Presentation (3.6 MB)

34
USING SIX SIGMA FOR PROCESS IMPROVEMENT IN HEALTHCARE Is 99% Good Enough?

description

 

Transcript of Presentation (3.6 MB)

Page 1: Presentation (3.6 MB)

USING SIX SIGMA FOR PROCESS IMPROVEMENT IN HEALTHCARE

Is 99% Good Enough?

Page 2: Presentation (3.6 MB)

Three hospital campuses

Six Sigma In Healthcare

380 acute care beds

110 long-term careBowling 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

Page 3: Presentation (3.6 MB)

Six Sigma In Healthcare

Introduction

In late 1997, President and Chief Executive Officer of Commonwealth HealthCorporation, (CHC), attended a conference and listened with interest as General Electric’s CEO spoke of his vision for GE as a World Class Six Sigmacompany. This innovative approach to quality and error reduction was at thispoint already receiving high marks for its transformational abilities at all levelsof corporate enterprise. Later conversations between the two leadersrevealed a shared passion for excellence and commitment to quality. Thisinitial encounter soon led CHC to embrace this vision of quality atCommonwealth Health Corporation.

Page 4: Presentation (3.6 MB)

Six Sigma In Healthcare

+ =

Page 5: Presentation (3.6 MB)

Six Sigma In Healthcare

CHC VIDEO

Page 6: Presentation (3.6 MB)

Six Sigma In Healthcare

What is Six Sigma?

Measure Measure of Quality:of Quality:Expresses how close a process or service comes to Expresses how close a process or service comes to meeting its customers’ expectation.meeting its customers’ expectation.

Method Method for Continuous Improvement:for Continuous Improvement:

Uses a rigid framework to approach process Uses a rigid framework to approach process improvement.improvement.

MindsetMindset for Culture Change:for Culture Change:When successful, Six Sigma fundamentally changes When successful, Six Sigma fundamentally changes the culture and operating philosophy of the company. the culture and operating philosophy of the company. It becomes “the way to do our job”. It becomes “the way to do our job”.

Page 7: Presentation (3.6 MB)

Six Sigma In Healthcare

Z or Sigma Level

Sigma Level Defect Rate Defects per Million

2 30.8% 308,5373 6.7% 66,8074 0.62% 6,2105 0.0233% 2336 0.00034% 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.

Page 8: Presentation (3.6 MB)

Is 99% Good Enough?

Six Sigma In Healthcare

99% Good (3.8 Sigma) 99.99966% Good (6 Sigma)

200,000 wrong drug 68 wrong prescriptionsprescriptions each year each year

5,000 incorrect surgical 1.7 incorrect surgical operations each week operations each week

50 newborn babies dropped One newborn baby droppedat birth each day every 2 months

Page 9: Presentation (3.6 MB)

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

Page 10: Presentation (3.6 MB)

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

Page 11: Presentation (3.6 MB)

Six Sigma In Healthcare

Strategic Alignmentto Driving Results & Leverage Resources

Page 12: Presentation (3.6 MB)

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)

Page 13: Presentation (3.6 MB)

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

Page 14: Presentation (3.6 MB)

Functional Structure

Six Sigma In Healthcare

PR

ES

IDEN

T A

ND

CEO

Hospital CEO &

Sponsor

EVP &Sponsor

EVP &Sponsor

Press Ganey Score & Target

Timeliness Z Score & Target

Cost Efficiency & Target

MasterBlack Belts

MasterBlack Belts

Brown BeltsBrown Belts

Cha

mpi

ons

& S

pons

ors

Cha

mpi

ons

& S

pons

ors

Green BeltsGreen Belts

Change AgentsChange Agents

Page 15: Presentation (3.6 MB)

Project Profile: Radiology Staffing Efficiency

Six Sigma In Healthcare

Baseline: .3 SigmaDPMM = 382,000

Critical X: Staff Schedule

Controlled Process:1.15 Sigma

DPMM = 125,000

Operational Problem: LaborCosts Too High in Radiology

Defect: Occurs any Time Staffing Exceeds Labor Resources RequiredFor Exam Volume

Improvements: •Staff Used CAP &

Work-out™ to Redesign Schedule

•14 Positions Eliminated•1st Yr. Savings $860,000

Page 16: Presentation (3.6 MB)

Six Sigma In Healthcare

Financial Returns

50%

60%

70%

80%

90%

100%

Radiology Cost Per Procedure

Page 17: Presentation (3.6 MB)

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”

Page 18: Presentation (3.6 MB)

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

Page 19: Presentation (3.6 MB)

Define

Problem Statement

As employers continue to pass more of the cost to their employees through larger deductibles, higher co-pays, lower percentage of reimbursement, etc., reducing the loss that results from the patient’s portion not being paid becomes increasingly important.Measuring the length of time involved from point of service until payment is received on the self-pay portion of the patients bill on commercial accounts.

