Six Sigma

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Six Sigma in Hospital OperationsSix Sigma in Hospital Operations

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• Quality – Six Sigma View• Hospital Management – Key Challenges• Six Sigma in Hospital Operations

Overview

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Quality…a perspectiveQuality…a perspective

• 20,000 items rejections per months

• ~15 minutes each day of unsafe drinking water

• 5,000 incorrect surgical operations per week

• 2 short or long landings at most major airports daily

• 200,000 wrong drug prescriptions each year

• 7 hours without electricity each month

The Classical View of Quality The Classical View of Quality

“ “99% Good” (3.899% Good” (3.8))


“ “99% Good” (3.899% Good” (3.8))

• 7 items rejections per month

• 1 minute every 7 months of unsafe drinking water

• 1.7 incorrect surgical operations per week

• 1 short or long landing at most major airports every 5 years

• 68 wrong drug prescriptions each year

• 1 hour without electricity every 34 years

The Six Sigma View of Quality The Six Sigma View of Quality

“ “99.99966% Good” (699.99966% Good” (6))


“ “99.99966% Good” (699.99966% Good” (6))

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Increasing Productivity

Innovation

Intersection

Customer Insight

Hospital Management: Key Challenges

Low Cost

High Quality

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Safe Environmen

t

Timely Services

Efficient Services

Effective Services

Data Collection

Hospital Operations: Key Challenges

Patient Centric CarePatient Centric Care

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Six Sigma in Hospital Operations: Why?

With the increased focus on customer requirements and

pressure to deliver the best quality every time, cost of healthcare is escalating.

It has become of equal importance, to optimize the performance with respect to quality and

to optimize cost of care.

Six Sigma addresses both these concerns

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What is Six Sigma?

Six Sigma is a “data driven”

problem solving methodology.

… how you utilize and implement that

methodology depends on you.

• A highly Structured and Data Driven Approach for Improved Customer Quality.

• A Measurement of Our Process and our Capability to deliver services.

• Goal of Six Sigma – Attain Less Than 3.4 Defects per Million Opportunities

Six Sigma?

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Six Sigma Vs Traditional Approach

StatisticalProblem

StatisticalSolution

TraditionalApproach

PracticalProblem

PracticalSolution

Six SigmaApproach

Customer Focused . . .Bottom Line “cost” DrivenCustomer Focused . . .Bottom Line “cost” DrivenCustomer Focused . . .Bottom Line “cost” DrivenCustomer Focused . . .Bottom Line “cost” Driven

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What’s Six Sigma . . .

• Generally “Sigma”Generally “Sigma” is used to designate the distribution or spread (standard deviation) about the mean (average) of any process or procedure.

• For a business, the Sigma For a business, the Sigma Capability (Z-value)Capability (Z-value) is a metric that indicates how well the process is performing.

DDDD

As DefectsGo Down . . . ZZZZ

. . . Sigma CapabilityGoes Up

308,537308,537308,537308,537

66,80766,80766,80766,807

6,2106,2106,2106,210

233233233233

3.43.43.43.4

PPM*PPM*PPM*PPM*

Defects perDefects per Million Million

OpportunitiesOpportunities

Defects perDefects per Million Million

OpportunitiesOpportunities

*PPM: Parts Per Million

2222

3333

4444

5555

6666

ProcessProcess

CapabilityCapability

ProcessProcess

CapabilityCapability

ZZZZ

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MeasureDefine ImproveAnalyze Control

what is important to the customer:

Project Selection

Team Formation

Establish Goal

how well we are doing:

Collect Data

Construct Process Flow

Validate Measurement System

the process:

Analyze Data

Identify Root Causes

the process gains:

Ensure Solution is Sustained

the process performance measures:

Prioritize root causes

Innovate pilot solutions

Validate the improvement

DMAIC: Basics

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Once the process is measurable, outcomes becomes measurable.

Right from patient’s admission to treatment to discharge, it is all measurable

As a result, the patient’s confidence and level of satisfaction increases.

