical centers
• Collectively known as UC Health, fourth largest health care delivery
system in California
• Train nearly 50% of the State’s medical students and medical
residents.
• Combined capacity of 808 beds.
• Two-campus strategy, integrating research, teaching and clinical care
at locations in Hillcrest and La Jolla.
• Each medical complex supports acute in-patient care and a
spectrum of outpatient primary and specialty care.
About UCSD Medical Center
4

UCSD
Lean Six Sigma Black Belt
Managing Medication Wastage in IV Room
UCSD Medical Center
Trained and Mentored by Ric Van Der Linden & Steve Spravzoff PharmD (619)244-8705

Overall Project Benefits
• Achieved $3.73 Million Annual revenue recovery
• Achieved $1.63 Million net income
• Gained three FTE’s opportunities
• Improved the total scanning rate from 34% (Sep 2016) to 63% (Dec 2016)*
• Eliminate two steps manual verification by adding scanning process,
Improved the medication safety
• Identified top root causes to improve scanning rate
• Gain insights from IV room staff what can be done to improve the fairly new
Prep/Check scanning process
• FMEA created to guide next step for scanning process improvement
* Five location average
UCSD IV Room Medication Wastage Management
6

Team Members
Information or Activity Target Audience Information Channel Who When
Project Status Pharmacy Leadership In person Meetings LA Weekly
UCSD Executive Team Approval Status UCSD PMO Office Email LA As needed
Data Collection and Verification EPIC Reporting Team Meetings/Emails LA As needed
KaiZen Event IV Dispense Staff Meetings, Survey Monkey LA As needed
Dispense Prep Scanning Outcome Review Pharmacy Quality Club Meetings/Action Items LA Quarterly
Communication Plan
7
Name
% share on
Project
White Belt
Trained?
Yellow Belt
Trained?
Green Belt
Trained?
Black Belt
Trained ?
Jo Anna Lamott 20% No No No No
Susan Wilson 10% No No No No
Carrie Coates 10% No No No No
Hieu Dao 10% No No No No
Lily Angelocci 50% Yes Yes Yes Yes
Team Leader
Chartering Manager
Mentor/Coach
Lily Angelocci
Jo Anna Lamott
Rick Van Der Linden & Steve Spravzoff

Project charter – Revised from Beginning of the project
UCSD IV Room Medication Wastage Management 8

Define

Background
• CMS new policy (JW Modifier) starting Jan. 1, 2017
• UCSD Medical Center had no process in place to embrace this
opportunity
Define Measure Analyze Improve Control
10

Problem Statement
Problem Statement
A.For years, because the drug companies refuse to produce smaller size vials to meet
individual patient needs in order to optimize their profit, hospitals are forced into buying
bigger than needed single-dose-vial medication and biologics that a lot of times end up
in waste (as they have to be disposed after 6 hour after opening). Government released
JW Modifier* policy starting Jan. 2017, those hospitals who are able to document and bill
drug waste will get reimbursed by appointed payors. As of Sep. 2016, the process was
not in place for UCSD to fully take advantage of this opportunity.
B.The IV room medication scanning process, which is a crucial step to achieve A, shows
significant variance among UCSD five locations. “The process desperately needs to be
improved” (staff feedback).
Benefits to Business/UCSD Medical Center
• Revenue Capture
• IV room Prep & Check process improvement
Benefits to Customers/Patients
• Safe medication
* For the purpose of this project, only Moores cost data is used as it represents 80% of UCSD infusion centers’ cost of goods

Define the Scope of the Medications Included in This Project
• A single-dose container is a single-unit container for articles or
preparations intended for parenteral administration only.
• It is intended for a single use.
• A single-dose container is labeled as such (Sample below).
• Opened/needle-punctured single-dose containers (vials) of sterile
products shall be used within 1 hour if opened in worse than ISO
Class 5 air quality (6 hours if in ISO Class 5 or cleaner air)
• Starting Jan. 1, 2017, UCSD is billing 23 top oncology medications
for waste reimbursement
Reference: The United States Pharmacopeial Convention © 2008, USP <797> Pharmaceutical
Compounding – Sterile Preparation
12

Measure

A Few Jargons Used Frequently Here
Prep-Carry over
Vs. Prep -Waste
UCSD IV Room Medication Wastage
Management
14

