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In This Issue...
By Don Redinius, Managing Partner, Six Sigma Qualtec
Six Sigma was born nearly twenty years ago and, like all new things, it has evolved and matured. Through its various experiences, Six Sigma has been shaped into one of the most powerful problem solving, business and quality improvement methodologies available today. The first businesses to experience Six Sigma were in the hightech manufacturing industry. The industry’s complex product problems provided a formidable testing ground for the new process. Later it was applied with great success to administrative, or transactional, processes. Today, Six Sigma can be found in most fields of economic endeavor. Healthcare systems, in their drive to improve quality, reduce costs and enhance financial performance, have discovered Six Sigma and its long history of performance in other U.S. industries. Healthcare is traditionally defined as the delivery of treatment and services to people in need of medical attention. Yet the industry’s performance is heavily reliant on a vast and complex supply chain of companies working to design, produce, deliver, and manage a wealth of health and medical related products and services. Although doctors, nurses and hospitals are at the center of this massive and complex industry, they represent only a small portion of its influence. A number of companies within the healthcare supply chain have already implemented Six Sigma and are discovering impressive results. Perhaps the most publicized company is General Electric that adopted its Six Sigma agenda in 1995. Other notables include GlaxoSmithKline, McKesson and Johnson & Johnson. In addition, hospital systems like Mount Carmel Health System, Commonwealth Health Corporation, Order of Saint Francis, Charleston Area Medical Center, Yale-New Haven, North Shore Long Island Jewish Health and Froedtert Memorial Lutheran (to name a few) have implemented, or are in the process of implementing, Six Sigma. Mount Carmel Health System of Columbus, Ohio has successfully implemented Six Sigma after years of trying a variety of “more traditional” health care quality improvement programs with varying degrees of success. Mount Carmel has produced positive margins in recent years. But, like all hospitals, it faced declining reimbursements and rising expenses. Mount Carmel leaders sought an initiative that would significantly improve its operational processes and enhance its financial performance, eventually settling on Six Sigma in July 2000. Mount Carmel leaders don’t view Six Sigma as just another quality program. Rather, they consider it a business management system that not only improves quality, but also improves employee morale and reduces expenses. Last year, the system
The Promise of Six Sigma: “Getting Better Faster” Page 3 Implementing Six Sigma to Achieve “Breakthrough” Results Page 7 Six Sigma Without Tears Page 8 Six Sigma: Using Statistics to Reduce Process Variability and Costs in Radiology Page 11 North Shore - Long Island Jewish Health System Teams with GE & Harvard Page 19 Commonwealth Health Corporation, the Healthcare Pioneer of Six Sigma Page 22 Operational Excellence- be the benchmark Page 23
Supply Chain continued on page 17
The Six Sigma Supply Chain in Healthcare
President’s Corner President’ esident’s
By Roxanne O’Brasky, President, ISSSP
Dear Members: Welcome to a special edition of EXTRAOrdinary Sense. In ISSSP’s continued pursuit of its mission to educate and advance the Six Sigma methodology, we’ve dedicated this issue to a focused initiative that represents a significant milestone in the history of quality management in business. The health care industry has long been plagued by a wealth of obstacles. Few industries have faced the sheer volume of challenges – both internal and external – that limit the ability to evolve and improve. This dynamic has offered a formidable opportunity for healthcare industry management and traditionally accepted quality initiatives alike. With it’s lengthy high technology and broad industry track record, Six Sigma has come to healthcare in recent years, bringing with it limitless potential for improved efficiency, productivity and service delivery, not to mention the great potential for cost savings passed to customers like you and I. The challenges that healthcare represents for Six Sigma sets the stage for ISSSP’s newest educational and development campaign. This effort represents the first time our organization has brought together players from all facets of the healthcare industry. Pharmaceutical companies, equipment manufacturers, suppliers, providers and practitioners alike will share their experience, their concerns, and their ambitions in an exciting forum for the benefit of our collective membership. While such opportunities will be exhibited through insight-filled programming — including roundtables and workshops like the upcoming Healthcare Symposium on April 29 — the overall vision for this campaign is unveiled in the pages that follow. Special thanks to our corporate sponsors for the support they have shown for this new program. If your company represents healthcare interests and you would like to get involved with this exciting new campaign, please don’t hesitate to contact ISSSP. We’d love to have you on board. This program is only a small taste of what is to come from ISSSP in the coming months. In order for us to continue to provide this sort of best-in-class association content, ISSSP launched a formal membership campaign last month. We are confident that you will find the small investment well worth the benefit of being able to contribute to the continued growth and enhancement of your own industry. For more information about your ISSSP membership, please contact us at 480-368-7083. Don’t forget to mark your calendar for the 3rd Annual Leadership Conference June 23—26 in Chantilly, VA – we’ve just confirmed renowned Six Sigma advocate and business leader icon Jack Welch. Since our inception in Jan 2000, we have been learning from more than 10,000 members about the kind of programming and resources you would like to see made available through ISSSP. It is this feedback that you have provided that allows us to continue to offer the cutting edge content that Six Sigma professionals across the globe seek for their various endeavors. Your voice inspires our success. So let ISSSP hear from you.
PUBLISHED BY International Society of Six Sigma Professionals 7678 East Greenway Road Scottsdale, AZ 85260 Tel 480-368-7083 Fax 480-585-0640 www.isssp.com Editor-in-Chief: Heather Redinius Editor@isssp.com President: Roxanne O’Brasky RoxanneO@isssp.com Chief Technology Officer: Ken Kaplan KenK@isssp.com Vice President Business Services: Robert Swagerty BobS@isssp.com Information Management Director: Edna Cribb EdnaC@isssp.com Membership Director: Jeannette Kesmarki JeannetteK@isssp.com Creative Director: Heather Redinius HeatherR@isssp.com ΣXTRAOrdinary Sense is the official publication of the International Society of Six Sigma Professionals. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without written permission from the Editor. Submissions Please submit article, author background and contact information to Editor@isssp.com. ISSSP’s editorial staff will respond within ten business days regarding suitability for publication and other submission guidelines. Questions may be directed to Editor@isssp.com
The Promise of Six Sigma: “Getting Better Faster” Promise Faster”
By Ian R. Lazarus, FACHE and Beatriz Stamps, MD MBA
How can you tell when an investment in quality improvement has truly paid off? Quality improvement consultants have suggested that “quality is like pornography…you know it when you see it.” But chief executives and senior managers clearly need more tangible measures for their investments in quality improvement and management effectiveness. Six Sigma, on the other hand, has done more than demonstrate improvements in quality; the techniques and philosophy of Six Sigma have fundamentally changed the way healthcare executives view their business. According to John Desmarais, CEO of Commonwealth Health Corporation (Bowling Green, KY), “it’s the single most important thing we have done in the history of our organization.” Indeed, when a quality improvement initiative has truly impacted the entire organization as it did at Commonwealth, the payoff is everywhere you look. Six Sigma provides both the framework and tools to “get better faster,” a combination of statistical tools and project management techniques that enable managers to clearly define problems, measure and analyze them, and reach sustainable improvements in practice. Six Sigma recognizes that “variation is the enemy of best practices,” and it targets excessive variation and waste within the system to achieve its intended goal of reducing defects, improving profits, and delighting customers. It has been credited with saving literally billions of dollars among the manufacturing sector, including such heavyweights as General Electric, Motorola, Honeywell and Allied Signal. That Six Sigma has a home in healthcare has already been amply demonstrated by pioneering CEOs like John Desmarais from Commonwealth and Joe Calvaruso at Mount Carmel Medical Center in Columbus OH. The commitment of CEOs to the process also sends an important message to future proponents: Six Sigma will not work without a commitment from the top, and without it, there is no point in ever getting started. Senior management commitment to Six Sigma is critical because the process will invariably cut across department lines and change job functions. It will also require that the organization take its best people out of comfortable roles and into the front lines of new initiatives. The popularity of Six Sigma in healthcare was clearly evident at the second annual Six Sigma Leadership Conference, held last October in Scottsdale AZ. Sponsored by the International Society of Six Sigma Professionals, the conference featured six presentations by health system executives, even though the event represented both manufacturing and service industries. “The healthcare industry, which has focused so much effort on the development of best practices, has a tremendous opportunity to gain from the application of Six Sigma principles,” notes Roxanne O’Brasky, President of ISSSP. A new compass. Most Six Sigma projects begin with a definition of healthcare deliverables that are critical to quality, delivery and price (see illustration). These tie inevitably to existing functions within the enterprise, and can be measured through the rate of defective procedures, length of stay, and cost. All too often, healthcare organizations find that their processes were designed around the convenience of their staff and physicians, and not the customer or patient. Ironically, physicians become strong proponents of Six Sigma programs once they understand the scientific basis and practical benefits of the methodologies.
Six Sigma Aligns Patient Goals with Strategic Goals Patient Satisfaction
Price/ Value Cost
Delivery Length of Stay
Six Sigma applies customer-driven measures to process improvement; Customers can be patients, physicians, and employees.
