Valley Baptist Health System and Six Sigma
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Transcript of Valley Baptist Health System and Six Sigma
Tomas A. Gonzalez, M.D., M.B.A.Tomas A. Gonzalez, M.D., M.B.A.Vice President of Six SigmaVice President of Six Sigma
WCBF's Lean Six Sigma ConferenceWCBF's Lean Six Sigma ConferenceNovember 16-18, 2005November 16-18, 2005
• 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
• Valley Baptist Medical Center – Brownsville– 243 Licensed Beds– Level 3 Trauma Center– State of the Art Imaging Center– Center of Diabetes Management
• Other Entities– Golden Palms Retirement and Healthcare
Center– Valley Baptist Health Plans– Advanced Medical Supply (DME)– 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 Health SystemValley Baptist Health System
• Strategic Initiatives– Integration– Simplicity– Six Sigma Quality– Relentless Service– Expansion of Services & Regionalization
• Values– Disciplined– Accountable– Entrepreneurial– Performance Oriented
Valley Baptist Health SystemValley Baptist Health System
September
October
December
January
February
May
AprilMarch
July
August
June
November
1st Quarter 2nd Quarter
3rd Quarter4th Quarter
Execute Initiatives:Mgmt. Mtg. Marching Orders
Performance Reviews
Board Retreat
QOR
Aug. Board
Meeting (Present budget)
QOR
QOR
Valley Baptist Health System Valley Baptist Health System Operating CalendarOperating Calendar
QOR
Talent Review / Succession, HR
Planning
Initiatives Dev. & Review +
Sr. Mgmt. & Review and
Key Mgmt. Retreat
Performance Stds. Set
Budget
= Work product req.= Processes link
Sr. Mgmt. Mtg
Key Mgmt. Retreat
Guidance
VBHS Confidential & Proprietary Information
VBHS ValuesVB
Survey II
Strategic Planning
Integration
Simplicity
Service Expansion & Regionalization
Relentless Service
Six Sigma Quality
VBSurvey I
• A comprehensive and flexible program for achieving, sustaining and maximizing business success that:
– 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.
– Is a management methodology with three perspectives:• A Measure of Quality• A Process for Continuous Improvement• An Enabler for Cultural Change
What is Six Sigma?What is Six Sigma?
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
Six Sigma Advantage, Inc.
What Six Sigma is not:What Six Sigma is not:
• Not a quick fix• Not a cost reduction program• Not a training program• Not a statistics program• Not a quality program• Not a publicity stunt
Six Sigma Advantage, Inc.
A Few Basic Terms:A Few Basic Terms:
• Black Belt – 6 Sigma Trained Specialist who works on a 6 Sigma improvement project, usually 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 – An individual contributor, trained in basic 6 Sigma methods, to assist on a problem solving task or solution implementation.
• Sponsor – Usually a member of management with responsibility to identify 6 Sigma projects, assign resources and remove barriers.
• DPMO – Defects per Million Opportunities, a common measure of process defects which can be converted to Sigma.
• Sigma (σ) – A Greek letter, symbol for a measure of variation in any process, where 6 Sigma represents only 3.4 defects per million opportunities.
• 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%
A Measure of Quality:A Measure of Quality:
DMAIC MethodologyDMAIC Methodology
How did we begin implementing How did we begin implementing Six Sigma?Six Sigma?
• CEO Commitment!– Vision– Leadership– Resources (time, money, people, etc.)
