Better care at less cost - a 'how to' for commissioners and providers, pop up...
How Lean and Six Sigma Can Improve Healthcare
1. How Lean and Six Sigma Can
Improve Healthcare Safety and
Predictability, and Reduce Costs
Eddie Pérez-Ruberté, CSSBB
Senior Lean Specialist
BayCare Health System
2. 22
Objectives
Illustrate applicability of LSS to healthcare
Present successful examples of LSS
applications in healthcare
Identify a path to incorporate LSS in
healthcare improvement journey
1
2
3
4. 44
Healthcare: The Case for LSS
Cost of Poor Quality
>2.4M
Additional hospital days
due to medical errors
$17B
Excess charges
every year
Health Affairs Study, The $17.1 Billion Problem, 2011
Poor quality | Access challenges | Unsustainable higher costs | Decreased payments
5. 55
High Cost – Average Performance
$8,508/person
79 Years
AUS
AUT
BLG
CAN
CHL
CZE
DEN
EST
FIN
FRA
GERGRC
HGR
ICE
IRL
ISL
ITA
JAP
KOR LUX
MEX
NTH
NZE
NOR
POL
PRT
SLO
SVN
SPA
SWE
SWI
TUR
GBR
USA
72
74
76
78
80
82
84
86
$0 $2,000 $4,000 $6,000 $8,000 $10,000
LifeExpectancy
Total Expense Per Capita (US$)
The U.S. spends more on health care per capita than any of the
other OECD countries; yet it ranks in the bottom 25% of those
countries on life expectancy
The Organization for Economic Co-operation and Development (OECD)
6. 66
Can we use LSS in Healthcare?
Arguments against
using Lean Six Sigma
in Healthcare
Arguments for using
Lean Six Sigma in
Healthcare
• Cars don’t bleed out
• Cookbook medicine
• That does not apply here
• Healthcare is different
• A process is a process
• So many opportunities
• No standardization
• Fragmented, inefficient
7. 77
And now…
PACU
• PACU Full ~ 2.5 hours/wk
• Suboptimal Patient Care
• Revenue loss
Lean Project
• Process Map
• Ishikawa
• Communication
• Standardization
• > 90% reduction in “PACU
Full” time
OPH
• High costs of cataracts surgery
• High variability in practices
among MDs
• $1,800 loss per case
Lean Project
• Value Stream Map
• Communication
• Standardization
• 32% time savings
• >30% cost reduction by case
9. 99
Situation
A Full PACU means inefficient care and lost revenue
PACU Full
event 16/22
days per month
Patients
recovering
in the OR
$100 / minute
Overtime
required
10. 1010
Background
300+ Beds 16 OR Rooms
40+ Cases / Day 39 PACU Bays
Problem Definition Questions:
• Why is the PACU Full 2.5 – 5 hrs. every week?
• Is it because we do not have enough bays?
• Is it because we do not have enough staff?
• Is it because we do not have adequate staffing?
11. 1111
Approach
ToC Training Map the Process
Data Collection
The Journey to Improvement Starts Here
Actions for Waste
ReductionIdentify Waste
15. 1515
Challenged Focus
Chopping tomatoes for tomorrow’s sandwiches
Gemba
Walk
Bundles
Tomorrow’s
Cases
Low Priority High Priority
PACU Full
Expectations ≠ Practice
Flow
When expectations are not effectively
communicated, practices seldom change
17. 1717
Improve - Communications
“In the event there is a PACU full (888)
event, we need everybody to be
engaged working to decompress and
lower PACU census to alleviate the
issue at the earliest as humanly
possible, without sacrificing patient or
staff safety.”
24. 2424
Situation
0
2
4
6
8
10
12
2011 2012 2013 2014
Costs Medicare
Cost vs Reimbursement of
Cataracts Surgery
Gap
$1,800
2014 Loss per case
2X
Disparity in case
duration by MD
0
1
2
3
4
5
6
7
8
9
10
May Jun Jul
MD1 MD2 MD3 MD4 MD5
Case duration by Physician
25. 2525
Background
6 OPH + 2 OPT
1 OR Room 13+ Cases / Week
Problem Definition Questions:
• Why do we have different practices among MDs?
• What is best for the patient?
• Where do we have waste?
Retina, Cataracts,
Glaucoma, Cornea, etc.
26. 2626
Approach
VSM Training Map the Value Stream
Actions for Waste
Reduction
The Journey to Improvement Starts Here
Identify Waste
NVA
VA
Increase Value-
Added Ratio
34. 3434
A Path Forward
IMAGECREDIT:DREAMATICO.
Enable Staff
(Knowledge,
Training)
Map the
Process or
Value Stream
Identify Waste
Eliminate Waste Through
Actions, Ownership &
Accountability
Standardization PDCA/PDSA Kaizen