Page 20: Presentation (3.6 MB)

Measure

Scope of Problem

Total

1

Characteristic

1.357

1.357

ZBench

1.500

1.500

ZShift

556922

556922

PPM

0.556922

0.556922

DPO

0.557

DPU

5121

5121

TotOpps

1

Opps

5121

Units

2852

2852

Defs

Report 7: Product PerformanceDefect: any length of time greater than 104 days

ZST = 1.36

DPPM = 556,922

Page 21: Presentation (3.6 MB)

Analyze

Root of Problem

107 36 39 99125139141142147272345459801

4 1 1 3 4 5 5 5 510121628

100 96 95 94 90 86 81 76 71 66 56 44 28

2500

2000

1500

1000

500

0

100

80

60

40

20

0

Defect

CountPercentCum %

Per

cen

t

Cou

nt

Pareto Chart for Location

Emergency Room charges account for 40% of the defects.

Page 22: Presentation (3.6 MB)

Analyze

Root of Problem

Mood Median Test: stacked versus subs

Mood median test for stacked

Chi-Square = 10135.57 DF = 4 P = 0.000

Individual 95.0% CIs

subs N<= N> Median Q3-Q1 ---------+---------+---------+-------

Amt. of 4531 590 1.0 1.0 +

Coded Bi 3221 1900 3.0 2.0 +

coded lo 74 5020 20.0 7.0 +-)

coded ty 1787 3334 7.0 4.0 +

Primary 3970 1151 2.0 2.0 +

---------+---------+---------+-------

6.0 12.0 18.0

Overall median = 3.0

There is a statistical difference in the medians based on location (Emergency Department).

Page 23: Presentation (3.6 MB)

Improve

Pilot

POINT OF SERVICE COLLECTIONS INITIATIVEEMERGENCY DEPARTMENT

 Modified ED patient flow processes to ensure all eligible patients are routed through a formal “checkout” after being treated and discharged by clinicians. Developed job description for Financial Counselor position. Interviewed and hired a Financial Counselor. Developed training schedule, which started on March 21st. Went through a very extensive training schedule including tutorials on collection techniques and role-playing. Training with CFM, Hillcrest Credit Agency, Patient Registration, and Six Sigma representatives. Hours for the position are Sunday through Thursday, 1:00pm through 9:00pm. Comprehensive education and dialogue took place prior to rolling out the new processes to secure buy-in and compliance from staff.  Developed a new policy and procedure for post dated checks which allows us to collect money while ensuring the post dated checks are not deposited before the agreed date. This new policy allows for a check to be written with a payable/deposit date up to 5 days from the time of service.  

Page 24: Presentation (3.6 MB)

Improve

Pilot

POINT OF SERVICE COLLECTIONS INITIATIVEEMERGENCY DEPARTMENT

 Developed a comprehensive reference manual for the Financial Counselor. Developed a patient education leaflet to distribute to all patients at time of registration. Murray Raines reviewed prior to implementation. Developed standardized cash collection procedures and forms. Developed necessary tools for ongoing performance analysis. These include sample scripting, payer matrix, key metrics to be completed daily, and monthly trend analysis. Will use the monthly trend analysis to benchmark progress against goals, highlight shortcomings and target interventions. Financial Counselor scripts have been developed specific for self-pay patients as well as insured patients with co-pays.  

Page 25: Presentation (3.6 MB)

Improve

Pilot

POINT OF SERVICE COLLECTIONS INITIATIVEEMERGENCY DEPARTMENT

  The newly designed process includes the nurse bringing patients to the checkout desk after treatment. We are currently working with the nursing staff to increase compliance of routing patients to the financial counselor desk. Careful scripting has enhanced customer interactions. The first full week of implementation was April 3rd and to date, we have had no official complaints.