• Partnership with General Electric Medical Systems– Guidance– Expert Knowledge– Training – Six Sigma, CAP, Work-Out™– Project Mentoring– Transition Assistance
VBHS TimelineVBHS Timeline
• May 2002– Engagement with GEMS– Wave 1: 6 initiatives– 11 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 underway– 2 Master Change Agents trained– 6 Green Belts trained
• March 2004– Wave 4: 16 initiatives underway– 14 Green Belts trained
• August 2004– Wave 4 completed
• July 2005– Wave 5 initiatives completed
• September 2005– Wave 6 initiatives begin at VBMC-H, Wave 2 at VBMC-B
Completed InitiativesCompleted Initiatives
• Wave 1– ED Wait Times– Diabetes Management– Pharmacy Order Verification– OR Turnaround Time– Staff Scheduling– Nursing Order Activation
• Wave 2– ED Wait Times– Laboratory Turnaround– Admissions Process– OR Turnaround Time– Radiology Turnaround – Discharge Process
• Wave 3– ED Wait Times– Surgery Patient Preparation &
PATT– DRG Assurance of Accuracy– RN Admissions Assessment– Patient Registration Accuracy– Outpatient Service Redesign– Performance Management– RN New Hire Process
Wave 4 InitiativesWave 4 Initiatives
• Timely Utilization of Ancillary Services in the ED
• Inpatient Floor to Floor Transfers
• Event Response• Golden Palms MDS Coding
Accuracy• CHF• Stroke Care• AMI
• Forms Management• Pain Management• STO Turnaround Time• Patient Identification• Outpatient Services Integration• Timely & Safe Medication
Turnaround• Abbreviations• Pathology Process Flow
Improvement
VBMC-HarlingenWave 5
• ED Registration & Accuracy• Pneumonia Core Measures• Interdisciplinary Communication• VBMC-H Accessibility• Ancillary Departments Results
Availability• Physician Pay for Performance• ED Charges
VBMC-BrownsvilleWave 1
• Emergency Department Hold Time• MeMedical Records / Transcription
Turnaround Process• ICU Care Management Process• Outpatient Registration Turnaround
Time• Length of Stay Planning & Mgmt
Process• Radiology Turnaround Time
Wave 5, Wave 1 Initiatives:Wave 5, Wave 1 Initiatives:
Six Sigma Practitioners October 31, 2005
• Master Black Belts (5)– 3 Certified– 2 Seeking Certification
• Black Belts (4)– 3 Harlingen– 1 Brownsville
• Green Belts (61)– 31 Certified – 30 Seeking Certification
• Yellow Belts (34)– 15 Executives– 19 Physicians
• Master Change Agents (2)• Change Agents (237)
– 190 Harlingen– 47 Brownsville
• Future– All Executives will be trained to Yellow Belt level– All Directors and Managers to Green Belt certification
Physician Yellow BeltsPhysician Yellow Belts
• Jose Ayala, DPM• Maria T. Camacho, MD• Miguel Cintron, MD• Chandler E. Deal, MD• Luis Gaitan, MD• Alfredo Garcia, MD• Giovanna Ghafoori, MD• Khadim Hussain, MD• Garner Klein, MD• Robert A. Lozano, MD
• Raul Maldonado, DPM• Juan Mancillas, MD• Carlos Medina, MD• John A. Partin, MD• Eric Six, MD• Adela S. Valdez, MD• Daniel F. Villarreal, MD• Gerald Witson, DDS• Robert T. Wright, DO
Six Sigma Six Sigma Physician Council MembersPhysician Council Members
• Miguel Cintron, MD• Lisa Dix-Emperador, MD• Luis Gaitan, MD• Giovanna Ghafoori, MD• Tomas A. Gonzalez, MD• Christopher Hansen, MD• Khadim Hussain, MD• Garner Klein, MD
• Bruce Leibert, MD• Juan J. Mancillas, MD• Clay W. Ross, MD • Michael Simpson, MD• Eric Six, MD• Adela S. Valdez, MD• Gerald Whitson, MD• Robert Wright, MD
VBHS Application of VBHS Application of Six SigmaSix Sigma
Operating RoomOperating Room
• The amount of time it takes to turnaround surgical suites from one case to the next has been decreased 34% from
61 minutes on average in 2002, to
40 minutes in 2005.
Emergency DepartmentEmergency Department
• The amount of time it takes a patient to see a doctor after walking into the ED has been decreased 21% from 105 minutes on average in 2002, to 83 minutes in 2005.
• The amount of time it takes to discharge a patient after the doctor has determined the discharge disposition has been decreased 30% from 33 minutes on average in 2003, to 23 minutes in 2005.
• The amount of time it takes to admit a patient after the doctor has determined the admission disposition has been decreased 46% from 226 minutes on average in 2004, to 122 minutes in 2005.
NursingNursing
• The amount of time it takes to complete the Nursing Assessment on inpatients at VBMC – H has been improved 68% from 102 minutes on average in 2003, to 33 minutes in 2005.
• Pain Management assessment and follow up has been improved 16% from a compliance rate of 73% in 2004, to 84% in 2005.
• The amount of time it takes the nursing department to activate physician orders has been improved 76% from 88 minutes on average in 2002, to 21 minutes in 2005.
• The amount of time it takes to discharge a patient after the physician has determined that the patient’s discharge from the hospital is appropriate has been improved 73% from 185 minutes on average in 2003, to 50 minutes in 2005.
PharmacyPharmacy
• The amount of time it takes the pharmacy to verify a physician order has been improved 79% from 110 minutes on average in 2002, to 23 minutes in 2005.
Diagnostic Related Group Diagnostic Related Group
• Assignment on 12 DRGs has improved 31% from an accuracy rate of
75% in 2003, to Six Sigma performance in 2005.