CHC Creative Healthcare USA
It’s hard to ignore the potential and broad appeal of Six Sigma Cost when talking to its proponents. Dr. Glenn Crotty, MD and COO of the Charleston Area Medical Center insists that “Six Sigma quality is more than a goal. It is a commitment woven deeply into the fabric of everything we do.” The changes caused through Six Sigma are “awesome and exciting” according to Lisa Thomerson, Six Sigma Corporate Champion at Commonwealth Health Corporation in South Central Kentucky. “Our CEO as well as our senior leaders
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ΣXTRAOrdinary Sense March 2002
Promise continued from page 3
are fully behind it. John Desmarais is full of passion. His commitment is tremendous.” To date, Commonwealth has invested about $900,000 and has realized improvements well in excess of $2.5 million. Spare parts. There are multiple day-to-day applications of Six Sigma in the healthcare and managed care setting. Typical projects include billing office, supply chain management, emergency department, operating room, high volume DRGs and analysis of high cost admitters. Charleston Area Medical Center (CAMC), a 919-bed three campus medical center in Charleston, West Virginia, focused on supply chain management to test the potential of Six Sigma methodologies. Upon reviewing and identifying this project they found a $1.7 million opportunity within the inventory of surgical equipment that remained in storage for over a year. Over 50% of this inventory were in orthopedic trays. Further analysis revealed that old items were not being removed from shelves when new products replaced them. Once Six Sigma techniques were utilized to assess improvements from more rapid turnover of inventory, specific team members were assigned to negotiate with each principal vendor. Requests for immediate refunds or “forward sales arrangements” were made that included no future requirement for bulk purchases. The medical center also initiated more rigorous inventory review procedures as part of Six Sigma’s “control process.” Today, there are plans for a just-in-time inventory system with a centralized procurement database for all 3 hospitals. Although the initial savings in this project was merely $163,410 (from returned merchandise), future cost avoidance is estimated to be $841,540, according to Beverly Begovich, a fulltime Six Sigma Black Belt at
CAMC. CAMC has moved forward on many additional Six Sigma projects, with stunning results (see illustration). Out of control. In Six Sigma jargon, a process is said to be “in control” when it operates within acceptable specification limits. At Scottsdale Healthcare (AZ), the process of “Bed Control” was decidedly “out of control.” The process of locating a bed and transferring a patient from the Emergency Department to the inpatient unit consumed fully 38% of the total time within the department. Six Sigma consultants defined this problem as a “defect” and through additional analysis, found that the problem was not locating a bed, but reducing the number of steps required to make the transfer possible. The hospital employed the use of an Administrative Nurse to perform “inspections” by locating beds on different floors, and this process actually complicated the process rather than expediting it. The process at Scottsdale Healthcare violated two arguments of Six Sigma: that inspection is fundamentally unproductive, and the more interim steps you add to a process, the more you reduce the potential yield on that process. As a result of eliminating the Administrative Nurse position and through related streamlining techniques, the hospital reduced the cycle time for bed control by 10%, increased ED throughput by an estimated 0.1 patients per hour, and produced nearly $600,000 in incremental profit. The hospital system is now considering the application of Six Sigma in improving the performance of specific DRGs.
Culture Shock. Beyond obvious financial measures, the most significant change across these profiled institutions has been the development of performance improvement cultures. But what makes Six Sigma different from previous quality management programs? Ms. Thomerson from Commonwealth suggests “staff and involved physicians are buying it Sigm Project Potential gma Six Sigm a Pr o ject Potential because it is data-driven, and is based on statistical analysis. It points to specific Hospital’s One Hospital’s Experience problems. Physicians understand and support this analytical approach to problem solving and Project Validated Savings LT Cost Avoidance improvements. They practice it everyday.” “Six Supply Chain Management $163,410 $841,540 Sigma gives practical applications to get projects started and to get them done quickly. “Captain of the Ship” 519,000 790,000 People are tired of forever committees,” adds Denials 232,637 425,000 Ms. Begovich from CAMC.
Results Reporting Medication Safety ED Wait Time HR Recruitment Physician Satisfaction
367,621 31,774 100,000 32,000 39,780
341,000 242,777 202,428 124,430 66,000
CHC Creative Healthcare USA
Commonwealth Health Corporation’s, Six Sigma vision (posted plainly on their website) is that “by the year 2004, we will be proudly recognized by our employees, patients, clients, community, physicians and payors as the unquestioned leader in care and service,
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ΣXTRAOrdinary Sense March 2002
Promise continued from page 4
providing flawless quality never before achieved in the healthcare industry.” Their dependence on these techniques to deliver such impressive results is a testament to The Promise of Six Sigma. “Shaken, not stirred.” If the culture of an organization can be described as a product of its “corporate DNA,” then Six Sigma aims to reshape the DNA of the organization, and to create a highly effective organism in the process. Its promise of “disruptive innovation” is cause for optimism and hope in an environment of regulatory and market constraints that are stifling in its effects. But CEOs considering Six Sigma must be careful not to push too hard or too fast. As with any cultural change, the process of introducing Six Sigma must be approached with patience and leadership. Although the development of knowledge workers has been recognized as one of the most impactful competitive strategies available to service industries, implementing such a strategy in a healthcare enterprise can feel like trying to boil the ocean. Because change is uncomfortable, CEOs can expect initial resistance and anxiety in connection with these efforts. If not addressed early on, any of the following conditions can ultimately lead to a failed attempt at implementing Six Sigma methodologies: Lack of understanding of Six Sigma principles Ambivalent involvement of senior management Lack of broad participation and involvement Dependence on consensus-based decisions Initiatives too broad or too narrow in scope Failure to attack cultural impediments Ultimately, the CEOs job in implementing Six Sigma is to engineer a cultural change first that recognizes the moral imperative of the organization to forge new ground in performance improvement. Attitudes that suggest “we are the best we can be” must be replaced with “we must get even better.” Constant monitoring to ensure quality must be replaced by systems and controls that make defects nearly impossible. On one hand, it may seem that Six Sigma demands as much from the organization as it delivers in return. This may be a valid observation, but you do not hear any of its proponents expressing anything but enthusiasm and anticipation from the promise that Six Sigma can offer them. Reprinted with permission from the January 2002 issue of Managed Healthcare Executive. No reproduction permitted without express written consent of authors and publisher. All rights reserved.
Ian R. Lazarus, FACHE and Beatriz Stamps, MD MBA are principals with Creative Healthcare USA (www.creative-healthcare.com) a consulting firm providing strategic advisory services, including Six Sigma consulting, to healthcare providers and suppliers. You may contact either Mr. Lazarus or Dr. Stamps at 1.888.376.8652.
Black Belt Training March 25 - 29, 2002 (Measure Phase) April 22 - 26, 2002 (Analyze Phase) Minneapolis, Minnesota Provided By: Breakthrough Management Group Inc. Visit www.bmgi.com for more information! Lean Six Sigma Executive Roundtable March 14, 2002 Atlanta, Georgia Provided By: George Group Visit http://www.georgegroup.com/events/events.asp ToolMaster March 18 - 21, 2002 Minneapolis, Minnesota Provided By: Breakthrough Management Group Inc. Visit www.bmgi.com for more information! Lean Six Sigma Executive Roundtable March 19, 2002 Houston, Texas Provided By: George Group Visit http://www.georgegroup.com/events/events.asp Lean Six Sigma Executive Roundtable March 22, 2002 Dallas, Texas Provided By: George Group Visit http://www.georgegroup.com/events/events.asp Lean Six Sigma Executive Roundtable April 4, 2002 Chicago, Illinois Provided By: George Group Visit http://www.georgegroup.com/events/events.asp Champion Training April 9 -11, 2002 Buffalo, New York Provided By: Breakthrough Management Group Inc. Visit www.bmgi.com for more information! Lean Six Sigma Executive Roundtable April 18, 2002 Detroit, Michigan Provided By: George Group Visit http://www.georgegroup.com/events/events.asp ISSSP Six Sigma in Healthcare Symposium April 29 - May 1, 2002 St. Louis, Missouri Provided By: ISSSP Visit www.isssp.com/symposium01.htm for more details! ISSSP 3rd Annual Six Sigma Leadership Conference June 23 - 26, 2002 Chantilly, Virginia Provided By: ISSSP
ΣXTRAOrdinary Sense March 2002
13th Annual National Forum on Quality Improvement in Health Care
By Bob Swagerty, VP Business Services, ISSSP
Our ISSSP team returned in December from the Institute for Healthcare Improvement Conference in Orlando, Florida and quickly assessed the impact that Six Sigma can have on the healthcare industry in the coming months and years. We presented our sponsoring Affiliates and spoke with hundreds of attending physicians, executives and quality leaders from all across the world. Our learnings were significant. First, there is a real and verified interest in Six Sigma methodology, within the Healthcare industry, to provide industry wide solutions and help solve the mounting problems of inefficiency and patient dissatisfaction. This was expressed in the Six Sigma session, “Six Sigma: Is it for Us? From Experiment to Strategy”, presented by Randal Linton, MD, President and CEO Elect, Luther Midelfort - Mayo Health System, and later reiterated by the many attendees that visited our booth over the two days. Secondly, Healthcare groups seem to be in an exploratory phase and need answers to questions concerning the Six Sigma methods and best practices. How can it help them? Who can they go to for answers? At what level are they able to enter and reap the benefits of process thinking across their operation. As a result of our learnings derived from our conference presence, we have developed our Six Sigma in Healthcare Campaign that will help organizations throughout the Healthcare supply chain investigate the power of the Six Sigma solution. This campaign will provide the many healthcare providers interested in Six Sigma a platform to acquire answers to their questions. All of this leading up to our Six Sigma Healthcare Symposium - “Six Sigma in Healthcare: Exploring the Opportunities”, scheduled for St Louis, April 29 - May 1, 2002.