§ Return on Investment (ROI) – Detail next slide
ü Sep. 2015 – Aug 2016 Moores Cancer Center data
ü Five payors (50%) will pay on drug wastage billed through “JW Modifier”
ü Billing for waste starting on Jan 1st, 2017 by CMS
ü In Jan. 2017, $900K was billed for waste (Feb 15th Financial report)
§ Process change required
ü Change from “Prep/carry over” model to “Prep/Waste” model
ü Crucial to ensure “Prep/Check” scanning process is 100% in place
ü Additional Pharmacy FTE’s needed for prep and documentation
ü Additional billing FTE needed for auditing
ü Increase in single dose vial medication purchase
ü Increase in charges & revenue
Overall Process Change and Financial Outcome
15

Single Dose Vial Medication Financial Analysis
(Moores Cancer Center; Sep. 2015 – Aug 2016)
Jan. 1, 2017
Single Dose Vial Med Name Cost/Vial
Vials
Used
Wasted
Vials
Vials
Used Cost/Yr
%
Wasted
Wastage at
Cost
Vials
needed Cost/yr
Wastage at
Cost
Increased
cost/Yr Wasted Charge
IPILIMUMAB 200 MG/40ML IV SOLN 18,842 237 42 237 4,465,554$ 18% 800,788 256 4,822,798$ 1,158,032$ 357,244$ 6,137,571$
PEMBROLIZUMAB 100 MG/4ML IV SOLN 3,321 734 86 734 2,437,614$ 12% 267,639 818 2,715,317$ 545,342$ 277,703$ 2,890,311$
PLERIXAFOR 24 MG/1.2ML SC SOLN 5,376 192 49 192 1,032,192$ 25% 260,917 214 1,151,291$ 380,016$ 119,099$ 2,014,086$
NIVOLUMAB 100 MG/10ML IV SOLN 1,854 2,148 118 2,148 3,982,392$ 5% 216,334 2,373 4,398,733$ 632,675$ 416,341$ 3,353,176$
RITUXIMAB 500 MG/50ML IV SOLN 1,411 1,136 131 1,136 1,602,896$ 12% 176,342 1,322 1,865,188$ 438,634$ 262,292$ 2,324,759$
CARFILZOMIB 60 MG IV SOLR 1,277 437 98 437 558,049$ 22% 125,782 451 576,051$ 143,784$ 18,002$ 762,055$
BORTEZOMIB 3.5 MG IJ SOLR 787 780 153 780 613,860$ 20% 119,632 825 649,446$ 155,218$ 35,586$ 822,655$
RAMUCIRUMAB 500 MG/50ML IV SOLN 3,829 83 28 83 317,807$ 34% 111,347 83 317,807$ 111,347$ -$ 590,139$
PEMETREXED DISODIUM 500 MG IV SOLR 1,603 384 55 384 615,552$ 14% 90,095 401 642,315$ 116,858$ 26,763$ 619,346$
BEVACIZUMAB 400 MG/16ML IV SOLN 522 1,832 155 1,832 956,304$ 8% 79,191 2,300 1,200,361$ 323,247$ 244,057$ 1,713,211$
BLINATUMOMAB 35 MCG IV SOLR 2,449 148 29 148 362,452$ 19% 70,534 148 362,452$ 70,534$ -$ 373,831$
DARATUMUMAB 400 MG/20ML IV SOLN 1,361 577 48 577 785,297$ 8% 61,439 590 803,350$ 79,492$ 18,053$ 421,305$
PACLITAXEL PROTEIN-BOUND PART 100 MG IV SUSR 686 633 83 633 434,238$ 13% 57,866 633 434,238$ 57,866$ -$ 306,692$
CETUXIMAB 100 MG/50ML IV SOLN 387 2,777 121 2,777 1,074,699$ 4% 45,859 2,825 1,093,149$ 64,309$ 18,450$ 340,835$
ERIBULIN MESYLATE 1 MG/2ML IV SOLN 685 357 58 357 244,545$ 16% 36,907 357 244,545$ 36,907$ -$ 195,608$
BRENTUXIMAB VEDOTIN 50 MG IV SOLR 3,282 91 10 91 298,662$ 11% 33,874 91 298,662$ 33,874$ -$ 179,533$
CYCLOPHOSPHAMIDE 1 GM IJ SOLR 269 758 126 758 203,902$ 17% 33,094 969 260,541$ 89,733$ 56,639$ 475,586$
DECITABINE 50 MG IV SOLR 654 98 38 98 64,092$ 39% 25,019 98 64,092$ 25,019$ -$ 132,599$
AZACITIDINE 100 MG IJ SUSR 129 965 170 965 124,485$ 18% 20,922 1,169 150,847$ 47,283$ 26,362$ 250,601$
ROMIPLOSTIM 250 MCG SC SOLR 812 93 23 93 75,516$ 24% 19,433 93 75,516$ 19,433$ -$ 102,995$
TOCILIZUMAB 200 MG/10ML IV SOLN 504 134 17 134 67,536$ 13% 8,874 134 67,536$ 8,874$ -$ 47,035$
BELIMUMAB 400 MG IV SOLR 1,169 7 - 7 8,183$ 0% 219 7 8,183$ 219$ -$ 1,158$
TOCILIZUMAB 400 MG/20ML IV SOLN 1,009 34 - 34 34,306$ 0% - 34 34,306$ -$ -$ -$
Total 14,635 1,635 14,635 20,360,133 11% 2,662,105 16,190 22,236,723$ 4,538,696$ 1,876,590$ 24,055,087$
Eliminate Increase cost Bill for waste
Prep/WastePrep/Carry Over
16
Highlights
Additional charges 24,055,087$
Eliminate drug wastage 2,662,105
Increase purchasing cost/yr $1,876,590

