This document summarizes a quality improvement project to increase last case efficiency and decrease overtime in a PET-CT department. The project team applied Lean Sigma concepts to improve workflow and scheduling. Through interventions like starting the first case earlier, improved patient and staff scheduling, and education, they increased the percentage of last cases completed before 5 pm from 47% to 91%, eliminating unplanned overtime. The project achieved its goals on time and increased both staff and patient satisfaction through greater efficiency.
Patient-centric technology moves surgical care beyond the hospital walls. Presented by Rachel Vickery, SHI Global, at HINZ 2014, 12 November 2014, 12pm, Marlborough Room
Patient-centric technology moves surgical care beyond the hospital walls. Presented by Rachel Vickery, SHI Global, at HINZ 2014, 12 November 2014, 12pm, Marlborough Room
Creating a culture of continuous improvement requires having an AIM or knowing exactly what the organization is striving for.
This means the entire organization should understand the concept of excellence and continually look for ways to do things better and more efficiently, resulting in higher levels of effectiveness.
When everyone understands the aim of excellence, there’s a synergy to achieve that objective. Excellence doesn’t just happen; it’s intentional!
To achieve excellence, you need a systematic approach to improvement initiatives that result in positive change for the organization.
Total Joint Replacement- Improving Day of Surgery Efficiency and ThroughputWellbe
Organic growth of total joint replacement volume is growing at 3-4% per year as the number of physicians entering orthopedic residency programs is in decline. Cuts in Medicare reimbursement for total joints is forecast every year producing stressors for the surgeon to perform more surgery just to tread water financially. Increasing surgical volume without increasing time in the day requires a team approach to process improvements. By taking a fresh look at operating room processes, it’s possible to accomplish this goal.
Discussion points include:
• Pre-op patient preparedness
• Resolving inherent conflicts
• Surgical case order
• Tracking case efficiency
• Surgical tray streamlining
About the Speaker:
Sandy Nettrour has specialized in orthopedics for 30 years. She is the Neurosurgery and Orthopedic Service Line Coordinator for Butler Health System, providing oversight of the business aspects of Neurosurgery and Orthopedics, while continuing to first assist in the operating room and provide patient care at the bedside.
Sandy graduated from Alderson Broaddus College in 1980 with a Physician Assistant degree. She has been awarded the Distinguished Fellow Recognition by the American Academy of Physician Assistants, the Hu C. Myers Award for lifetime professional achievement and community service, and the Pennsylvania Society of Physician Assistants Humanitarian of the Year 2013. She was a Round Table Participant in Orthopedics Today June 2012′s “Effective and Efficient Joint Replacement Programs Need Constant Review and Renewal of Processes.”
QI initiative: Acute Kidney Injury (AKI) Care in Acute OncologyCarl Walker
Dr Al-Sayed et al (The Christie NHS Foundation Trust) share their successful QI project to improve patient care in AKI as part of NQICAN Patient First 2016 presentation.
Improving the Effectiveness & Outcomes of Clinical AuditCarl Walker
Dr Venkatesh Kairamkonda talks about how the neonatal unit at UHL have used root cause analysis & PDCA model to make the audits undertaken more effective as part of NQICAN Patient First conference 2016.
Creating a culture of continuous improvement requires having an AIM or knowing exactly what the organization is striving for.
This means the entire organization should understand the concept of excellence and continually look for ways to do things better and more efficiently, resulting in higher levels of effectiveness.
When everyone understands the aim of excellence, there’s a synergy to achieve that objective. Excellence doesn’t just happen; it’s intentional!
To achieve excellence, you need a systematic approach to improvement initiatives that result in positive change for the organization.
Total Joint Replacement- Improving Day of Surgery Efficiency and ThroughputWellbe
Organic growth of total joint replacement volume is growing at 3-4% per year as the number of physicians entering orthopedic residency programs is in decline. Cuts in Medicare reimbursement for total joints is forecast every year producing stressors for the surgeon to perform more surgery just to tread water financially. Increasing surgical volume without increasing time in the day requires a team approach to process improvements. By taking a fresh look at operating room processes, it’s possible to accomplish this goal.