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Daniel Gee, MD, MBA
Beatriz Stamps, MD, MBA
ΣXTRAOrdinary Sense March 2002
Implementing Six Sigma to Achieve “Breakthrough” Results
By Jeffrey Burnich, M.D., and Tammy Weidner, R.N., MBA, Mount Carmel Health System
In the spring of 2000, Mount Carmel Health System -- a three-hospital system in Columbus, Ohio with 7,300 employees and a medical staff of 1,200 physicians -- was experiencing severe financial challenges like many healthcare systems nationally. The senior management team realized that we needed to drastically improve our financial performance, and that incremental improvement wasn't going to be sufficient -- we needed a breakthrough level of improvement. At about that time, Mount Carmel's CEO and its Chief Quality Officer each began reading about Six Sigma without the other's knowledge. They both came to the conclusion that Six Sigma had the potential to help the organization achieve breakthrough results. Mount Carmel selected Breakthrough Management Group (BMG), Scottsdale, Ariz., to help facilitate our deployment of Six Sigma throughout the organization, a process that began in the summer of 2000. Leadership Buy-In And Infrastructure Development Our deployment began with a two-day broad overview of Six Sigma system for the senior management team, ensuring buy-in and support for the implementation. The Chief Quality Officer was selected to provide executive oversight of the deployment, and a vice president's position was converted into the dedicated role of Vice President of Six Sigma to direct the day-to-day implementation activities. Next, an in-depth, week-long training session was held for those within the organization who would likely become Six Sigma Champions responsible for identifying and overseeing Six Sigma projects. This group mostly included the senior management team as well as vice presidents (we currently have 16 active Six Sigma Champions). Then, a Six Sigma core team was formed with the responsibility of developing the infrastructure necessary for the successful deployment of Six Sigma at Mount Carmel. The core team was crossdepartmental, including representatives from finance, human resources, information technology, communications, as well as learning and education. The core team received a full week of training and met for two-day working sessions every month during the early stages of deployment, with additional committee work as needed. The responsibilities of the core team included developing job descriptions and a compensation program for Six Sigma black belts (which the organization prefers to call Six Sigma Guides); preparing the strategy for training black belts; ensuring the information technology resources necessary to track Six Sigma projects; developing the tools and metrics for measuring and validating the financial returns of Six Sigma projects; and preparing a strategy for communicating Six Sigma to Mount Carmel's internal stakeholders -- especially managers, employees, and physicians -- as an important new strategic initiative the organization was undertaking as an investment in its future. Black Belt/Brown Belt Strategy And Training We selected a total of 44 employees from among the organization's best staff in two training waves to serve as black belts, and an additional four employees to serve as brown belts (which Mount Carmel prefers to call Six Sigma Scouts). While black belts assume their positions on a full-time basis in working on Six Sigma projects, brown belts retain their functional responsibilities and fulfill their brown belt responsibilities part-time in helping scope projects. We are now in the process of implementing a green belt strategy to train select employees in the Six Sigma methodology so that they can pursue less complex Six Sigma projects in their functional areas of responsibility and/or assist black belts on their projects on a part-time basis. To avoid adding unnecessary labor expense, only a few of the black belts' previous positions were back-filled. We knew that this approach would cause some consternation in affected departments since we were taking one of their best employees our of their role - and asking the remaining employees to absorb the workload among themselves. We acknowledged the sacrifice we were asking them to make, and promised them that they eventually would begin to see positive benefits as these black belts helped fix problems in work processes that were a source of frustration and dissatisfaction for them. The black belts and brown belts received four weeks of intensive training, one week each month for four months, while spending the other three weeks applying what they were learning by working on an actual Six Sigma project during the training period. The first wave of black belts graduated in March 2001, and the second wave in July 2001 Organization-Wide Deployment Rather than limiting the implementation of Six Sigma to one deBreakthrough continued on page 9
Tears: Six Sigma Without Tears:
How Healthcare Providers can Effectively Integrate Six Sigma into CQI
By Rick Tucci, President, Leap Technologies, Inc.
Picture this: A meeting of the senior staff at a regional integrated healthcare provider after attending the recent IHI Quality Improvement in Healthcare Conference in Orlando, Florida. COO, Administrative Services…“There seemed to be a lot of attention around Six Sigma at the conference. The results being reported by a number of our peers are impressive. Maybe we should consider launching a Six Sigma initiative. What do you think?” Director of Patient Care…“I’m all for getting a bigger return on our CQI (Continuous Quality Improvement) initiative, but I’m worried about the time commitment required. Where will these full time Black Belts that Six Sigma relies on come from? We’re short staffed as it is!!” Director of Engineering Services…“I’ve had a number of QATs (Quality Action Teams) launched in my department since we started CQI. For the time and resources committed, I haven’t seen the return. If Six Sigma will get us some concrete cost savings, I’ll support it. But I wonder if it’s overkill. A lot of the safety and cost problems we have require basic blocking and tackling.” Manager, CQI…“I’d be crazy to say no to anything that will improve our CQI effort. But, I’m very skeptical about our ability to take on any new quality tools or programs. The fact is we have trouble today getting consistent participation on our CQI councils and QATs. We’ve invested in quality tools training, including SPC. It feels like Six Sigma is a solution to the symptom, not a response to the root causes of our CQI problems.” COO, Administrative Services…“I appreciate everyone’s concerns and will admit that we’re in no position to spend a million dollars on anything right now. Nonetheless, I’d sure like to be able to tell our Board that we aren’t sitting here with our heads in the sand when it comes to CQI.” The Six Sigma “Cross Roads” for Healthcare Providers The fictional conversation described above is in fact taking place in the executive offices of many healthcare provider organizations. The debate about Six Sigma is a critical one, because the stakes are high – both in risk and return. What’s clear is that making real breakthroughs in quality performance is more likely with Six Sigma versus conventional TQM methods. The discipline of the DMAIC model, the dedication of highly trained full-time project leaders (Black Belts) and the emphasis on improving performance measurement systems has produced faster and bigger gains over other quality improvement methods. What’s much less clear, however, is how to go about implementing Six Sigma in healthcare provider organizations without adding greater burdens to an already overtaxed workforce; without disenfranchising the internal CQI staff; and without busting the budget. Taking a Balanced Approach A real-world recent experience with a regional healthcare provider offers a useful case example of what to do and what not to do in “crossing the road” to Six Sigma. Lesson One: Don’t Buy the Whole Six Sigma Farm Once on the radar screen, Six Sigma can take on an “all or nothing” or “nothing else works” aura. The message from some Six Sigma consultants seems to say, “You’re not serious unless you train everyone on Six Sigma philosophy, build a critical mass of Black Belt project leaders, invest in a special Six Sigma support infrastructure and do it all fast with a big budget commitment.” This approach can pay dividends in giant multi-national companies where the potential for cost savings justifies the large, upfront investment. However, for the majority of companies, this approach is simply not affordable or smart business. At the aforementioned healthcare provider, for instance, the executive team rejected proposals for an organization-wide Six Sigma launch with price tags starting at $500,000. Instead, the team chose a focused project approach that offered a just-intime, pay as you go plan for deploying Black Belts as each Six Sigma project opportunity emerged.
Tears continued on page 15
Breakthrough continued from page 7
partment, Mount Carmel adopted an organization-wide deployment. All business units across the organization have been expected to use the Six Sigma methodology and the black belt resources to tackle business problems that drag down financial performance and act as a source of patient, employee, and physician dissatisfaction. Additionally, Six Sigma is now the established methodology in the organization's Performance Improvement Plan which is reviewed by the Joint Commission on Accreditation of Healthcare Organizations. "Soulful" Six Sigma We read in the Six Sigma literature that as a result of efficiencies achieved through Six Sigma, an organization could save money by eliminating positions. Early on in our implementation, the senior management team committed to a more “soulful” approach to deploying Six Sigma at Mount Carmel by taking into account the potential impact of Six Sigma projects on employees. We didn’t think that our corporate culture would accept or embrace any other approach to implementing Six Sigma, and we needed
the enthusiastic support and cooperation of our managers and employees to make the deployment successful and realize the expected benefits. If positions are eliminated because we have removed inefficiencies through Six Sigma projects, we have pledged that affected employees will receive training and have an opportunity to move to other open positions within the organization. That is why we refer to our deployment as “Soulful Six Sigma.” Project Selection During the first year of our deployment, Six Sigma champions selected business problems that were their biggest operational headaches. Now in our second year of implementation, we are taking a more strategic approach by selecting Six Sigma projects based on key business themes. We expect our projects to achieve an average financial return of $100,000. During the strategic planning cycle for our next fiscal year beginning July 1, 2002, our Six Sigma champions have identified six key business themes on which our Six Sigma projects will concentrate — revenue enhancement, bad debt reduction, patient throughput in all operational units, labor/right staffing, labor retention and recruitment, and patient safety.
Breakthrough continued on page 28
INTERNATIONAL SOCIETY OF SIX SIGMA PROFESSIONALS
Six Sigma In Healthcare
Attend the Symposium!
The Symposium is a 2 1/2 day program designed for Healthcare executives and practitioners. One full day is focused on lessons learned and deployment case studies targeted to Healthcare leadership. One and a half days are focused on best practices, advanced educational sessions and project case studies demonstrated by Six Sigma Experts, Practitioners and Deployment Leaders.