Return on Investment for JW Modifier Billing
JW Modifier Drug Wastage Billing Financial Overview
Moores Cancer Center 23 Billable Drugs (Sep. 2015 - Aug. 2016)
Revenue Capture
Charge 24,055,087$
50% Payor participation (12,027,544)$
Cash Receivable (at 31% realization rate) 3,728,539$
Cost /Expenses
Additional pharmacy labor (2.0 FTE Salary + 30% Benefits) ($162,863)
Additional billing labor (1.0 FTE Salary + 50% Benefits) ($60,000)
Increase in drug purchasing cost ($1,876,590)
Total Cost ($2,099,453)
Net Income 1,629,085$
Note: Realization rate and other financial modeling based on FY2016 Oncology data analysis
17

Findings on Cost of the Wasted Medications at MCC
$130,968
$179,715
$188,922
$199,729
$213,909
$239,009 $238,509
$325,229
$252,693
$231,124
$211,042
$251,258
13.2%
14.3%
13.7%
14.3%
14.1% 14.2%
11.8%
16.1%
12.4%
12.6%
12.0%
11.3%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
$100,000
$150,000
$200,000
$250,000
$300,000
$350,000
Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16
MCC 23 Single Dose Vial Drug Monthly Waste
Sep. 2015 - Aug. 2016
Total Waste % of waste by month
18
Peak in April 2016 was due to two additional Leukemia patients being treated with Blinatumomab and 25% of each vial had to be
Wasted.

Control Chart
UCL=301481
LCL=136855
CEN=219168
0
50000
100000
150000
200000
250000
300000
350000
9/1/2015 10/1/2015 11/1/2015 12/1/2015 1/1/2016 2/1/2016 3/1/2016 4/1/2016 5/1/2016 6/1/2016 7/1/2016
Total Waste by Month
UCL=101097
LCL=0
CEN=30945
-40000
-20000
0
20000
40000
60000
80000
100000
120000
9/1/2015 10/1/2015 11/1/2015 12/1/2015 1/1/2016 2/1/2016 3/1/2016 4/1/2016 5/1/2016 6/1/2016 7/1/2016
Moving R Chart
19

Medication Waste Cost Pareto
31%
42%
51%
60%
67%
71%
76%
80%
84%
87%
89%
92%
93%
95%
96%
97% 98% 99% 100% 100% 100%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
$0
$500,000
$1,000,000
$1,500,000
$2,000,000
$2,500,000
TotalWasteatCost
Medication
Distribution of Drug Waste At Cost
Time Frame: Sep 2015 - Aug 2016
Location: MCC
$2.1 Million/Year Waste at
Cost
Top Eight Drugs
20
Take away is that if everything else fails, we can capture 80% of revenue if we successfully bill for these eight drugs.

