This document discusses using Lean Six Sigma methodology to improve processes at a hospital pharmacy. It provides an agenda that covers hospital process improvement, Lean Six Sigma, the pharmacy services at a specific hospital, and the Six Sigma DMAIC methodology. The DMAIC methodology is then applied as an example to improving processes related to diabetes diagnosis and treatment. The document references literature on Lean Six Sigma, hospital processes, pharmacy robotics, and diabetes diagnosis and management.

1. HOSPITAL PROCESS
IMPROVEMENT
The Lean Six Sigma Methodology
Dr. Armando Martinez, M.B.A., M.S., L.S.B.B.
martinez.armand@gmail.com

2. Presentation Agenda
1. Hospital Process Improvement
2. Lean Six Sigma
3. Hospital Pharmacy Services
4. The Six Sigma DMAIC Methodology

3. Process Improvement at BH 1
• Across Baptist Health it is encouraged to
identify opportunities for improvement in
the workplace and come up with solutions
to improve patient safety and satisfaction,
and the quality and efficiency of care.
• One performance improvement tool that it
is used is TRIM (Teams, Refocus, Imagine,
Measure).
• This is the proposal for implementing a
Lean Six Sigma Project at Baptist Hospital
Pharmacy Services (BH-Pharmacy-LSS).

4. Lean Six Sigma 2
Process management methodology driven by:
• Close understanding of customer needs.
• Disciplined use of facts, data, and statistical analysis.
• Diligent attention to managing, improving, and reinventing
business processes.
It is a comprehensive and flexible system for achieving,
sustaining and maximizing business success.

5. Body Levels of Organization 3
• Chemical
• Cellular
• Tissue
• Organ
• System
• Organism

6. Hospital Processes Framework
4

7. Hospital Processes – Pharmacy
5

8. BH-Pharmacy-LSS 6
• Where does the process start?
• Where does it end?
• Who is involved?
• What are the process steps?
• What are the process inputs?
• What methods are used?

9. Six Sigma DMAIC 7
Quality Strategy for Improving Processes

10. DMAIC and Diabetes 8,9,10
Diabetes Mellitus
Define
Group of metabolic diseases
Customer, Critical to Quality (CTQ) issues,
characterized by hyperglycemia
Core Business Process involved.
resulting from defects in insulin
secretion, insulin action or both.
• Who customers are, their requirements
(products and services), their expectations
1. Symptoms of diabetes plus a plasma glucose
• Define project boundaries,- the stop and start concentration >11.1 mmol/l obtained at any
of the process time of day and without regard to meals, OR
• Define the process to be improved by mapping
the process flow 2. Fasting plasma glucose >7 mmol/l, OR
3. A plasma glucose concentration >11.1 mmol/l
2 h after 75 g of oral glucose

11. DMAIC and Diabetes 8,9,10
Measure Tests and diagnosis
Performance of the Core Business Process 1. Glycated hemoglobin (A1C):
6.5 percent or higher on two separate
tests
• Develop a data collection plan
• Collect data from many sources to determine 2. Random blood sugar:
types of defects and metrics 200 milligrams per deciliter (mg/dL)
• Compare to customer survey results to — 11.1 millimoles per liter (mmol/L)
determine shortfall
3. Fasting blood sugar test:
126 mg/dL (7 mmol/L) or higher on
two separate tests

12. DMAIC and Diabetes 8,9,10
Analyze Symptoms: polydipsia, polyphagia,
polyuria
Determine root causes of defects and
opportunities for improvement. Complications: arise from damage to
blood vessels.
• Identify gaps between current performance and
goal performance • Macrovascular: accelerated
• Prioritize opportunities to improve atherosclerosis coronary, carotid and
• Identify sources of variation femoral arteries
• Microvascular: retinopathy,
nephropathy and neuropathies

13. DMAIC and Diabetes 8,9,10
Improve Treatments and drugs
Target process by designing creative solutions 1. Blood sugar monitoring, insulin and
to fix and prevent problems. oral medications
• Create innovate solutions using technology and 2. Healthy weight through a healthy diet
discipline and exercise plan
• Develop and deploy implementation plan

14. DMAIC and Diabetes 8,9,10
Control Lifestyle and Prevention
Improvements to keep the process on the 1. Commit to manage your diabetes
new course. 2. Regular physical and eye exams
3. Keep immunizations up-to-date
4. Pay attention to your feet
• Prevent reverting back to the “old way”
5. Blood pressure and cholesterol
• Develop, document and implement an
under control
ongoing monitoring plan
6. Take care of your teeth
• Institutionalize the improvements through
7. Quit smoking or tobacco use
the modification of systems and structures
8. If you drink alcohol, do so
(staffing, training, incentives)
responsibly
9. Take stress seriously

15. References
1. Becoming Our Best. Nursing Annual Report. Baptist Health South Florida. 2010-2011.
http://baptisthealth.net/en/media-center/Documents/Nursing_Annual032012.pdf
2. Peter S. Pande, Robert P. Neuman, Roland R. Cavanagh. The Six Sigma Way: How GE, Motorola, and
Other Top Companies are Honing Their Performance. McGraw-Hill; 1 edition (April 27, 2000) ISBN-10:
0071358064
3. Gerard J. Tortora. Principles of Anatomy and Physiology (John Wiley & Sons Inc) – Hardcover (2005)
International Edition
4. Seetharaman Hariharan, Prasanta K. Dey, Harley S.L. Moseley, Areti Y. Kumar, Jagathi Gora, (2004) "A new
tool for measurement of process-based performance of multispecialty tertiary care hospitals",
International Journal of Health Care Quality Assurance, Vol. 17 Iss: 6, pp.302 – 312
5. David J. Hill. Robots Take Over Hospital Pharmacy as Human Pill-Counting Talents Go To Waste. Singularity
Hub. April 17th, 2011. http://singularityhub.com/2011/04/17/robots-take-over-hospital-pharmacy-as-
human-pill-counting-talents-go-to-waste-video/
6. MoreSteam University. Lean Six Sigma Black Belt – Healthcare Course. Body of Knowledge.
7. Sprickgroup. The Better Results Blog for Laboratories. http://sprickgroup.com/blog-the-laboratory-
strategy-space/bid/78890/Awesome-Valuable-and-Free-Lean-Six-Sigma-Tools
8. iSix Sigma. DMAIC. http://www.isixsigma.com/dictionary/dmaic/ From GE’s DMAIC Approach,
http://www.ge.com/capital/vendor/dmaic.htm.
9. Nussey S, Whitehead S. Endocrinology: An Integrated Approach. Oxford: BIOS Scientific Publishers; 2001.
Chapter 2, The endocrine pancreas. Available from: http://www.ncbi.nlm.nih.gov/books/NBK30/
10. Mayo Clinic. Diabetes. http://www.mayoclinic.com/health/diabetes/DS01121