April 29 - May 1, 2002 - St. Louis, Missouri
This video represents featured speakers from the 2nd Annual Six Sigma Leadership Conference Key Topics Include: • Creating a Six Sigma Culture in Healthcare • Clinical & Operational Six Sigma Projects • Reducing Cycle Time & Improving Productivity in Hospital ER’s • Open Discussion on Six Sigma Related Healthcare Issues • Six Sigma in Pharmaceutical Manufacturing
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Six Sigma Affiliates
The Six Sigma Affiliates Program - a program developed for the benefit of ISSSP Six Sigma providers.
Our members regularly request information on the products and services available from the various providers, ranging from software to full deployments. This program enables Six Sigma providers to share, learn, network and market their Six Sigma products and services. We look forward to serving you.
Six Sigma Affiliates
ISSSP is proud to recognize the following companies as Six Sigma Affiliates: Air Academy Associates Breakthrough Management Group Convergence Corporation e-ZSigma, Inc. George Group
Convergence Corporation offers clients Six Sigma Quality Business Management Consulting and Seminar services. Focus: provide clients with the insight, tools & methods to implement Six Sigma Business Process Management and Process Improvement Methodology: DMAIC. Vision: enable clients to increase corporate profits, invigorate corporate culture, and achieve corporate Excellence! Rath & Strong/Aon Management Consulting is a leading provider of customized global Six Sigma solutions and a pioneer of many concepts proceeding Six Sigma. Provides a comprehensive, flexible range of Six Sigma consulting services and training for leading companies, specializing in combining leadership and people issues with Six Sigma methods. Creators of the best-selling Six Sigma Pocket Guide. Six Sigma Qualtec is a premier provider of training and implementation services that drive measurable financial results. The Six Sigma Qualtec methodology is an integrated deployment of training and tools for achieving breakthrough performance including dramatically reduced cycle times, defects and costs. This approach has significantly improved productivity, efficiency and customer satisfaction with clients worldwide. Six Sigma Qualtec continues to expand its client base, worldwide involvement, portfolio of service offerings, and client services delivery capacity while exceeding our client’s expectations. Our company works with leaders in both the public and private sectors throughout North America, Asia, and Europe, and across all industry and government segments, leading them to increased profitability. Six Sigma Qualtec world headquarters is located in Tempe, Arizona with offices in Tokyo, Japan and Oxfordshire, UK. Y-change offers an internet-based, enterprise-wide strategy and project management application that ensures strategic initiatives are efficiently deployed down to the individual project level. Y-change’s unique Project/ Portfolio Management allows managers to track the progress of multiple Six Sigma projects in real-time. With y-change, Six Sigma initiatives can now be centrally coordinated and monitored leading to faster, more efficient deployments.
Global Learning Systems Global Productivity Solutions Hertzler Systems, Inc. Human Capital Associates iGrafx, a product of Corel Institute for International Research International Institute for Learning JMP, A Business Unit of SAS Leap Technologies Inc. Minitab Movaris Oriel Inc. Pivotal Resources ProActivity PROSPERO LLC PwC Consulting The Quality Group Rath & Strong Sigma Breakthrough Technologies Inc. Six Sigma Qualtec Smarter Solutions StatSoft Y-change
ISSSP thanks you for your continued support! For more information on the Six Sigma Affiliates Program, please visit www.isssp.org.
Six Sigma: Using Statistics to Reduce Process Variability Process Variability and Costs in Radiology Radiology
By Jean Cherry, M.S., FACHE and Sridhar Seshadri,
In many corners of the corporate world, Six Sigma has developed a reputation as the mother of all quality initiatives. Pioneered at Motorola Corporation in the 1980s, Six Sigma is a quality initiative based on rigorous statistical process control. It augments traditional quality tools with exacting statistical analysis and a systematic problem-solving approach, targeting the root cause of variations and redefining processes for long-term results. The methodology has been used in a variety of settings to solve a broad array of issues: from improving manufacturing capabilities to customer service to aircraft design…and everything in between. It has been used to transform organizations of all types and is now beginning to be applied in healthcare.
• Pioneered at Motorola Corporation in the 1980s, Six Sigma is a quality initiative based on rigorous statistical process control. It augments traditional quality tools with exacting statistical analysis and a systematic problem-solving approach, targeting the root cause of variations and redefining processes for long-term results. • “Sigma” is the Greek letter used by statisticians to define standard deviation from the norm. At Six Sigma, defects are roughly 3.4 per million opportunities, or nearly error-free. • The methodology has been used in a variety of settings to solve a broad array of issues. It has been used to transform organizations of all types and is now beginning to be applied in healthcare. • Commonwealth Health Corporation in Bowling Green, Kentucky , launched its Six Sigma program in its radiology department. Within 18 months, the culture had been transformed, productivity levels increased and patient experience improved while eliminating more than $800,000 in total costs. • After Six Sigma was implemented, CHC’s radiology cost per procedure went from $68.13 to $49.55. With over 100,000 procedures performed each year, the cumulative savings exceeded $1.65 million. And most notably, exemplifying the essential quality aspect of Six Sigma, errors in the MR ordering process were reduced by 90 percent. • Six Sigma training involves several phases, reaches various levels of expertise, and can extend anywhere from one to 14 days. Training is always linked to particular projects impacting operations, giving participants a chance to learn the methodology while at the same time achieving results within their own work environment. • One of the primary keys to unlocking Six Sigma success is solid commitment from leadership. Since this initiative will compete for capital and time resources, participants have to be able to count on unambiguous support from senior management. • To carry this quality improvement forward at CHC will require ongoing training and the generation of approximately 120 trained staff within two years. Every CHC employee will receive a minimum of one full day’s training.
Sigma 1.5 2.0 3.0 4.0 5.0 6.0
Defects per million opportunities 500,000 308,537 66,807 6,210 233 3.4
“Sigma” is the Greek letter used by statisticians to define standard deviation from the norm. A higher sigma indicates a lower rate of defects and more efficient processes. At Six Sigma, defects are roughly 3.4 per million opportunities, or nearly error-free. Consider this: Three Sigma translates into about 5,000 incorrect surgical procedures each week nationwide, a somewhat less than desirable ratio. With excessive variability and medical error rates currently under the microscope, some healthcare administrators and department managers are looking for some additional guidance and reliability. The point of deploying Six Sigma in healthcare is not to diminish the authority of a radiologist, physician, nurse or other professional, but to enhance the predictability of positive outcomes, whether clinical or operational. And it’s an approach that is flexible and scaleable. It can be used to improve a single process in a single department within a small, rural medical center, or it can be deployed throughout an entire multi-hospital system.
Radiology Takes the Lead at CHC Initially implemented in CHC’s radiology department in early 1998, the program began to spread throughout the organization within the next two years. Results have been impressive across several areas: within 18 months, the culture had been transformed, productivity levels increased and patient experience improved while
Radiology continued on page 13
Meet the ISSSP Corporate Sponsors
The ISSSP Healthcare 2002 Corporate Sponsorship Program gives corporate leaders the opportunity to effectively develop personnel resources, share lessons learned with healthcare partners and develop a continuous open forum for healthcare industry solutions utilizing Six Sigma methodologies. GlaxoSmithKline - one of the world’s leading research-based pharmaceutical and healthcare companies - is committed to improving the quality of human life by enabling people to do more, feel better and live longer. Headquartered in the UK and with operations based in the US, the new company is one of the industry leaders, with an estimated seven per cent of the world’s pharmaceutical market.
CommoNWeAlTH HeAlTH CoRpoRATIoN
In 1984, Commonwealth Health Corporation CHC) was formed as a not-for-profit holding company for The Medical Center and other health related businesses. By the year 2004, CHC will be proudly recognized by its employees, patients, clients, community, physicians and payors as the unquestioned leader in care and service, providing flawless quality never before achieved in the healthcare industry.
Since the Company’s founding in 1886, Johnson & Johnson continues to provide innovative health care products that improve or save lives. Johnson & Johnson has 197 operating companies worldwide. A shared system of values, known as its Credo, serves as a guide for all who are part of the Johnson & Johnson Family of Companies.
Mount Carmel has been caring for residents of central Ohio for over 113 years. Its core values, which underlies everything that it does, are: dignity of persons, service to others and social justice for all. Mount Carmel is committed to treat all people with fairness, respect and compassion and to ensure that everyone has access to quality healthcare services. Each year, Mount Carmel provides millions of dollars in free care and benefits to the community.