Page 26: Presentation (3.6 MB)

Improve

Results

Total

2

1

Characteristic

2.342

3.402

1.828

ZBench

1.500

1.500

1.500

ZShift

200000

28571

371429

PPM

0.200000

0.028571

0.371429

DPO

0.029

0.371

DPU

70

35

35

TotOpps

1

1

Opps

35

35

Units

14

1

13

Defs

Report 7: Product Performance

Totals Dollarscollected duringthis time frame

$1,613

$9,141

7 Weeks (35 days)Prior to Pilot

7 Weeks (35 days)During Pilot

Page 27: Presentation (3.6 MB)

Improve

ResultsChi-Square Test: GOOD, BAD

Expected counts are printed below observed counts

GOOD BAD Total

1 22 13 35 (Before Pilot)

28.00 7.00

2 34 1 35 (After Pilot)

28.00 7.00

Total 56 14 70

Chi-Sq = 1.286 + 5.143 +

1.286 + 5.143 = 12.857

DF = 1, P-Value = 0.000

P value of 0 indicates a statistical difference in the number of days that money was collected prior to and after the pilot. The same 7 week time period was used (35 days).

Page 28: Presentation (3.6 MB)

Improve

Results

Chi-Square Test: Re-Measure Pass, Re-Measure Fail

Expected counts are printed below observed counts

Re-Measu Re-Measu Total

1 37 3304 3341 (BEFORE PILOT)

122.69 3218.31

2 209 3149 3358 (AFTER PILOT)

123.31 3234.69

Total 246 6453 6699

Chi-Sq = 59.846 + 2.281 +

59.543 + 2.270 = 123.941

DF = 1, P-Value = 0.000

P value of 0 indicates a statistical difference in the number of patients that money was collected from prior to and afterthe pilot. The same 7 week time period was used (35 days).

Page 29: Presentation (3.6 MB)

Improve

Results

Identifying incorrect information given at time of registration and making corrections (re-scanning correct insurance card, etc.), reducing re-work and increasing turn around time on payment.

Continuing to work on clinical compliance (24 hour mandate should show marked improvement).

With relatively little investment, the analysis suggests potential increases in POS annual cash collections in the ED by approximately $203,712.

During this 35 day time frame, promissory notes amounting to $11,716 have been signed at POS. No attempts made at POS previously.

Deter future unnecessary visits to the Emergency Room.

Page 30: Presentation (3.6 MB)

Control

Results

Sample Size Required To Statistically Confirm PPM Reduction

DPPM p(d) ZST

Process performance (Before change) --> 371,429 37.1% 1.8

Process performance (After change) --> 28,571 2.9% 3.4Opportunities on each unit: --> 1

Confidence --> 95.0%

TOP's UnitsSample size required to distinguish between processes --> 20 20

Page 31: Presentation (3.6 MB)

Control

Financial ResultsFinal Cost Savings and Cost of a Defect

p(d) ZST

Original Defect Rate --> 37.1% 1.8

New Defect Rate --> 2.9% 3.4

Reduction in the Rate of Defects --> 92.3%

Cost of a Defect from R2 --> $1,504,099 <-- Enter Cost of a Defect from your R2

Cost Savings from reduced defects --> $1,388,401

Other Costs associated with your Project -->

Total Final Cost --> $1,388,401 <-- Report this in your R4

Current Cost of a Defect --> $115,698 <-- This is what remains as a Cost of a Defect

Finalized cost based on a 92.3% reductionin the rate of defects = $1,388,401

Page 32: Presentation (3.6 MB)

Control

Sustaining Success

Presented findings to stakeholders and corporate sponsors.

Met with Director/Supervisor of ER registration and turned project over. Reviewed re-measure dates and procedures for collecting and monitoring.

Developed procedure for collecting data and updating dashboards.

Provided dashboards and training/instructions for updating and distribution.

Leveraged learnings in Outpatient setting.

Completed project binder.

Page 33: Presentation (3.6 MB)

Control

Transfer the Learnings

Based on the success of the Emergency Department project, we started a similar project in the Outpatient areas and are currently transferring those learnings to our Scottsville and Franklin hospitals for their Emergency Departments and Outpatient areas.

Prior to the project, there was virtually no point of service collection. We now collect more that $10,000 in the ED most months at our Bowling Green location. In the Outpatient areas, we previously collected about $5,000 in a three-month period. After applying the same methodology, monthly collections for outpatients have increased to $50,000 each month.

The Point of Service collection projects are in the pilot phase preparing for implementation. We anticipate equally good results in those locations.

Page 34: Presentation (3.6 MB)

Six Sigma In Healthcare

QUESTIONS?

THANK YOU!