Objective: To reduce the total admission waiting time at Rehabilitation Center

1. ADMISSION TO REHABILITATION
SERVICES AT SCVMC
A LEAN SIX-SIGMA APPROACH
Presented by: Date:
Mamata Sanagowdar 12/13/2016

2. GOAL STATEMENT
The project aimed at analyzing the root causes that are inducing the
delay in the admission process for Rehabilitation services in SCVMC and
finding the solution using LEAN Six-Sigma principles, DMAIC
methodology.

3. DMAIC METHODOLOGY
A
> Define the > Data Collection > Failure Mode > Value Stream Map >
Implement
Current process Effects Analysis Future State Improvements
> Voice of > Value Stream Map > Root Cause >
Establish
Customer of current state Analysis Control Plan
Define
Measur
e
Analyze Improve Control

4. DEFINE PHASE
 Current State Process Map
 Voice Of Customer (VOC)

5. CURRENT PROCESS MAP
 Referrals are received from various
sources
 Patient information is loaded to All Scripts
 Insurance check is done by admin
 Case is reviewed by Case Manager/
Liaison
 Insurance authorization is obtained
 Prescreen, Medical review are done in
parallel
 Letter of Acceptance is requested from
contract department
 Pre admission is carried out and the
admission is given at the Rehabilitation
center

6. VOICE OF CUSTOMER
Voice of customer is a process where the requirement or feedback is
collected from both internal and external customer to provide the
best service quality.
 Insufficient admin support
• Lack of back-up in the absence of the admin
• Admin not available to respond to the request by Liaison
 The staff get distracted by conversation since the office room is
small and it adds delay to the process
 Unwanted phone calls

7. MEASURE PHASE
 Data Collection
 Value Stream Map of Current Process

8. DATA COLLECTION
The goal of Measure phase is to get as much as information
possible. Data collection is the key step in this phase
 Data was collected for over 3 weeks
 Process was monitored at admission office and in field with
Liaison

9. VSM CURRENT STATE
Referral received through Right Fax
Cycle Time: 2650
minutes

10. EXPLANATION
 Loading All scripts from Right Fax: 28 minutes
 Re-work on insurance authorization: 870 minutes
 Physician Review delayed due to delay in authorization: 570
minutes
 Pre-screen: 45 minutes
 Giving verbally information to part time employees: 15 minutes
 Total Cycle Time: 2650 minutes

11. ANALYZE PHASE
 Failure Mode Effects Analysis (FMEA)
 Root Cause Analysis (RCA)

12. FAILURE MODE EFFECTS
ANALYSIS
Type of Failure Mode Effect Analysis
(Score) Seriousness 1-
10
Referral by Liaison Delayed to follow up due to
other cases
Patient dissatisfaction due
to delay
10
Reworking on email Admin did not have
complete information
Delay in loading all scripts 9
Wastage of time on
Re-reading all the
information to staff
Part timers are not
completely aware of every
case
Delay in the entire case 7
Failure Modes and Effects Analysis (FMEA) is a step-by-step approach to
identify the severity of possible failures in the present system.

13. ROOT CAUSE ANALYSIS (RCA)
 RCA is a systematic way of identifying the highest-level problem
and finding a solution to it. Focusing on corrective measures of
root causes is more effective than simply treating the symptoms of
a problem or event.
 There are several tools or methods for the development of root
cause; one of it is Ishikawa diagram.

14. ISHIKAWA DIAGRAM

15. IMPROVE PHASE
 Recommendations
 Value Stream Map for Future State with Recommendations

16. RECOMMENDATIONS
 Getting Referrals only through All-scripts saves 25 minutes
 Maintaining the progress of each patient in online datasheet
saves 15 minutes of time wasted in explaining status of the
patient admission to part time employee
 Making sure to give admission before 3 pm avoids patient
admission slipping to next day
 If the insurance authorization was taken care of, Medical review
would have been faster
 The total cycle time is reduced to 1707 minutes

17. VALUE STREAM MAP FUTURE
STATE
Cycle Time: 1707
minutes

18. CONTROL PHASE
 Implement the Improvements
 Establish the Control Plan

19. IMPLEMENTATION
 The process should be monitored to make sure suggested
changes are in action
 Monitoring the new issues that rise in each case and generating
action plan is very important
 Expand the improved process throughout the organization

20. CONCLUSION
 The overall cycle time is reduced by 35% from the scenario taken
 The DMAIC approach can help the organization to find the areas
of improvement and time reduction, which is proved by the use of
Value Stream Mapping.
 Lean Six Sigma continuous improvement can increase the
utilization of resources in a measurable way

21. RECOMMENDATIONS
 Addressing the referral request from Liaison can be faster –
Assigning an employee from admin office to Liaison’s request
 Initiating insurance check and medical clearance on time will
make liaison’s work easier on the field.
 If the Liaison can send the referral through All Scripts, the process
would result in a less cycle time.

22. SCOPE FOR IMPROVEMENT
 Addition of staff at the intake office can reduce the total cycle time
in admissions
 Considering the Cost-Benefit analysis, increase in staff can
generate an increase in the revenue