Radiology continued from page 11
eliminating more than $800,000 in total costs. After this program was implemented, CHC’s radiology cost per procedure went from $68.13 to $49.55. With over 100,000 procedures performed each year, the cumulative savings exceeded $1.65 million. And most notably, exemplifying the essential quality aspect of Six Sigma, errors in the MR ordering process were reduced by 90 percent. Interestingly, hard times weren’t the impetus for this Six Sigma project, since CHC was already financially sound and a leader in their market area. Of course, this comfort level can produce its own set of challenges, since motivating a team is sometimes more difficult when things are going well. Also, CHC recognized the need to maintain their competitive edge, cope with reimbursement and regulatory issues, and meet rising patient expectations. Internally, leaders recognized a genuine opportunity to build teamwork and transform the corporate culture. Changing the Cultural Landscape Six Sigma was seen as having the potential to drive quality to new heights and sharpen the competitive edge for both the radiology department and the system as a whole. Like most providers, CHC has had some form of quality initiative in place for years. The difference is that Six Sigma actually becomes ingrained in work and
thought processes, and instead of simply solving short-term quality issues, creates a knowledge base to get it right the first time. But Six Sigma can also be viewed as a catalyst for corporate-wide transformation of the existing culture. By collecting and analyzing relevant data, possibilities for improving even the most intransigent processes begin to emerge. Six Sigma relies on a foundation of methodically collected and analyzed data, rather than managerial experience or expertise. This evidence-based approach makes it somewhat easier to present the case for change and garner staff support. How the Process Unfolded As is customary when launching any major change initiative, the Six Sigma project began by assembling key players for a preliminary strategy session. During this meeting, the team set a goal to become a Six Sigma organization by the year 2004. With that target set, the first round of training began. Six Sigma training involves several phases, reaches various levels of expertise, and can extend anywhere from one to 14 days. Training is always linked to particular projects impacting operations, giving participants a chance to learn the methodology while at the same time achieving results within their own work environment. Through these educational sessions, leaders learn to better manage strategic change, cultivate support, mobilize constituencies, and establish systems for long-term results. Employees also learn to use a problem-solving approach designed to reduce organizational redundancies. Participants successfully planning and completing two Six Sigma projects attain what is commonly known as Green Belt status. The completion of additional projects and achieving higher levels of accomplishment lead to the attainment of Black Belt and Master Black Belt status. CHC’s radiology department was chosen as the launching pad for Six Sigma. Twelve participants within Radiology used the various training processes to focus on learning team dynamics, identifying specific areas of opportunity within the department, and putting improvement and control mechanisms in place. Making sure that process changes are built-in and remain as guidance systems for the long haul differentiates Six Sigma from previous quality initiatives at CHC. This radiology-focused phase significantly reduced wait times for patients, generated faster turnaround times for radiology reports and increased productivity. In fact, CHC’s team managed to boost
Radiology continued on page 28
ΣXTRAOrdinary Sense March 2002
Commonwealth Health Corporation
• A not-for-profit integrated delivery network located in Bowling Green, KY. • The Medical Center in Bowling Green: 487 beds • The Medical Center in Scottsville: 157 beds (includes 105 extended care beds at Cal Turner Extended Care Pavilion) • The Medical Center at Franklin: 50 beds • Employees: Over 2,000 • Radiology diagnostic technology includes state-of-the-art MRI, Cat Scan, CT-3D treatment planning and Angiography. Modalities: • MRI • Mammography •Nuclear Medicine • Number of procedures per year: FY’99: 91,055 FY’00: 104,036 FY’01: 108,780* *estimate based on available ‘01 data • Radiology • CT • Ultrasound
Six sigma in Healthcare educational program Educational Program
As a leading source of credible information regarding Six Sigma, ISSSP has decided to provide a platform for those who are learning how Six Sigma can be the best improvement solution for an organization’s need to improve quality, reduce costs, eliminate defects and enhance financial performance. To this end, ISSSP in conjunction with its Affiliates and Corporate Sponsors, is offering a program of educational, one-hour, interactive , webcasts that will take you through the elements of Six Sigma from A to Z. As a registrant of this program, you will have the option to attend (12) different one-hour sessions. The schedule of sessions currently available represent many different topics within Six Sigma and will be updated to ensure that participants have the greatest opportunity to learn and the availability to attend a variety of topics that may meet their individual scheduling needs. In the event you've already missed a few sessions, rest assured. ISSSP will continually add new modules and repeat modules to ensure participants receive the full value of this program. As a registrant, you will receive email notices of any enhancements to the schedule. Sessions are also recorded and archived. If you miss a session or if there is a particular session that provides you great insight, you have the opportunity to re-visit those topics that benefited you most. So sign up now and join us for our next session!
Special Bonus! Networking Program
Our Healthcare Corporate Sponsors invite you to join their networking sessions where they will present case studies and demonstrate the problem and the solution using the Six Sigma methodology. Each one-hour networking session includes 2-4 project case studies. Registered participants will receive regular updates and invitations to these networking sessions. Live recordings are available for viewing for those that were unable to attend.
Corporate Sponsors To Date
• Commonwealth Health Corporation • GlaxoSmithKline • Johnson & Johnson • Mount Carmel Health System
February 28, 2002 March 7, 2002
Six Sigma Overview The Keys to the Methodology
Six Sigma Qualtec Global Productivity Solutions
March 14, 2002
What is a Six Sigma Project?
March 21, 2002
Six Sigma Roles & Responsibilities
March 28, 2002
The Financial Impacts of Six Sigma
April 4, 2002
Using Action Workout™ as the "on ramp" to Six Sigma in Healthcare Statistical Analysis for the Healthcare Industry
April 11, 2002
April 18, 2002
Six Sigma, The Medical Staff and You
April 25, 2002
May 9, 2002
May 16, 2002
Engaging Your Partners: Including Your Customers and Suppliers
Creative Healthcare USA PwC Consulting
May 23, 2002
Rath & Strong
For a more detailed description of each session, please visit our website at www.isssp.com.
Breakthrough Management Group Inc.
Six Sigma Qualtec
Six Sigma Qualtec
Tears continued from page 8
Lesson Two: Refocus and Recharge Internal CQI Staff CQI managers and quality professionals are often threatened by Six Sigma. They know that in some Six Sigma companies, the internal quality staff ends up marginalized and reduced to a paperwork compliance office. Of course, some CQI managers persist in spinning the broken record of “no management commitment” as the cause of failed CQI efforts in the past and use this as an excuse to block Six Sigma introduction. The truth is that CQI efforts in many healthcare provider organizations have yielded significant benefits by identifying patient expectations, educating the workforce on quality values and concepts, and establishing process documentation systems. The COO of the healthcare provider in our case example made the wise choice of holding his CQI manager accountable for the success of Six Sigma. In addition, the COO used the introduction of Six Sigma to conduct a complete audit of the CQI effort, “sunsetting” unproductive Quality Action Teams and refocusing the CQI staff on improving the CQI infrastructure – from satisfaction measurement to best practices. Lesson Three: Get More Employees and Managers “Into the Right CQI Game” One of the biggest concerns about Six Sigma is captured in a water cooler exchange making the rounds. Question: “How many Black Belts do you need to achieve Six Sigma performance?” Answer: “A few good ones to do the work and an army of certificate holders to impress Wall Street.” Sarcasm aside, the point worth noting is that Six Sigma is not a backyard sport. Black Belt training is rigorous and not for the masses because everyone can’t be an expert. Furthermore, there typically aren’t enough problems worth the dedication of Black Belts to justify “excess inventory”. Black Belt certification as a career or stock price booster becomes very expensive. When Black Belts become a substitute management team for solving problems that don’t require rigorous statistical analysis, Six Sigma initiatives spiral down into a game for the elite only. A better approach is to adopt a simpler, but equally reliable methodology for getting more participation in quality improvement
efforts, just as our example regional healthcare provider chose to do. The decision was made to introduce a complementary improvement process called Action Workout to work in parallel and in support of the Six Sigma DMAIC process. Action Workout is the latest generation of the fast change process first used by Jack Welch at General Electric to “break down bureaucracy”. Action Workout has evolved over the last decade into a system for converting employee know-how and creativity into focused results. Action Workout is a natural complement to Six Sigma. It uses the same rigor of business case-based project selection, a structured improvement process and expert guidance. What’s different is the nature of the problems Action Workout attacks and hence, the level of expertise and time required to succeed. Action Workout fills the gap between the “no-brainer” fixes made with decisive management action and problems that can’t be reliably fixed without detailed analysis. At our regional healthcare provider, Action Workout was used to attack problems like these: • Reducing the use of contract nurses through more effective scheduling and management • Improving the accuracy of patient treatment records to smooth claims processing • Reducing materials and energy waste • Shortening hiring cycle time and improving employee retention These problems were attacked using frontline employees, supervisors and managers organized into small (five to seven people) action teams and equipped with an Action Workout Team Kit – an expert improvement process literally packaged in a box. Action Workout was chosen over DMAIC or the in-place Quality Action Team process for two reasons: Speed and simplicity. Action Workout allowed this particular healthcare provider to mobilize more than 50 employees to make performance improvements without classroom training or overtime. Then, they were turned loose to achieve major financial gains in a 60-day “sprint” timeframe.
Tears continued on page 17
ΣXTRAOrdinary Sense March 2002
April 29- May 1, 2002 St. Louis, Missouri
six sigma in healthcare symposium
The Symposium is a 2 1/2 day program designed for Healthcare executives and
practitioners. One full day is focused on lessons learned and deployment case studies targeted to Healthcare leadership. One and a half days are focused on best practices, advanced educational sessions and project case studies demonstrated by Six Sigma Experts, Practitioners and Deployment Leaders.
Leadership Program (1.5 Days)
• Company leaders of Healthcare organizations present their deployment strategies, lessons learned and the value of Six Sigma within their organization • Networking Reception with Project Storyboards
Full Program (2.5 Days)
• Six Sigma Applications and Project Case Study Presentations • Advanced Educational Sessions • Networking Riverboat Trip • Member Challenge Game
Companies Featured to Speak
Featured speakers will be from the Healthcare industry (across the supply chain) and Six Sigma professionals from across the country. Distinguished companies include: • GlaxoSmithKline • Johnson & Johnson • Commonwealth Health Corporation • McKesson • Mount Carmel Health System • GE Medical Systems
Full Program (Leadership Program included)
Networking Reception with Project Storyboards
Riverboat Trip for Full Program Participants
Final Round of Member Challenge
(interactive Six Sigma game)
Who Should Attend?