Stroke CareStroke Care
Letter dated September 27, 2005 from Joint Commission’s Executive Vice President, Russell P. Massaro, MD, FACPE:
The Joint Commission is pleased to award Disease – Specific Certification to your organization’s primary stroke center as a result of the September 2, 2005 review at Valley Baptist Medical Center
This certification is effective for two years from September 3, 2005, and is indicative of your program’s compliance with consensus-based national standards; effective use of established clinical practice guidelines to manage and optimize care; and performance measurement and improvement activities.
Patient Identification Patient Identification
• Proper patient identification prior to medical procedures has been improved from a compliance rate of 96.8% to 100%
Evidenced Based MedicineEvidenced Based Medicine
• The compliance with the Joint Commission on Accreditation of Healthcare Organization’s core measures for Acute Myocardial Infarction has been improved from 94.6% in 2004, to 100% in 2005.
• The compliance with the Joint Commission on Accreditation of Healthcare Organization’s core measures for Heart Failure Management has been improved from 58% in 2004, to 100% in 2005.
Wave 5
Six Sigma Improvement Initiatives:Initiative:Initiative: Baseline Baseline
Yield:Yield:Baseline Baseline Sigma:Sigma:
Pilot Pilot Yield:Yield:
Pilot Pilot Sigma:Sigma:
Control Control Yield:Yield:
Control Control Sigma :Sigma :
VBMC-H Accessibility 78% 2.27 82.6% 2.44 85.8% 2.57
Interdisciplinary Communication
1.9% 0 100% 6+ 100% 6+
Ancillary Departments Results Availability
64.3% 1.87 75.8% 2.2 87.5% 2.65
Community Acquired Pneumonia
5% 0 86.7% 2.61 84.6% 2.52
ED Registration Process (accuracy and cycle time)
89.3% 2.74 93.3% 3 95.5% 3.24
45.2% 0 89.1% 2.7 95.5% 3.24
ED Charges 80.3% 2.35 92.2% 2.92 92% 2.9
Wave 1 Theme: Patient Flow/Throughput
Six Sigma Improvement Initiatives:
Initiative:Initiative: Baseline Baseline Yield:Yield:
Baseline Baseline Sigma:Sigma:
Pilot Pilot Yield:Yield:
Pilot Pilot Sigma:Sigma:
Control Control Yield:Yield:
Control Control Sigma:Sigma:
ICU Care Management 58% 1.70 80% 2.34 83% 2.46
Length of Stay Planning and Management Process
57% 1.68 86% 2.60 86% 2.21b
OP Registration Turnaround Time
58% 1.70 88% 2.68 90% 2.81c
Radiology Turnaround Time
29% 0.00 91% 2.82 90% 2.80c
Medical Records/Transcription Turnaround Process
12% 0.00 85% 2.60 92% 2.90c
Emergency Department Hold Time
54% 1.61 98% 3.67 96% 3.28c
a. Yield = percent of opportunities with specification limit (customer requirements)
b. Translated to additional medical-surgical unit
c. Translated hospital wide
Translation Theme–IntegrationTheme–Integration
Initiative:Initiative: Baseline Baseline Yield:Yield:
Baseline Baseline Sigma:Sigma:
Control Control Yield:Yield:
Control Control Sigma:Sigma:
Patient ID
–Labor & Delivery 99% 3.75 100% 6+
–Ancillary Departments
100% 6 100% 6+
AMI Core Measures 81% 2.39 100% 6+
CHF Core Measures 53% 1.56 96% 3.27
Surgical Preparation 73% 2.12 - -
a. Yield = percent of opportunities with specification limit (customer requirements)
Six Sigma Translation Initiatives:
VBMC – Harlingen• Surgical Preparation – Day Surgery• DRG Assurance of Accuracy• Inpatient Identification Process – Mother Baby Unit• Inpatient Identification Process – Ancillary Departments• Forms Management• Acute Myocardial Infarction• Heart Failure Management• MDS Accuracy – Golden Palms
VBMC-Brownsville• Patient Identification (IP/OP) – Ancillary Departments• Acute Myocardial Infarction
Initiatives Reaching Initiatives Reaching Six Sigma PerformanceSix Sigma Performance
Start: 01/05 End: 06/05Interdisciplinary Communication
Start: 01/05 End: 06/05Interdisciplinary Communication
Initiative Description: Ensure interdisciplinary collaboration and communication in patient care
Initiative Description: Ensure interdisciplinary collaboration and communication in patient care
Interdisciplinary CommunicationInterdisciplinary CommunicationJanuary 12, 2005 – Present
Interdisciplinary CommunicationInterdisciplinary CommunicationJanuary 12, 2005 – Present
Initiative Title: Interdisciplinary Communication
Champion: Shane Spees, CEOSponsor: Chris Hansen, MD