SIPOC
Suppliers Inputs Process Steps Outputs Customers
Physicians
Medication
Orders
IV room manual compounding
process IV medication mixture Patients
Physicians
Medication
Orders
IV room compounding process
& "prep & Check" to ensure
accuracy and timeliness IV medication mixture
Pharmacists &
technicians
Pharmacy
EPIC "Prep &
Waste"
Configuration
Prep-Waste process in EMR
system
Bill for waste, revenue
capture
UCSD Medical
Center
21

• Manually collect data by end of the day or next
day – time consuming, estimated vial remainder
• It has been know we waste “expensive”
medication everyday, but no data showed by how
much, and “We can’t help it”!
• Inventory tracking – discrepancy between
purchased and administrated *
• Can’t bill for waste so we leave money on the
table!
Current State Drug Wastage Tracking and Opportunity for Improvement
(Oct. 2016)
* Potential project (in Appendix) 23

Process Map - Past, Current and Future
Order Received (in
EPIC Verification Que)
Order Verified by
Pharmacist
Medication label
prints in Pharmacy
Technician Grabs
label and
approperiate
drugs/NDC’s
Technician mixes
and completes
preparation of
mixture
Technician writes
NDS’s used for
prep on med
receipt label
Tech initials bag
and places all
products used in a
bin for pharmacist
Pharmacists
checks drug
mixture and
products used
Pharmacist verification
of compounding
accuracy(Yes/No)
Deliver to patient
Yes
NO
Tech scans label
in EPIC
“Dispense Prep”
Tech scans NDC’s
used for
preparation
Tech completes
preparation of IV
mixture
Allow charging for
waste
Drug qualified for
charging waste?
Document waste
drug name/
amount in EPIC
“Prep & Waste”
No
Yes
Charge dropped
upon
administration
Human Error
24

Charging for Waste During Dispense Preparation
(EPIC Team Workflow)
150 mg of Bevacizumab (6 ml) being documented for waste
25

IV Room Dispense Preparation Scanning Implementation Overview
La Jolla
(July 2015)
La Jolla
Encinitas
Vista
Hillcrest
(June - Aug 2016)
La Jolla
Encinitas
Vista
Hillcrest
Moores
(Sep 2016)
Implementation Timeline
“However, are
Ready to bill
Yet?”
26

95%
94%
97% 97%
99% 99% 99%
2% 1%
13%
63%
67%
69% 69%
40.8%
16.0%
7.2% 7.7%
5.4%
17.4%
24.6%
0% 0% 0%
34%
98% 99% 99%
0% 0%
85%
93%
97%
96%
97%
28%
10%
12%
34%
59%
62%
63%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16
Pharmacy Dispense Prep & Check Scanning Rate
( Jun 2016 - Dec 2016)
Encinitas Hillcrest La Jolla Moores Vista Overall
27

Root Cause Analysis
0%
50%
100%
150%
200%
250%
300%
350%
400%
450%
Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16
Are All 5 Locations Equal in Performance?
(Dispense Prep Scanning Rate)
Jun 2016 – Dec 2016
Encinitas Hillcrest La Jolla Moores Vista
Why?
28

A few Key Points from Survey (VOC)
THANK YOU!
§ “Desperately need to improve the process”
§ “Exhausting to run back and forth from central dispensing
area to IV room”
§ “Scanner doesn’t work sometimes, and we have to restart”
§ “It slows down the process”
§ “Get everyone compliant”
§ “Why do some drug lot and expiration date scan in the
system and a lot do not”
§ “I like the Prep& Check feature for patient safety reasons,
but it takes time to scan each components, can we get
better technician coverage for IV room, esp. during busy
hours”
§ …….

IV Room Process Improvement and Root Cause Analysis
Not 100% Scanning Rate
System
Lots of run back and forth between central dispensing
area and IV room
Some items not scanning
Dissatisfied with the process
Not everyone compliant at
The same level
Need more technician support due
To slower process
Inefficient
No auto -move forward
When scan multiple
items
Slower due to scanning
Measures
Inconsistency for “Expiration date” & “Lot #)
In system
Logistically
impractical
System needs to be updated
& streamlined
Not feasible during
Busy hours
Checking feature is not robust
Not all waste default in mg
Have to restart
When scanner does
Not work
Sometimes scanner
Does not work
Some functionality
Not useful
Need better coverage
Like the concept of
Extra safety feature
Process Work Enviroment
Machines People
Friday, January 20, 2017
IV Room Prep & Check Scanning Process Opportunities to Improve & Root Cause analysis
30

