Six Sigma Method for QI & PI MHS 665 William C. Brannan, MD

Classic Components of Quality

Institute of Medicine’s New Components of QI

Relationship of Classic & New Components of Quality §Not one or the other §Not competitive §They are to complement each other §They form the matrix or fabric for Quality Management (QM) in either Quality Assessment (QA) or Quality Improvement (QI)

The Fabric of QI Safety Effective Pt. Centered Timeliness Efficiency Equity OutcomesCustomerCostProcess SatisfactionImprove

History of Six Sigma §Developed by Motorola & General Motors in mid-1980’s §Data-driven quality methodology §Seeks to eliminate variation (and its associated costs) from a process

Sigma Levels SigmaDefects Per Million Opportunities (DPMO) 1 690, , , ,

Sigma Comparison of Industries

What is Six Sigma? §A process must not produce more than 3.4 defects per million opportunities. §In Healthcare it means not more than 3.4 medication errors in 1 million doses. §Not more than 3.4 foreign bodies left in patient during 1 million surgeries. §Not more than 3.4 no shows per 1 million appointments.

The Six Sigma Cycle DefineTraining Implementation objectives, Designate Black Belts.Develop set goals Train SS methodology.Projects Involve organization- wide projects.Define Staff advancementMeasure in SSAnalyze Continue trainingImprove new staffControl Continue identifying new projects

Key Six Sigma Roles CEO Champion Master Black Belts Black Belts * Experts * Guides Green Belts

Central Components - Existing §Define §Measure §Analyze §Improve §Control

Central Components - New §Define §Measure §Analyze §Design §Verify

Define §What is the business case for this project? §Current state map vs future state map. §What is the project’s scope? §Due date determined.

Measure §What are the metrics for this process? §Are they valid and reliable? §How will I measure progress? §How will I measure success?

Analyze §Can the process be improved? §Who will help make the changes? §What resources are required? §What could cause this change effort to fail?

Improve §What is the work breakdown structure? §What specific activities are necessary to meet project goals? §How will I reintegrate various subprojects?

Control §How will I control quality, cost, schedule, scope and changes to the plan? §How will I ensure that the business goals of the project were accomplished? §How will I keep the gains I made?

Implementation Step 1 §Begin with senior leaders. §Train them in the principles and tools. §Direct the management infrastructure. §Cultivate the environment for innovation and creativity. §Reduce organizational hierarchy. §Remove barriers to experimentation and change.

Implementation Step 2 §Develop external quality measures. §Communicate with patients, employees, stakeholders and suppliers. §Develop rigorous methods to obtain input §Conduct baseline studies of starting point. §Identify cultural, policy and procedural obstacles to change.

Implementation Step 3 §Rigorously assess and conduct top-to- bottom training in systems-improvement tools, techniques and philosophies.

Implementation Step 4 §Develop a framework for continuous process improvement. §Monitor progress and success. §Metrics should focus on strategic goals, drivers and key business processes.

Implementation Step 5 §Managers & staff with intimate process knowledge at all levels of the organization choose processes for improvement. §Improve business performance linked to measurable financial results.

Implementation Step 6 §Individual employees and teams, led by Green Belts, conduct Six Sigma projects.

Medical Error Reductions §Reducing patient falls §Reducing ADE’s from medications §Reducing ordering & administration errors §Improving turnaround time for pharmacy orders

Business Operations §Improving revenue cycle §Improving nurse or pharmacy technician recruitment §Improving employee retention §Increasing OR throughput

Patient Case Management §Decreasing stroke patient LOS §Decreasing CHF LOS §Reducing lost MRI films §Improving MRI exam scheduling §Reducing emergency department diversions

Patient Satisfaction §Reducing ED wait times §Improving patient satisfaction in ED

WEB SITE

Six Mission §CEO §Champion §Master Black Belt §Black Belts §Green Belts §DMAIC §Bob Burgin §Bill Brannan §Tom Knoebber §PI Consultants §Collaborative Practice Team §FOCUS-PDCA

QI Mission