VP, Medical AffairsOwner: Joanne WetchMaster BB: Art Rangel, CHEBlack Belts: Patrick Ybarra Terri Teinert
Initiative Title: Interdisciplinary Communication
Champion: Shane Spees, CEOSponsor: Chris Hansen, MD
VP, Medical AffairsOwner: Joanne WetchMaster BB: Art Rangel, CHEBlack Belts: Patrick Ybarra Terri Teinert
Team Members:
Rosemary Perkins David MannNicole Ballenger Candy Woodin Shelley Eyzaguirre Eddie UribeJeannie Dodson-Brown Rita VillarrealShirley Fisher Cindi BrentSue Griffin Henrietta PeynadoRosie Arredondo Sylvia Garza
Team Members:
Rosemary Perkins David MannNicole Ballenger Candy Woodin Shelley Eyzaguirre Eddie UribeJeannie Dodson-Brown Rita VillarrealShirley Fisher Cindi BrentSue Griffin Henrietta PeynadoRosie Arredondo Sylvia Garza
Alignment with Strategic Plan: Disciplined Offering of Services, Six Sigma Quality, Relentless Customer Service, Employee Partnership
Alignment with Strategic Plan: Disciplined Offering of Services, Six Sigma Quality, Relentless Customer Service, Employee Partnership
Initiative Scope:In: 6 South Tower, Inpatients, Interdisciplinary Team Members, Care Paths, Discharge Planning Rounds
Initiative Scope:In: 6 South Tower, Inpatients, Interdisciplinary Team Members, Care Paths, Discharge Planning Rounds
Problem Statement:
There is no standardized process for interdisciplinary communication in patient care. Currently there are multiple forms (Kardex, Care Path, Care Plan) for communication.
Problem Statement:
There is no standardized process for interdisciplinary communication in patient care. Currently there are multiple forms (Kardex, Care Path, Care Plan) for communication.
METRICS BASELINE
Dates Oct. 2004 –Jan. 2005
n 315
DPMO 980,952
Yield 1.9%
Z Score 0
Baseline Metrics/Process CapabilityBaseline Metrics/Process Capability
1.90%
0.0 20.0 40.0 60.0 80.0 100.0
1
% Compliance
Improvement efforts:- Developed an electronic Interdisciplinary Communication Record (ICR) to include documentation from:
Nursing, Care Management, Pastoral Services, Respiratory, Rehabilitation Services, Nutrition, Cardiac Rehab,
Enterostomal Therapy, Diabetes Educators
- Developed a SOP , “Interdisciplinary Communication Record”
- Numerous Change Acceleration Process activities
Improvement efforts:- Developed an electronic Interdisciplinary Communication Record (ICR) to include documentation from:
Nursing, Care Management, Pastoral Services, Respiratory, Rehabilitation Services, Nutrition, Cardiac Rehab,
Enterostomal Therapy, Diabetes Educators
- Developed a SOP , “Interdisciplinary Communication Record”
- Numerous Change Acceleration Process activities
What did you change/improve?- Interfaced discipline specific documentation in IDX (clinical documentation
software) to the electronic ICR
- Nutrition Services adopted 100% electronic documentation
- Rehabilitation Services created an IDX documentation screen for the ICR (Goal – 100% electronic documentation by August 31, 2005)
- Respiratory created an IDX documentation screen for the ICR; requires discipline to document per shift to assist with compliance ( Goal – to utilize IDX for all documentation with the next upgrade)
What did you change/improve?- Interfaced discipline specific documentation in IDX (clinical documentation
software) to the electronic ICR
- Nutrition Services adopted 100% electronic documentation
- Rehabilitation Services created an IDX documentation screen for the ICR (Goal – 100% electronic documentation by August 31, 2005)
- Respiratory created an IDX documentation screen for the ICR; requires discipline to document per shift to assist with compliance ( Goal – to utilize IDX for all documentation with the next upgrade)
How do you know your changes made a difference?Statistical significant difference between baseline and pilot data (Chi-Square Test P-value = 0.00)
How do you know your changes made a difference?Statistical significant difference between baseline and pilot data (Chi-Square Test P-value = 0.00)
Respiratory NursingPastoral Services
Nutrition
Care Management
Rehab Services
Cardiac Rehab
Enterstomal Therapy
ICR View
Diabetes
1.9%
100%
100%
0 20 40 60 80 100
Control
Pilot
Baseline
Interdisciplinary Communication Compliance Rate
Questions?