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Successfully Implementing Six Sigma in Healthcare: An Introduction to Six Sigma Principles,
Practical Exercises and Case Study Examples
Matiana Gonzalez Vela, Ed.D., M.Ed., R.D.Tracy Drake-Kirkconnell, M.B.A.
March 17 , 2009
Premier integrated healthcare delivery system serving SouthTexas since 1925
• Valley Baptist Medical Center - Harlingen– 611 Licensed Beds– Lead Level 3 Trauma Center– State of the Art Children’s Center– # 1 Rated Orthopedics Service– Heart & Vascular Institute– Teaching facility for The Regional Academic
Health Center of The University of Texas Health Science Center at San Antonio
– Certified Stroke Center
• Other Entities– Golden Palms Retirement and
Healthcare Center– Valley Baptist Health Plans– Valley Baptist Ambulatory Surgery
Center– Clinical Pastoral Education Center– Licensed Vocational Nurse School– Family Practice Residency
Program– Internal Medicine Residency
Program– Home Health & Hospice– Rehabilitation & Wellness– Behavioral Health Services
• Valley Baptist Medical Center – Brownsville– 243 Licensed Beds– Level 3 Trauma Center– State of the Art Imaging Center– Center of Diabetes Management– Certified Stroke Center
Valley Baptist Health SystemValley Baptist Health System
• Strategic Initiatives– Integration– Simplicity– Growth and Development– People– Quality and Excellence
• Values– Disciplined– Entrepreneurial– Performance Oriented– Accountable
Valley Baptist Health SystemValley Baptist Health System
How did we begin implementing Six Sigma?How did we begin implementing Six Sigma?
• CEO Commitment– Vision– Leadership– Resources (time, money, people)
• Partnership with General Electric Medical Systems– Guidance– Expert Knowledge– Training – Six Sigma, CAP, Work-Out™– Project Mentoring– Transition Assistance
• A comprehensive and flexible program for achieving, sustaining and maximizing business success that:
– Is a management methodology with three perspectives:• A Measure of Quality• A Process for Continuous Improvement• An Enabler for Cultural Change
– Is uniquely driven by a clear focus on the “Voice of the Customer”
– Is founded in a rigorous use of facts, data and statistical analysis
– Provides for diligent attention on managing, improving and reinventing business processes
What is Six Sigma?What is Six Sigma?
Define Measure Improve ControlAnalyze
What is Six Sigma?What is Six Sigma?
• Integrated part of management system
• Fact & data based decision making
• Knowledge transfer, learning process
• Value added focus on defect removal
• Utilization of technology tools
• A lasting infrastructure
• Not a cost reduction program
• Not a training program• Not a statistics program• Not a quality program• Not a quick fix
Six Sigma Advantage, Inc.
A Measure of QualityA Measure of Quality
• Six Sigma is a statistical measure that expresses how close a service process comes to its quality goal
• Six Sigma refers to a process that produces only 3.4 defects per million opportunities
Sigma DPMO Yield
2 308,537 69.1463%
3 66,807 93.3193%
4 6,210 99.3790%
5 233 99.9767%
6 3.4 99.9997%
Sigma Score vs. Percentage Yield
0
10
20
30
40
50
60
70
80
90
100
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6
Sigma Score
Per
cen
tag
e Y
ield
Sigma Score vs. Percentage YieldSigma Score vs. Percentage Yield
DMAIC MethodologyDMAIC Methodology
Lean Six SigmaLean Six Sigma
• 5 Ss– Seiri………….…..Sort– Seiton……………Standardize– Seiketsu…………Simplify– Seiso…………….Sweep– Shitsuke…………Sustain
• Value Added vs. Non-Value Added activity
• Genuine Focus on the customer
• Data and Fact Driven Management
• Process focus, management and improvement
• Proactive management
• Boundaryless collaboration
• Drive for perfection; tolerance for failure
Six Sigma ThemesSix Sigma Themes