• Healthcare Executives • Physicians • Senior Managers • Deployment Leaders • Champions • Six Sigma Practitioners
Corporate Sponsors To Date
• Commonwealth Health Corporation • Johnson & Johnson • GlaxoSmithKline • McKesson • Mount Carmel Health System
Affiliate Sponsors To Date
• Breakthrough Management Group Inc. • Creative Healthcare USA • Global Productivity Solutions • Leap Technologies • Minitab • PwC Consulting • Rath & Strong • Six Sigma Qualtec
Hotel Reservations Millennium Hotel, St. Louis
To reserve your room, please contact the hotel directly at 866-866-8086. Refer to the ISSSP Six Sigma in Healthcare Symposium to receive the discounted rate.
If you are interested in Speaking Opportunities at this Symposium, please contact Edna Cribb at 480-368-7083 or EdnaC@isssp.com. If you are interested in Sponsorship Opportunities, please contact Roxanne O’Brasky at 480-368-7083 or RoxanneO@isssp.com.
* All cancelations/substitutions must be received in writing. All cancelations will be subjected to a $150 administrative fee. No refunds will be given after April 12, 2002.
Tears continued from page 15
Supply Chain continued from page 1
Making the Transition Without Tears The introduction of Six Sigma into healthcare provider organizations can be made smoother with attention to three key questions: • Where are the opportunities for the Six Sigma DMAIC process and Black Belts to achieve a return that justifies the investment? • How to reliably and cost-effectively get more managers and frontline employees into the CQI game to quickly solve problems outside the DMAIC domain? • How to refocus existing CQI activities and redirect the CQI staff to hold gains from all improvement projects? Healthcare provider leadership teams who fully answer these questions will get “on the Six Sigma bandwagon” at a ticket price they can afford and experience a smooth ride.
experienced a 23 percent turnover rate. After seven months of applying Six Sigma, that rate dropped to only 11 percent. The realized cost savings are also impressive. Since beginning the implementation of Six Sigma, the organization has seen a financial return of $2.4 million through the end of 2001. And those returns are expected to grow as they tackle more Six Sigma projects. The International Society of Six Sigma Professionals (ISSSP), in conjunction with its Affiliates and Corporate Sponsors, has begun a campaign to help tell the story of health care entities that have experienced great success with Six Sigma. ISSSP’s objective for this campaign is to provide credible information and expertise in Six Sigma to quality-minded practitioners in healthcare and its allied fields. The source of this information comes from the healthcare industry itself, from outside the industry and from the healthcare supply chain. Programs have been developed to equip healthcare professionals with the knowledge to make informed decisions about the application of Six Sigma. One specific forum brings together organizational leaders from the healthcare supply chain and hospitals to examine a variety of issues facing healthcare. Programs like this and others have been developed to provide healthcare professionals with a keen understanding of Six Sigma and the potential it represents. The health care industry, with its unique challenges and opportunities is clearly ready for Six Sigma…but what about you?
Participate in an online networking exchange of information and best practices about Six Sigma in Healthcare!
Post your comments and questions using this stateof-the-art bulletin board system located on the ISSSP Members website. 17
ΣXTRAOrdinary Sense March 2002
North Shore - Long Island Jewish Health System Teams with GE and Shore Teams Harvard to Launch Center for Learning and Innovation
By Roxanne O’Brasky, President, ISSSP
I had an opportunity – thanks to an invitation from GE Medical Systems — to attend a special event announcing the launch of an exciting new venture called “Center for Learning and Innovation.” This new initiative — a collaborative effort between the North Shore Long Island Jewish Health System (LIJ), GE Medical Systems and Harvard University’s School of Public Health – is the largest of its kind in the healthcare industry to date. The afternoon program featured four key players, among others, in the Center’s planning and implementation. They included Michael Dowling, President and CEO of North Shore - LIJ; David Shore, Associate Dean Harvard School of Public Health; Paul Mirabella, President and CEO GE Medical Systems Healthcare Services; and Jeffrey Immelt, Chairman and CEO General Electric. As the guest speakers explained, the new Center represents the first learning initiative ever undertaken by a healthcare organization in cooperation with these two internationally renowned organizations. Created to enhance the health system’s ability to deliver services in today’s competitive marketplace, this effort signifies a major step in the healthcare industry that could spark far-reaching changes. With GE’s business leadership and Harvard’s unparalleled academic program, the Center aims to transform North Shore LIJ’s organizational culture, invest and develop new groups of leaders at different levels in the health system, and create worldclass learning organizations. Opportunity for Change The healthcare industry has long been ripe for implementing a new management perspective. As one of the most complex and constantly changing industries, representing more than $10 billion annually, the healthcare system is synonymous with countless pressures and obstacles that inhibit ongoing implementation of quality improvements. The combination of ongoing financial pressures, discovery of revolutionary new technologies and medical treatments, more educated and demanding work force and consumers, nursing shortages, declining reimbursements, changing patient demographics, and aging and diversifying populations all contribute to an industry whose evolution has been stifled by internal and external limitations. And, what’s more, consider the statistic that medical errors are the 8th leading cause of death accounting for 50,000 per year. According to David Shore, Associate Dean Harvard School of Public Health, “In response to the changing demands of patients and other constituents, organizations and technology are evolving so rapidly that health care professionals must continually seek new insights, perspectives and skills that enable them not only to respond to change, but also to anticipate it.” Jeffrey Immelt, Chairman and CEO General Electric. Agrees, “In the US, we have the best technology, best hospitals, best doctors, but healthcare still isn’t where we want it. I think the missing link is leadership.” Such common shortfalls have long represented a call to arms for industry heads to seek out new and better alternatives to manage the system. In healthcare, there is a prevalent understanding of the connection between patient satisfaction and employee satisfaction. Michael Dowling, President and CEO of North Shore-LIJ adds “We must invest in our people…by creating an environment that facilitates learning and professional growth.” Outside of the health care system, organizations that foster an environment of professional growth and life long learning among their employees create a culture dedicated to excellence, innovation, teamwork, and continuous change. This notion planted the first seeds for the Center for Learning. The shift toward a learning organization promotes a culture that is more productive, delivers improved care and more passionate care, more services and customer focus, and continues to strive to streamline work processes throughout the organization. This is the basis for The Center. North Shore – LIJ, like many of its industry peers, acknowledges the success of its traditional educational resources such as joint programs with local colleges, technical training and internal management development programs. However, the urgent need to coordinate, enhance and expand these efforts throughout the system is obvious. “We have done many things in the past, but we need to do more,” says Dowling. “We want to be an organization that people want to come TO and work FOR.”
North Shore continued on page 21
Six sigma in Healthcare Video
ISSSP is proud to present this 2001 Six Sigma in Healthcare Video. This video represents featured speakers from the
2nd Annual Six Sigma Leadership Conference and we are excited to offer this to you. As you learn from these experts, you are sure to create energy and commitment for your team, helping you develop a strong and successful Six Sigma program.
• • • • • Creating a Six Sigma Culture in Healthcare Clinical & Operational Six Sigma Projects Six Sigma in Pharmaceutical Manufacturing Open Discussion on Six Sigma Related Healthcare Issues Reducing Cycle Time and Improving Productivity in Hospital ER’s
Chairman & CEO Honeywell
Some of What You Will Hear:
“I have not seen anything that can deliver the sustainable results like Six Sigma.” “You have to get the best people you can.” “Leadership is the most critical aspect of any successful program.” “You have to dedicate yourself to a life of learning.” “There's plenty of data that indicates you will get twice your money back in the first year (of Six Sigma).” “Six Sigma takes an organization and shakes it up.” “Six Sigma has the ability to change an organization...as if by magic.” “Six Sigma creates a restlessness within an organization.” “Give Six Sigma constant care, until it becomes part of the culture.”
President & CEO Commonwealth Health Corporation
Pres. World Wide Mfg. & Supply Operations GlaxoSmithKline
CQO & Senior VP . Mount Carmel Health System
Creative Healthcare USA
THE GOAL IS RESULTS™ www.BMGI.com 1-800-46-SIGMA
Continued from page 19
Leaders of Change Over the past three years, Michael Dowling has been conceptualizing ways of transforming North Shore – LIJ into a “learning organization.” The GE Leadership Institute in Crotonville, NY where Dowling attended several leadership programs served as a basis for a number of initiatives envisioned for the North Shore – LIJ. In March of 2001, Dowling wrote his initial plans for a broad based learning center at North Shore – LIJ. By June 2001, strategy committees were established between the health system, GE and Harvard to begin planning and implementation of the Center. “To achieve our goals, we turned to GE and Harvard to harness the best expertise from the private sector, academia and healthcare,” says Dowling. GE’s Leadership Institute, is considered one of the best corporate universities in the business world. The Institute is a model for promoting organizational change and leadership development at GE while affording the Center to draw on experience in leadership development, knowledge and skills, including the management processes with the very successful Six Sigma. Harvard University’s academic reputation is unsurpassed, and the Harvard School of Public Health has designed courses for physicians and healthcare executives that are highly regarded in the healthcare industry. “ Harvard University, runs the world’s more renowned leadership education programs. Executives wait years to get into these programs,” according to Dowling. GE and Harvard provide LIJ with the best of the corporate sector and academia, along with expertise and experience in assisting large, complex healthcare organizations. Implementing Change The Center’s leadership has long echoed the sentiments of the healthcare industry regarding the system’s endless battles. The nagging question has always been: what to do about them. “Employees are the greatest asset any organization has. It (healthcare) is about people taking care of people; it is about human relationships; it is about continuity of human interactions, “ says Dowling. Positioned as the driving force that transforms the health system into a learning organization, the basis for the Center’s mission is a three-tiered employee-centered approach: • To create an environment that facilitates learning and professional growth • To develop employees knowledge, skills, attitudes that consistently support business and strategic goals. • To create leaders at all levels of the organization, right down through the organization.