FMEA
Process or
Product Name:
Lily Angleocci
Responsible: FMEA Date (Orig): (Rev): 1/20/2017
Process
Step/Input
Potential Failure Mode Potential Failure Effects
S
E
V
Potential Causes
O
C
C
Current Controls
D
E
T
R
P
N
Actions
Recommended
Resp. Actions Taken
p
S
E
V
p
O
C
C
p
D
E
T
p
R
P
N
What is the
process step/
Input under
investigation?
In what ways does the key
input go wrong?
What is the impact on the
key output variables
(customer requirements) or
internal requirements?
Howsevereistheeffectto
thecustomer? What causes the key input to
go wrong?
Howoftendoescauseor
failuremodeoccur?
What are the existing controls
that prevent either the cause or
the failure mode?
Howwellcanyoudetectthe
cause/failurebeforenextstep?
What are the actions
for reducing the RPN.
Should have actions
only on high RPN's or
easy fixes.
Who is
responsible
for the
recommende
d action?
What actions have been
taken and date
completed?
Scanner stops
working
Cant's scan Wait till it's fixed 10 Equipment not programed right 7 None 10 700 high RPN's
Pharmacy IS
team
none 4 4 10 160
Computer
screen logs out
every 30
seconds
Re-log in Slow down process 7 System Defult 4 None 4 112
Modify system
configuration
Phamacy IS
Team
none 4 7 4 112
Not enough
coverage at busy
hours
Can't mix IV Patient wait 10 need more tach coverage 7 hiring in process 7 490 hire more technicians
Pharmacy
management
yes 7 7 7 343
Not enough
coverage by
pharmacist
process stops for
verification
Technician wait, patient wait 4 more coverage on weekend 4 none 4 64
staff pharmacist in
busy hours
pharmacy
management
none 4 1 4 16
Allow go back to
previous screen
can not check previous
work
human errors 4 system configuration 4 none 4 64 system configuratino IS team none 4 1 1 4
Lily Angelocci
IV Room Prep/Check Scanning process Prepared by:
Process/Product
Failure Modes and Effects Analysis
(FMEA)
31

Prep/Check Process Current and Future State
63%Dispense Prep
Scanning Rate
100% Scanning
Rate
(Trackable &
Accurate
Information –
Patient Safety)
Bill for
Waste
Revenue
Capture!
“Have to focus on improving the KEY STEP!”
33

Kaizen Event on Feb. 6th
34

Tools used for this event
• Lean Six Sigma application in IV room
• “8 wastes” introduced
• Fishbone diagram displayed
• Survey conducted ahead of time
• 5 whys for “bottle neck” discovery
• Evidence based data talk: Scanning data shows
the gap between now (26%)and ideal stage
(above 70% by June 2017)
35

Output of Kaizen Event
• Brought transparency to staff so they had better understand
the importance of scanning process
• Built staff consensus to improve the current process and
improve scanning rate
• Gained staff support for future “change for better” event
• Quick wins:
o Manager: Hiring in process for extra FTE to cover the “slow downs” due to scanning
o Frontline staff:
o mount scanners on supporting posts to speed up (eliminate NVA motions)
o Touch screen to avoid “logging in” after short “go –to sleep” duration (NVA motions)
o Standardize the process so there is no doubt we need to compliant (decrease variation)
o Add Kanban to notify inventory low (decrease interruptions)
o Move frequent use drugs into IV room to avoid traveling back and forth from central
dispense area (eliminate NVA motions)
o Add pharmacist staffing on weekends to avoid bottle necks – waiting for verification
o Better quality scanners
o Allow multiple drugs to be scanned w/o pushing “next” (NVA motions)
36

Voice of the Customer (VOC)
Who are your Customers?
•UCSD Medical Center
•UCSD Medical Center IV room staff
•UCSD Medical Center Patients
What do they want?
•Revenue recovery for expensive infusion drug wastage
•Prep & Check scanning process improvement
•Accurate IV medications for safety
Quote from customer before project (if available)
“Desperately need to improve this process!”
“Inefficient, it can be exhausting running back and forth from central dispensing area to
IV room.”
“Scanners don’t work sometimes. Waste of time to reset and restart.”
“can we get everyone compliant to this process?”
Quote from customer after project (if available)
“We are hiring more staff to cover busy hours” _ IV room manager
“ It’s crucial for us to keep close attention on revenue capture” _ UCSD Med Center
Executive Team
37

Tools Applied
Define
• Current state process map
• Financial analysis to track trend of the drug waste
• List of variables
Measure
• Process map
• Trend chart, histogram, fishbone diagram
• Pareto
Analyze
• DOE
• Cause & Effect
• FMEA
Improve
• Survey Monkey
• Diagnosis event
• Improve List
Control
• Control chart
• Department Quality Assurance Dashboard
• Control plan
38