• Traditional Quality Programs– Driven internally– Focuses on outcomes– Fixes defects– Improves quality– Looks backwards– Concentrates on products– High on theory and people
The Six Sigma DifferenceThe Six Sigma Difference
• Six Sigma– Driven by the
customer– Focuses on processes– Prevents defects– Improves bottom line– Looks forward– Concentrates on
CTQs– High on methodology
and data– Forces disciplined
decision making
• Dependant• Output• Effect• Symptom• Monitor
• Independent• Input & Process• Causes• Problems• Control
Y X1 … Xn
Six Sigma Focus Six Sigma Focus Y = ƒ(x)Y = ƒ(x)
The Effectiveness (E) of the result is equal to the Quality (Q) of the solution times the Acceptance (A) of the idea
times the Accountability (A) to solution execution
Six Sigma Methodology
Change Acceleration
Process
Effective Results
Work-OutTM
Q x AQ x A22 = E = E
Six Sigma EffectivenessSix Sigma Effectiveness
Art
Spirituality
Science
Fundamentals/Foundation
Six Sigma and the Art of Medicine
PATI
ENT
CAR
E PA
TIEN
T CA
RE
6σAccuracy and Speed
Medication Management
Turnaround times
Wait Times
Research Based Disease Management
Ventilator Associated Pneumonia
Core Measures
AMI
CHF
Pneumonia
CABG
VBHS Confidential & Proprietary Information
Performance Measurements
Not just about formulas….Cultural AcceptanceChange ManagementA² = Acceptance &
AccountabilityDefines Success or Failure
Foundations of SuccessFoundations of Success
VBHS Confidential & Proprietary Information
RespectPeople
RecognizeEffort
RewardPerformance
System Executive Council
Entity Leadership
Department
Managers
Individual
Annual Goals
Monthly R
eportsQ
uarte
rly E
valu
atio
ns
System Executive Council
Board of Directors
AccountabilityAccountability
Roles at VBHSRoles at VBHS
• Master Black Belt – 6 Sigma mentor and educator• Black Belt – 6 Sigma trained specialist who works on 6
Sigma improvement initiatives on a full time basis• Green Belt – 6 Sigma trained specialist who uses the Six
Sigma methodology to solve problems as a function of their normal work
• Yellow Belt – Physicians and Executives trained in basic 6 Sigma methods who assist with problem solving, initiative sponsorship and solution implementation
• Sponsor – Executive with responsibility to identify 6 Sigma initiatives, assign resources and remove barriers
• Change Agent - Expert in the application of CAP and Work-Out™ tools
Six Sigma Practitioners at Six Sigma Practitioners at VBHSVBHS
• Master Black Belts (5)– 5 Certified– Black Belts (9)– 3 Harlingen– 2 Brownsville– 2 Corporate– 2 Seeking Certification
• Green Belts (93)– 73 Certified – 20 Seeking Certification
• Yellow Belts (43)– 17 Executives– 26 Physicians
• 16 Six Sigma Physicians’ Council members
CEO Expectation:All Executives will be trained to Yellow Belt levelAll Directors and Managers to Green Belt certification
• Master Change Agents (2)• Change Agents (263)
– 196 Harlingen– 67 Brownsville
VBHS TimelineVBHS Timeline
• May 2002– Engagement with GEMS– Wave 1: 6 initiatives– Green Belts trained
• March 2003– Wave 2: 6 initiatives– 3 Full Time Black Belts appointed
• April 2003– 3 Full Time Master Black Belts
appointed and trained• June 2003
– Wave 3: 8 initiatives– Green Belts trained– 2 Master Change Agents trained
• March 2004– Wave 4: 15 initiatives – Green Belts trained
• July 2005– Wave 5/1: 13 initiatives – Green Belts trained
• September 2005– Wave 6/2/1: 14 initiatives– Green Belts trained
• May 2006– Wave 7/3/2: 14 initiatives– Green Belts trained
• November 2006– Wave 8/4/3: 16 initiatives– Green Belts trained
• May 2008 – Wave 9/5: 8 initiatives– Green Belts trained
• May 2009 – Wave 10/6; 12 initiatives
95 Completed Training and 95 Completed Training and Translation InitiativesTranslation Initiatives
Examples of Clinical and Examples of Clinical and
Operational InitiativesOperational Initiatives
Case Study 1Case Study 1
Case Study 2 Case Study 2
Questions?Questions?