As part of the Center for Learning and Innovation, GE Medical Systems Healthcare Services will lead a 36-month initiative to bring GE’s approach to leadership development and change management to LIJ. Specifically, GE will provide courses on “fast track decision making” for solving organizational problems, “change acceleration” processes for breaking down barriers to change and helping employees embrace new concepts, and “Six Sigma” management processes that have been widely recognized in the corporate sector for more than two decades. “We’re pleased that Six Sigma is a major component of this system…that trust is the centerpiece of the system,” says Shore. “Healthcare, by definition, requires a level of trust.” The all-encompassing vision of the Center and its resulting programs is designed to touch employees at virtually every level – physicians, nurses and other healthcare professionals, administrators, support staff and other non-clinical workers, including volunteers and trustees. And, although representing a significant overhaul in current North Shore – LIJ processes, all current learning programs will not be altogether abandoned, but brought under The Center for Learning umbrella. Realizing Change At the completion of the GE partnership in three years, LIJ will establish its own Six Sigma organization. By that time, about 175 key health system employees are expected to be proficient in Six Sigma management skills. In addition, the health system will have completed about 60 Six Sigma projects devoted to improving process efficiencies in areas such as patient wait time, billing, admissions and bed availability. Other initiatives will be phased in over three years. Developing a corporate university in healthcare and creating a learning culture improves the working environment, the quality and capacity of the workforce, and therefore the quality of the care and services delivered to patients. Some of the courses taught through the Center will involve teaching VOC (voice of the customer) methodology and understanding customers CTQs (Critical to Quality elements) both of which will be designed to enhance service quality and patient satisfaction. Some of the Six Sigma projects may be clinical in nature and will more directly impact patient processes and outcomes. Also, as employees acquire vital change management skills, they will be empowered to solve long-standing problems or prepare for future challenges. Removing the redundancies and inefficiencies that can become part of any job helps to improve productivity and
North Shore continued on page 28
Commonwealth Health Corporation, the Healthcare Pioneer of Six Sigma
By Lisa Thomerson, Six Sigma Corporate Champion, Commonwealth Health Corporation
Commonwealth Health Corporation’s Six Sigma initiative was launched in March 1998 after President and CEO John C. Desmarais listened intently to Jack Welch tout the amazing success General Electric (GE) had experienced by implementing Six Sigma. Welch had proven globally that Six Sigma was the way to improve process design and reduce costs. The encounter of these two executives led to a partnership between GE and CHC, in which GE Master Black Belts trained a diverse group of CHC executives and managers in Six Sigma methodology. This initial Green Belt training designated Commonwealth Health Corporation as the pioneer in healthcare to become a Six Sigma organization. Presently, CHC’s Six Sigma team develops training materials, teaches the Six Sigma methodology, and mentors Green Belts and Black Belts as they progress through the various levels of projects. These projects represent a variety of processes within the organization, both operational and clinical service lines. Projects are selected based on a variety of considerations: benchmarking, peer group data, and/or invaluable suggestions or ideas from employees, patients, and physicians. Although there are many challenges inherent in applying the Six Sigma methodology in a healthcare setting, CHC has seen many positive results in these ongoing Six Sigma projects. All projects must impact at least one of the following Critical-to-Quality factors (CTQs): Customer Satisfaction, Timeliness/Speed/ Convenience, Quality of Care/Service, or Cost. A typical CHC Six Sigma project takes four to seven months to complete. Every project is an intense objective study of a particular process that is driven by data. Neither subjective assertions nor random recommendations for improvements are tolerated in the DMAIC process (Define, Measure, Analyze, Improve, Control). Black Belts and Green Belts must prove statistically that a problem exists and the improvements made within the process have been improved using objective data. One of the innumerable strengths of Six Sigma is that all projects are approached the same, utilizing each of the five phases in DMAIC.
Commonwealth continued on page 24
Operational Excellence - be the benchmark
Operational Excellence is fundamentally changing the way in which GlaxoSmithKline’s Global Manufacturing & Supply business (GMS) operates, which is a worldwide organization with over 40,000 people working to manufacture the quality medicines and consumer products on which GSK patients and customers depend. In GMS, Operational Excellence is engaging and developing the full potential of our people throughout the organization, by delivering a unique blend of five components:
• LeanSigma – a methodology to eliminate waste and drive efficiency throughout the GMS organization • Knowledge Management – to enable the sharing of ideas, information, knowledge, good practices and experience to systematically create value for business benefit • Common Language and Global Processes – identifying and applying global processes consistently across GMS • Performance Management and Benchmarking - robust Performance Management methods and tools to continuously measure and improve performance, benchmarked against the best internal and external standard. • Education and Training – developing a range of education programs and activities, delivered via a variety of media from traditional classroom events to self-paced e-learning modules, to enable delivery of all components of Operational Excellence.
combined with detailed training of designated individuals who operate in an ‘expert’ role. An Expert Certification Process has been introduced to formally recognize this key resource. Our target is to have at any one time one percent of the GMS organization actively practicing as LeanSigma Experts. Beyond this an understanding of the principles is driven down to all levels of the organization by means of ‘Advocate’ training. The whole process is underpinned and sustained by a group of LeanSigma Internal Consultants who provide specialist teaching, mentoring and project support. In GMS the LeanSigma methodology is being used effectively in conjunction with the other elements of Operational Excellence to deliver step change improvements in the way we do business. “The powerful combination of the five components of Operational Excellence will enable us to meet business challenges in the way that is most effective for the business”, says Jean-Paul Reynaud, Vice-President, Operational Excellence. Jean-Paul is also keen to point out that Operational Excellence is a global initiative, which can be applied to all technical and business / transactional processes within GMS to enable optimum effectiveness. “It is helping GMS to learn and work as one team, so that good practice, breakthroughs and successes are shared and applied rapidly throughout our global network”. The GMS philosophy is that Operational Excellence should not be viewed only in terms of tools and techniques, but more as a major cultural change initiative designed to deliver significant benefits to the business. It provides a blueprint to help build a world-class manufacturing and supply organization. This will serve to realize the vision of GMS in being the benchmark in the pharmaceutical industry in five years and in all industries in ten years.
In GMS, LeanSigma is viewed as a methodology for sustained, customer-focused business improvement, based on the implementation of a powerful combination of two proven management approaches – Lean thinking and Six Sigma. The central themes of Lean thinking are the elimination of waste and the simplification of processes, minimizing activities that are nonvalue adding to the customer. Six Sigma provides tools to eliminate variation and drive robustness in order to deliver highly reproducible processes. The LeanSigma program has been successfully embedded in GMS by means of a systematic deployment program. This commenced with gaining leadership commitment from the executive level down,
GSK Corporate Offices, Philadelphia, Pennsylvania, US
ΣXTRAOrdinary Sense March 2002
Commonwealth continued from page 22
Six Sigma Strategy CHC’s successful implementation of Six Sigma can be directly attributed to the organization’s steadfast commitment to quality – to continually “raise the bar.” Six Sigma training was mandated for every employee to become adept at its use within CHC as the vehicle to continually improve processes and the delivery of care. It became the focal point of a culture change within the organization. Part of the lasting culture change, Six Sigma’s methodology and its approach to process improvement has facilitated a transformation in organizational communication. With that change, CHC’s senior leaders recognize the importance of their employees and understand their invaluable contribution to improve the “way we work.” At its inception, John C. Desmarais made the commitment that no one would lose their job due to improvements made by Six Sigma projects. Any reduction in CHC’s workforce would be through attrition. Black Belts are selected as the full-time project leaders who drive process improvements to meet CHC’s strategic organizational goals. Green Belts are Directors and Managers who lead projects part-time and incorporate Six Sigma methodology within their respective departments. These “Belts” consist of a wide array of employees leading projects on project teams. They discuss their projects directly with executive management at each phase (Review) of their projects. Reviews are the forum utilized to improve the flow of information to ensure the Black Belt, Green Belt, project team, and members of executive management are current on project developments. Black Belts and Green Belts, reinforced with management’s unequivocal support to the Six Sigma initiative, critically examine processes within their respective departments. The value of applying Six Sigma’s methodology to solve problems and improve processes is viewed as the mechanism to enhance their everyday work. This can only result in improved customer satisfaction, reduced costs, more efficient processes, and improved quality as CHC produces more and more Green Belts and Black Belts who have completed Six Sigma training. Intensive Six Sigma Training Senior leaders fostered their commitment to Six Sigma by identifying individuals who would become CHC experts in Six Sigma methodology and would provide internal training to employees. These individuals, Master Black Belts, developed healthcare-related training material for classes, a tool kit, and project simulation for learning. Additionally, they provide all levels of training for CHC employees as well as coaching and mentoring for Green Belts and Black Belts.