Discussion points include:
• Pre-op patient preparedness
• Resolving inherent conflicts
• Surgical case order
• Tracking case efficiency
• Surgical tray streamlining
About the Speaker:
Sandy Nettrour has specialized in orthopedics for 30 years. She is the Neurosurgery and Orthopedic Service Line Coordinator for Butler Health System, providing oversight of the business aspects of Neurosurgery and Orthopedics, while continuing to first assist in the operating room and provide patient care at the bedside.
Sandy graduated from Alderson Broaddus College in 1980 with a Physician Assistant degree. She has been awarded the Distinguished Fellow Recognition by the American Academy of Physician Assistants, the Hu C. Myers Award for lifetime professional achievement and community service, and the Pennsylvania Society of Physician Assistants Humanitarian of the Year 2013. She was a Round Table Participant in Orthopedics Today June 2012′s “Effective and Efficient Joint Replacement Programs Need Constant Review and Renewal of Processes.”
QI initiative: Acute Kidney Injury (AKI) Care in Acute OncologyCarl Walker
Dr Al-Sayed et al (The Christie NHS Foundation Trust) share their successful QI project to improve patient care in AKI as part of NQICAN Patient First 2016 presentation.
Improving the Effectiveness & Outcomes of Clinical AuditCarl Walker
Dr Venkatesh Kairamkonda talks about how the neonatal unit at UHL have used root cause analysis & PDCA model to make the audits undertaken more effective as part of NQICAN Patient First conference 2016.
Improve performance through Lean - Six Sigma managementGhinea Rodica
First steps for improving the performance of companies using Lean Six Sigma methodology, starting with manufacturing and supply chain departments (partial presentation).
An Application of DMAIC Methodology for Increasing the Yarn Quality in Textil...IOSR Journals
Abstract : This article presents a quality improvement study applied at a yarn manufacturing company based
on six sigma methodologies. More specifically, the DMAIC (Define, Measure, Analyze, Improve, and Control)
project management-methodology & various tools are utilized to streamline processes & enhance productivity.
Defects rate of textile product in the yarn manufacturing process is so important in industry point of view. It
plays a very important rate for the improvement of yield & financial conditions of any company. Actually
defects rate causes a direct effect on the profit margin of the product & decrease the quality cost during the
manufacturing of the product. By checking & inspection of defects of product at different point in production
where more defects are likely to happen. A thousand defects opportunities create in the final package of yarn.
That’s why it is decided to do work & implement DMAIC methodology in winding departments where the final
package of yarn is make.
Keywords - Six Sigma; DMAIC; Lean manufacturing; Yarn manufacturing
This is a study case in all the photosthe SIPOC diagram bel.pdfjkcs20004
This is a study case in all the photos
the SIPOC diagram bellow is incomplete and wrong I need to fix it
Perfect Match TEAM APPLIES n January 2008, the University of Toledo Medical Center
(UTMC) in northwest Ohio collaborated with the University of Toledo's Industrial SIX SIGMA
TO Engineering Department to analyze and improve the preoperational processes for patients
undergoing kidney transplants. Six Sigma was applied to the REDUCE TIME project, and the
following goals were established: IT TAKES TO - Optimize cycle times. QUALIFY PATIENTS
- Enhance customer satisfaction. - Improve efficiencies. FOR KIDNEY - Reduce costs.
TRANSPLANTS - Streamline administrative processes. - Eliminate errors. - Improve protocol
execution and effectiveness. The project's primary metric was the number of days required from
the date a patient was referred to UTMC for a kidney transplant to the date the hospital staff
declared the patient a suitable transplant candidate. The research By Matthew was needed and
the project selected because of an increase in the number of Franchetti and year because of the
increased service area for UTMC. Because of a waiting list of nearly 500 patients, it was
determined a reduced cycle time would save lives. Kyle Bedal, Background and terminology
University of For more than 30 years, UTMC has performed adult and pediatric kidney Toledo
transplants as one of the treatment options for end-stage renal disease. Since UTMC's first
kidney transplant operation in 1972, more than 1,500 kidney transplant operations have been
performed there, with an average patient survival rate of 98% and a graft survival rate of 94%.