Six Sigma- Application

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Six Six Sigma Sigma

ProjectsProjects

Co

st

Services

Process

Some Six Sigma Projects at MHC…

Reducing Discharge TimeDischarge Time Before: 282 mins - After: 135 mins

Increase Dispatch Capacity-CPS Process Sigma improved by 1.22

Optimizing Diagnostics PricingAvg realization – 1.78 Sigma increased

Optimization of Dialysis ProcessProcess Sigma Increased by 1

Improving Lift Efficiency 50% Improvement in Customer Satisfaction 50% Process Capability increased

Standardization of Consumable Process Sigma improved by 3.4

Reducing Cathlab Waiting Time 30% improvement in waiting time

Reduction in CRBSI RateInfection reduction - 3.66 to 6 Sigma

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High rate of Catheter Related Blood Stream Infections (CRBSI) in ICUs

Increased Length Of Stay (LOS) for patients, due to CRBSI

Patient Dissatisfaction

Revenue loss due to increased LOS

To Standardized process & eliminate CRBSI from MHC

Problem Problem

Goal Goal

CRBSI – Six Sigma approachCRBSI – Six Sigma approach

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PeoplePeople

MaterialMaterial

HIGH ICU CRBSI RATES

HIGH ICU CRBSI RATES

ProcessProcess

Culture process

TNA data availableBSI Confirmation

Patient Immunity

Dressing Technique

EnvironmentEnvironment

Contaminated LinesPeriodic dressing

Sterilized material

Patient Behavior

Wire ControlInsertion Site

Causes for High CRBSI

Patient MovementEmergency /code

Multiple PricksSupervision

Assistance

TAT for informationCriteria for CRBSI

Sterile techniqueGuidelines for catheter

insertionUniversal Precaution

C/L protocol

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Pt. in MICU

Patient consent & procedure explanation

Procedure preparation

Doctor's decision for C/L

Site –Subclavian /Femoral/Jugular

Site dressing

Suturing

Patient preparation & C/L insertion

Key Improvements

Monitoring

Site Drying

Hand Wash & Dr. Assistant Drying time for site, increased to 3-5

mins., as per WHO standards

Drying time for site, increased to 3-5

mins., as per WHO standards

Established measurements

system

Established measurements

system

Revised Standard procedures - Hand Wash Revised Standard procedures - Hand Wash

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CRBSI Rate in MICU – 4 CRBSI Rate in MICU – 4


“ “98.45% Good” (3.6698.45% Good” (3.66))


“ “98.45% Good” (3.6698.45% Good” (3.66))


“ “99.99966% Good” (699.99966% Good” (6))


“ “99.99966% Good” (699.99966% Good” (6))

Achievement…Achievement…



“ “99.61% Good” (4.1699.61% Good” (4.16))


“ “99.61% Good” (4.1699.61% Good” (4.16))


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Bed related Inpatient Functions

Out patients related Functions

Diagnostics and Treatment Functions

Administrative Functions

Research and Teaching Functions

Supply Chain

Medical OperationsMedical Operations

Administrative OperationsAdministrative Operations

Six Sigma Scope in Hospital Services

Focus on Process Capability, Utilization, Cycle Time, Cost Optimization

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Six Sigma Infrastructure

The actual infrastructure and number of roles will be dependent on the size and complexity of an Organization &maturity stage of deployment of Six Sigma.

Six Sigma ChampionSix Sigma Champion

Master Black Belt Black Belt Green Belt Yellow BeltResourcesResources

Primary RolePrimary Role

Role DurationRole Duration 24 Months 18 Months 12 Months 6 Months

Culture change agent Mentor Project Identify opportunity

& Execute Project Execute Project

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• LEADERSHIP COMMITMENT Time Effort Resources

• MANAGING WITH DATA Design-measure-analyze-improve-control

• TRAINING AND CULTURAL CHANGES Integrated business strategy Impact on career paths

Essential of for Six Sigma

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Our focus...

“Providing highest quality at lowest cost”

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Thank You

Six Sigma

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