USING SIX SIGMA FOR PROCESS IMPROVEMENT IN HEALTHCARE Is 99% Good Enough?

Three hospital campuses Six Sigma In Healthcare 380 acute care beds 110 long-term care Bowling Green Scottsville Franklin Full range acute & tertiary Open Heart Surgery Cancer Treatment Neonatal Intensive Care Psychiatric Services Home Health Emergency Medical Services Managed Care Primary Care Walk-in Clinics OP Rehab Center Physician Practices Free Clinic Long Term Acute Care Hospital Health and Wellness Center

Six Sigma In Healthcare What is Six Sigma? Measure of Quality: Expresses how close a process or service comes to meeting its customers’ expectation. Method for Continuous Improvement: Uses a rigid framework to approach process improvement. Mindset for Culture Change: When successful, Six Sigma fundamentally changes the culture and operating philosophy of the company. It becomes “the way to do our job”.

Six Sigma In Healthcare Z or Sigma Level Sigma LevelDefect RateDefects per Million % 308, % 66, %6, % % 3.4 By using the Sigma level to express how good a process is, we are able to compare dissimilar processes. Example: Radiology report turnaround time is at 2 sigma while an ambulance’s arrival on the scene is 4.3 sigma.

Is 99% Good Enough? Six Sigma In Healthcare 99% Good (3.8 Sigma) % Good (6 Sigma) 200,000 wrong drug 68 wrong prescriptions prescriptions each year each year 5,000 incorrect surgical 1.7 incorrect surgical operations each week 50 newborn babies dropped One newborn baby dropped at birth each day every 2 months

Six Sigma In Healthcare What Makes Six Sigma Different? Methodology is robust Process is measured using the customer’s specification rather than internally established thresholds Analysis is data driven Improvements are statistically valid Improvements are tested and proven Processes are controlled Project framework is rigid

Six Sigma In Healthcare Culture change Traditional Beliefs: –Quality costs money –Inspection and rework can capture defects –Quality of output is enough –Control the worst case and the average –99% defect free is good enough –Documentation can control quality Six Sigma Beliefs: –Poor quality is extremely expensive –Defects must be prevented –Quality must be built into the process (Sony TVs) –Variability is the enemy –Need to achieve 3.4 defects per million –Mistake proof to sustain quality

Six Sigma In Healthcare Strategic Alignment to Driving Results & Leverage Resources

Organizational Dashboard for Success Six Sigma In Healthcare Customer Satisfaction Quality of Service Efficiency Measured by Press Ganey Scores Measured by Timeliness (a rolled “z” score) Measured by Operating Margin (cost per unit produced at departmental level)

Action Plan Six Sigma In Healthcare –Customer Service/Satisfaction  Reduced Wait Times  Meeting Service Expectations –Delivered Quality of Care  Reduced Medical Errors  Increased Safety  Use of Appropriate Technology –At Lower Cost  Increased Productivity  Decreased Cost

Functional Structure Six Sigma In Healthcare PRESIDENT AND CEO Hospital CEO & Sponsor EVP & Sponsor EVP & Sponsor Press Ganey Score & Target Timeliness Z Score & Target Cost Efficiency & Target Master Black Belts Master Black Belts Brown Belts Champions & Sponsors Green Belts Change Agents

Project Profile: Radiology Staffing Efficiency Six Sigma In Healthcare Baseline:.3 Sigma DPMM = 382,000 Critical X: Staff Schedule Controlled Process: 1.15 Sigma DPMM = 125,000 Operational Problem: Labor Costs Too High in Radiology Defect: Occurs any Time Staffing Exceeds Labor Resources Required For Exam Volume Improvements: Staff Used CAP & Work-out ™ to Redesign Schedule 14 Positions Eliminated 1 st Yr. Savings $860,000

Six Sigma In Healthcare Financial Returns Radiology Cost Per Procedure

Senior Management’s Involvement Six Sigma In Healthcare Created Vision Statement Identified CTQs Attended CAP/Workout Training Attended Greenbelt Training provided by GE “Shadowed” Greenbelt Projects Participate in Formal Reviews by Greenbelts Driven from “top-down”

Key Learnings Six Sigma In Healthcare Commitment is Critical Ideally From the Top Watch for & Address the “Holdouts” People Selection Best & Brightest Project Selection Tied to Strategic Objectives Financial Results & Validation Challenging, Challenging, Challenging Culture Change vs. Quality Tool