The program relies on advanced surgical techniques-including laparoscopic kidney donation,
improved anti-rejection medications and high-quality patient care-to make it one of the most
successful programs in the country. There are a number of steps patients must complete before
receiving a kidney transplant. Generally, the patient must be referred to a medical center and
complete required labs and tests to determine if he or she is suitable. The labs and tests are
usually similar among all transplant centers and among patients. The labs include tuberculosis
(TB) tests, dental clearance, a colonoscopy, chest X-rays, electrocardiography tests, stool
samples, blood work, mammograms, pap smears and diabetes tests. Once the patient fulfills the
requirements, a committee reviews the results and determines whether the patient is a good
candidate. The patient is then allowed to receive a kidney; this is called being "listed," or placed
on the waiting list.
Fil TB EK Often, the time required to complete these health Partnering With Your Transplant
Team, The Patient's Guide screenings is up to nine months. In addition, another to
Transplantation. 2 two years may pass after the patient is listed before a The team deployed the
define, measure, analyze, kidney transplant is performed. improve and control (DMAIC)
approach for this Six It is.
Total Quality Management (TQM) by Dr Anurag YadavDr Anurag Yadav
Laboratory Total Quality Management, Concept of Laboratory errors, the quality control material, quality assurance program, factors affecting the quality of report, Steps in quality management, PDCA cycle, accuracy, precision, EQAS, IQAS, Proficiency testing.
the details are related to medical laboratory and help MBBS, MD, BSc MLT, MSc MLT, etc
Aldo Rolfo, National Clinical Development Manager, Genesis Cancer Care, Austr...GenesisCareUK
A program that seeks to redefine best practice across the drivers of the GenesisCare business (Quality, Access and Efficiency) in order to deliver on their vision of “Innovating Healthcare. Transforming Lives.”
Presented at Association of American Medical Colleges Integrating QI meeting in Chicago, IL June 2010. Chronicles journey incorporating QI education for students, residents, faculty, and allied health professions.
North west COPD joint collaborative - 60 day check in
PET-CT Last case efficiency BGebrewold
1. System Improvement to Increase Last
Case Efficiency and Decrease Overtime
Bineyam Gebrewold1 Corina Voicu2, Esther Mena2, Natarsha Fields2
May 27, 2015
Nuclear Medicine/PET Center
2. Team members
Bineyam Gebrewold: Project leader (Technologist)
Corina Voicu : member (Supervisor)
Esther Mena : member (Physician)
Natarsha Fields : member (PSC)
3. Objectives
• Describe our efforts to improve last case
efficiency by applying the Lean sigma system
improvement concept.
• To demonstrate the impact of innovative
utilization of existing resources in workflow
improvement.
4. QI Project “Elevator Speech”
• In PET-CT department Residents
and Technologists were required
to stay for unplanned overtime
due to poor last case efficiency.
• This project improved the last
case efficiency by applying the
lean sigma system improvement
concepts.
5. JHH Strategic Priorities
• Integrity: Innovative model of
care delivery …. Enhance
quality and reducing cost.
• Our Department’s mission is
to improve the public health
and well being by …….,
supplying an outstanding
education for our residents,
fellows
6. Six Sigma DMAIC QI Stages
Define
Measure
Analyze
Control
Improve
Lean Sigma, Prescription for Healthcare. Armstrong Institute for Patient Safety
and quality. Johns Hopkins Medicine. Rev Sep-2014. 6
7. Problem Statement
Work flow efficiency in PET-CT is particularly challenging because of
combination of out patient and inpatient being scheduled through out
the day.
Inefficiency results in delays and ultimately, the necessity for
technologists and residents to stay over time.
The Residents overtime violates the residency duty hours standard set
by Accreditation Council for Graduate Medical Education (ACGME).
The Technologists overtime may lower staff satisfaction and incurs
additional avoidable expense to the department.
8. Project Goal and Scope
To improve last
case efficiency in PET-CT
department from base line of
47 %
in September 2014 to
90 %
in February 2015.
9. Project Benefits
– Hard Benefits
• Compliance with residency duty hours set by
ACGME.
• Minimize unplanned over time.
– Soft Benefits
• Increase staff satisfaction.
• Increase patient satisfaction.