Actions Taken to Improve Process to Improve Processes
•Site Visit (MCC IV Clean Room) to collect first hand
information on drug wastage tracking (Oct 2016)
•Process mapping created (Jan 2017)
•Data collection and analysis (Sep. 2016 – Feb 2017)
•Survey Monkey sent out in Dec. 2016
•Cause and Effect diagram created
•Kaizen event after Survey Monkey results collected
•Engage front line pharmacists and technicians for
process improvement
•Create more LSS projects
39

Results Achieved - Qualitative
• One year (Sep 2015 – Aug 2016) of historical waste
analysis provides clear picture for the leaders to
understand the scope of the problem
• Introduced LSS ideas to immediate team members and
generated ideas for future quick and feasible projects
• Wins at the mini Kaizen events – positive feedbacks
• More desire to comply to “standard practice” by “owning”
the process
• Engage PMO office for more corporation on pharmacy
initiatives.
40

Action and Result Summary
Project or Event Title: IV Room Dispense Preparation Scanning Rate Improvement Date: Jan 2017
Problem Results
Before Picture After Picture
Action and Results Summary
Team Members: Lily Angelocci, Ashely Dalton, LJ IV room staff
Monthly reported data July 2016 through Sep 2016
reveals that the scanning rate at our La Jolla location
was below 10% compliant rate. Other than
environmental reasons such as broken machines
and fungus in IV room, the Dec. 2016 Monkey Survey
also showed staff dissatisfaction with current
scanning process.
Survey Monkey sent in Dec 2016 to all
locations; Staff feedback collected; LSS
concept applications introduced to LJ IV
room staff; Eight wastes, 5 whys and 5S
discussed at the event; some quick solutions
such as "mounting the scanners", "move
inventory around" came out of this event;
FMEA completed for next stage of
improvements.
Action Taken
Scanning rate improved from
10% (1Q FY17) to 25% (Dec
FY17)
16%
7% 8%
0%
5%
10%
15%
20%
25%
30%
Jul-16 Aug-16 Sep-16
La Jolla IV Room Prep -Check Scanning Rate
5%
17%
25%
0%
5%
10%
15%
20%
25%
30%
Oct-16 Nov-16 Dec-16
La Jolla IV Room Prep -Check Scanning Rate
41

Control Plan (I)
• Bi-weekly meeting with UCSD Medical Center Project Management Office – track and assess
• Monthly financial report from Revenue Cycle Department to track revenue captured
• Monthly Pharmacy QAPI club meeting to discuss tracking outcome and action items (sample
below)
• Ongoing work with Pharmacy IS team to ensure optimization of scanning process
• Ongoing effort to update system with most current drug library
43

Control Plan (II) Define Measure Analyze Improve Control

Next Steps
Remaining Actions Owner Planning Completion Date
Meeting scheduled on Feb 15th with PMO office to
set baseline and goals for revenue capturing for
billing wastage Lily, David, Jo Anna, Chuck Feb 15th, 2017
Continuing IV room scanning process improvement
Kaizen event/s Lily & Pharmacy Dep Managers April 30th, 2017
Monitor Scanning rate data and provide leaders
status update Lily Monthly meetings
Wastage revenue capture effectiveness Lily & Revenue Cycle analysts Ongoing till stabilization
Quarterly update to Pharmacy leaders Lily Ongoing
45

Training and Mentoring
• Team selection and notified; identified scope
• Educate team with Lean Six Sigma concept that led to
various ideas for office work flow process improvement
• Instruction on identifying 8 Wastes (Feb 2017)
• 5 Whys led to the root cause for bottle necks in IV room
process (Jan 2017)
• What’s Lean Six Sigma (Feb 2017)
• IV room technician review of current root cause of low
scanning rate; coordinate platform for solutions
46

Lessons Learned
• Stating specific problem without giving solution, there might be better
ways to solve the problem using DMAIC tools
• Scope of the project might change as process moved on. Adjust
expectation so the project can be completed in the timeframe
• Stay focused, but be flexible when priority changes
• Expect resistance from the process owner/s and work through: the
focus is the process improvement, not to assign blame
• Build effective Survey Monkey (VOC):
– Respect survey takers time – preferably provide time needed to complete
– Option to clarify location/department so to target follow up actions
• One person, one vote – regardless of position
• Plant seeds but don’t overpower the team with your own ideas
• Teach/share LSS methodology whenever you can _ it takes time to build
LSS culture
• Have fun, just do it!
47

Getting Started
49
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SUCCESS STORY: How Lean Six Sigma Saved $4 Million at UCSD Medical Center

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SUCCESS STORY: How Lean Six Sigma Saved $4 Million at UCSD Medical Center