10. Project Name: System Improvement to Increase
Last-Case Efficiency and Decrease
Overtime in PET-CT
Champion:
Rathan Subramaniam M.D., Ph.D
Quality Advisor: Jeff Leal
Problem Statement:
Work flow efficiency is highly impacted by the timeliness of the first-
case of the day in a department like PET-CT that require longer
physiological preparation before a scan can be done. Patient
scheduling in PET-CT is carefully designed to avoid camera down time,
as soon as a patient scan is completed the next one will follow with in
a minute. Any delay in a patient scan will have a cascade effect on the
subsequent scans leading to poor last case completion rate and
unplanned overtime.
Project Goal:
To improve last-case efficiency in PET-CT
department from base line of 47 % in
September 2014 to 90 % in February 2015.
Project Y / Path-Y:
Percentage of last cases completed before 5:00 pm.
Scope:
First and last case of the day in PET-CT
division from September 2014 to April 2015.
Team Members:
Bineyam Gebrewold: Project leader
Corina Voicu : member (Technologist)
Esther Mena : member (Physician)
Natarsha Fields : member (PSC)
Benefits:
Minimize unplanned over time.
Compliance with residency duty hours set by
ACGME.
Increase staff satisfaction.
Increase patient satisfaction.
Project Charter
13. Six Sigma DMAIC QI Stages
Define
Measure
Analyze
Control
Improve
Lean Sigma, Prescription for Healthcare. Armstrong Institute fro Patient Safety
and quality. Johns Hopkins Medicine. Rev Sep-2014. 13
14. Baseline Data (September, 2014)
• Data was collected
everyday using a
spread sheet form.
• Data accuracy was
verified by
comparing with time
stamp information
in the PACS system. 0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Before
5:00
5:00-5:30 5:31-6:00 After 6:00
47%
33%
13%
7%
JHU PET/CT Percentage distribution of Last
Patient Of the Day for September, 2014
15. Interventions
• Start the first case 30 minutes earlier (6:30 am)
• Change in patient scheduling.
– No in-patients in late afternoon
– Reduce successive inpatients
– No cardiac viability after 12:00 pm.
• Change in residents work distribution.
• Change in Staff schedule. (Add early techs)
• Eliminated unnecessary delayed scans.
• Staff education and empowerment.
16. Six Sigma DMAIC QI Stages
Define
Measure
Analyze
Control
Improve
Lean Sigma, Prescription for Healthcare. Armstrong Institute fro Patient Safety
and quality. Johns Hopkins Medicine. Rev Sep-2014. 16
17. Results and Outcomes
91% of last cases completed
before 5:00 pm by April, 2015.
Patient volume increased by
from September, 2014.
No Staff overtime reported for the
last three months.
44 %
I
n
c
r
e
a
s
e
I
n
c
r
e
a
s
e
20%
18. Projected in February- Achieved in April
8/4/2016 Bineyam Gebrewold Rad QI 2015 18
0%
10%
20%
30%
40%
50%
60%
70%
80%
Before 5:00 5:00-5:30 5:31-6:00 After 6:00
47%
33%
13%
7%
80%
10% 10%
0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Before 5:00 5:00-5:30 5:31-6:00 After 6:00
47%
33%
13%
7%
91%
9%
Sep vs. Feb Sep vs. April
19. JHU PET-CT Percentage distribution of Last Patient
from Sep, 2014 - April, 2015
8/4/2016 Bineyam Gebrewold Rad QI 2015 19
0%
20%
40%
60%
80%
100%
47%
60%
76%
65%
85%
80%
73%
91%
Before 5:00 5:00-5:30 5:31-6:00 After 6:00
20. Lessons Learned
Lean sigma concepts are instrumental to improve
efficiency in imaging departments.
Data collection is often challenging and needs patience.
Testing accuracy of data should be done at the early
stage of the project.
Seeking continuous feedback and advise from
champions and colleagues is a key for project success.
21. Six Sigma DMAIC QI Stages
Define
Measure
Analyze
Control
Improve
Lean Sigma, Prescription for Healthcare. Armstrong Institute fro Patient Safety
and quality. Johns Hopkins Medicine. Rev Sep-2014. 21
22. What’s the Next Step
• Second phase: (Refine Operation)
– distribution of the work through the day.
– achieve 45% of completion 12 noon.
23. What’s the Next Step
Control
• Maintain and
improvise patient
scheduling template.
• Maintain staff
scheduling.
• Monitor the trend
periodically.
24. The Result of Efficiency
August 4, 2016 Gebrewold 24