CommoNWeAlTH HeAlTH CoRpoRATIoN
CHC made a remarkable organizational commitment to the success of Six Sigma by training all employees in Six Sigma methodology. By the end of 2001, over 2000 employees had attended at least one full day of Six Sigma training (“Awareness”). This Awareness training offers an introduction to basic concepts of the methodology, and each person who attends this training receives knowledge of the Six Sigma process and becomes a valuable contributor to a project team. The commitment to train every employee stands firm. “Lite” training is the next level of exposure to Six Sigma’s methodology. Department Directors and Clinical Managers identify high-potential employees who will be most involved in projects. These individuals, typically supervisors, attend an intense threeday session that is designed to familiarize the Lite-trainee with the aspects of the methodology. These employees build on the basic knowledge of Six Sigma in order to assist the Green Belt within the many facets of a project. Green Belt training is an action-based learning model where trainees actually complete projects. This training is a 13-day course presented in five phases (D-M-A-I-C) over a six-month period. Each step of the DMAIC process is presented by Master Black Belts in a classroom setting, and the trainee applies these principles to an ongoing project. CHC has 120 Department Directors and Managers trained as Green Belts. Each will be expected to complete one project every nine months. Training Green Belts at this level assures that Six Sigma is intertwined within every department. Additionally, all vice presidents, members of the senior management team, and CHC’s President and CEO have received Green Belt training and “shadowed” a Green Belt through a Six Sigma project. CHC’s Corporate Champion is responsible for the deployment throughout the organization and ensures necessary resources are obtained when needed improvements are recommended. Additionally, the Champion eliminates any barriers experienced within a Black Belt or Green Belt project. The Champion also
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communicates the organization’s Six Sigma successes internally and externally as well as manages the strategy’s acceptance. Six Sigma’s Triumph Tangible benefits of process improvements utilizing Six Sigma methodology projects are being experienced throughout the fabric of our organization. The first Green Belt class focused on processes in Radiology, engaging a cross-functional group of employees to enhance the corporate-wide implementation. As a result of these projects, costs per procedure have been significantly reduced. Exam results are distributed to ordering physicians faster, patients receive treatments more timely, and physical workspace has been re-designed to increase employees’ efficiency. Other Green Belt classes have focused on other areas of the organization: Maternal care, specific Pulmonary DRGs, Admissions, Billing processes, Documentation/Charge Entry, Human Resources, Staffing, Managed Care, and Surgery processes. Each project represents a significant opportunity to improve aspects of the services provided by CHC, and Green Belts are beginning to realize the extent to which they can positively impact the way CHC does business. As training objectives are met, processes throughout CHC will continue to improve as the organization continues its journey to become a Six Sigma organization. Along this journey, the American Productivity and Quality Center (APQC) named CHC a Six Sigma “Best Practice Partner”. CHC was among only a few others in the nation to receive this award: American Express, Iomega, DuPont and Raytheon. CHC executives have also had many opportunities to share this approach to quality improvement with several organizations. In March 2001, CHC was profiled at the Association for Quality and Participation’s 23rd annual spring conference in Chicago. In May 2001, CHC hosted healthcare executives from Japan. Additionally, CHC executives have delivered presentations to the American Society for Quality’s Annual Quality Congress; Healthcare Financial Management Association’s conferences; International Quality and Productivity Center’s Six Sigma Conference; International Society for Six Sigma Professionals’ Leadership Conferences; numerous Healthcare Symposiums; and, a Six Sigma Conference hosted by Marcus Evans. Along with numerous other presentations, CHC’s experience with Six Sigma has been featured in various publications including Strategic Finance, Radiology Management, Modern Physician, Managed Healthcare Executive, Hospitals and Health Networks, and Diagnostic Imaging. Since beginning in 1998, CHC invested approximately $900,000 through the course of this implementation. Improvements have resulted in savings well over $3 million in 2001 alone. To date, the
cumulative savings have exceeded $7 million. CHC boasts that all existing employees have received Six Sigma training – from a primer in Orientation to Master Black Belt level training. Toward that end, this includes over 120 trained Green Belts, six Black Belts, three Master Black Belts, a Corporate Champion, three Corporate Sponsors, and a CEO who continuously drives the challenge of becoming a Six Sigma organization. It is evident through continued process improvements that CHC will realize escalated savings, increased morale and customer satisfaction. As the pioneer for Six Sigma in healthcare, CHC’s leadership changed the organization’s approach to problem solving utilizing Six Sigma methodology to deliver absolutely the premium service to customers. The Way We Work at CHC In addition to CHC leadership’s commitment to Six Sigma quality, organizational buy-in is one of the most vital elements of its success. Part of the Champion’s responsibility is to gauge the progression of Six Sigma and determine its effectiveness from a corporatewide perspective. Perhaps the greatest measure of this success is to hear from those closest to the pulse of Six Sigma methodology – CHC’s Six Sigma Green Belts. A few of CHC’s over 120 Green Belts were asked to share their perspective of Six Sigma. This is what they said: “Six Sigma has been a true learning experience for me. I am working on my third Green Belt project currently. I am finding this project particularly interesting since it involves our Corporate Wellness program and the results from the Health Risk Assessments. The tools of Six Sigma are proving very beneficial in analyzing the aggregate data from the assessments with the end result being an even stronger, more effective wellness program for our employees.” Linda Rush, Director of Community Wellness; Green Belt; led project for Health Risk Assessments “I have found Six Sigma methodology very beneficial. At one time during my project, I considered the possibility that there was no reason to proceed to the next phase. I felt there was no way I could improve the process after analyzing my data. We proceeded, and on my 2nd measurement, I had only one defect. I was able to make a positive change for all involved and addressed all CTQs (critical-to-quality).” Gary Sullivan, Director of Security; Green Belt; studied the process of direct admits from EMS “I know that Six Sigma methodology can and is making a difference in our organization. It allows us to continually ask ourselves how
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we can improve processes as we go about our regular duties. The best part is the ability to hold improved processes in place so we can strive for further improvement in that process and move toward improving other processes. I’m just glad I’ve been able to be such an active part of the Six Sigma initiative because I’ve learned so much. It is so valuable in my new position as we look at process improvement - it’s just such a different way of looking at things.” Lorraine Bormann, Director of Corporate Clinical Facilities; Green Belt; currently leading a project in the process of medication charge audits “The Six Sigma training has spawned a “new and improved” way of thinking not only for myself but for staff within my department. It has expanded our thought processes to continually question “why” is a task performed in such a way and question “Is this the best way?” As the Six Sigma approach is expanded throughout our department, we desire to realize and improve upon our weaknesses and celebrate our strengths.” Cristi Pruitt, Director of Corporate Accounting; Green Belt; member of the Green Belt class studying process of documenting charges “For me, Six Sigma changes the way that I look at my department, the daily activities of the hospital, and how I do my job. Using the Six Sigma methodologies, each process can be studied and evaluated. Not all projects will reach a “Six” Sigma, but any increase in sigma levels can be considered a success. When a project has an increase in the sigma level or improvement noted, then our patients and the facility will ultimately benefit. Having the tools, such as this methodology, that allow me to look at my processes and improve patient care, makes my job and career much more rewarding.” Melinda Joyce, Director of Pharmacy; Green Belt; currently leading a project studying the crediting process for medication As you can see by these testimonials, Six Sigma has proven to be not only a way of improving processes but also a method for employees to achieve stretch goals. These Green Belts are living proof of CHC’s ability to continually seek greater and greater levels of quality. Lisa Thomerson became the first Six Sigma Corporate Champion at Commonwealth Health Corporation (CHC) in January 2000. Ms Thomerson received CAP & WorkOut training from General Electric Medical Systems following CHC’s kick-off of Six Sigma in March 1998. In early 2000, she was GreenBelt trained by CHC’s Six Sigma training staff of Black Belts and received Champion training through Juran Institute. CHC is the first healthcare organization to partner with General Electric, fully integrating Six Sigma into its culture.
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raise the satisfaction level for employees, reducing burnout and unwanted attrition. Well-developed, highly satisfied employees translate into higher patient satisfaction and improved healthcare delivery. Dowling is optimistic about his expectations for the Center, saying, “We are doing this because I believe it will enhance the product we are delivering, as well as the business we are running… When we talk about this with our department heads and employees, you can absolutely observe the excitement. There is an excitement that people will improve themselves. Excited about the relationship with outside partners.” Changing Health Care and Beyond Although North Shore – LIJ is not the first healthcare organization to apply Six Sigma methodologies, this project is the largest endeavor to date, according to GE. Currently, it is estimated that there are more than 3,000 Six Sigma healthcare projects worldwide, including such organizations as Commonwealth Health Corporation in Bowling Green, KY, Charleston Area Medical Center in Charleston, WV, Virtua Health in Marlton, NJ and Northwestern Memorial Hospital in Chicago, IL. The impact that the simple principles of Six Sigma are going to have on North Shore-LIJ and subsequently the collective health care may not be immediate. However, the path of this troubled industry toward improved process management is something that all of as practitioners of quality will anxiously follow in the months to come.
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radiology throughput by 25% using fewer resources, while simultaneously decreasing cost per radiology procedure by 21.5%. Keys to Making It Work One of the primary keys to unlocking Six Sigma success is solid commitment from leadership. Since this initiative will invariably
Applying Six Sigma to Radiology: Snapshot of Success
• Decreased the time between reports dictation and
report signature • Reduced patient wait time from arrival in radiology to time of exam • Reduced time between patient dismissal and dicta tion completion • Decreased patient wait time for radiology registration process • Enhanced radiology scheduling process • Reduced time from radiologist signature to report distribution •Increased efficiency in the MRI ordering process • Optimized the content quality and delivery of preexam patient education • Reduced time for dismissal of radiology patients • Enhanced film jacket retrieval process • Decreased MRI report turnaround time • Improved general radiology staff scheduling • Increased efficiency of Ultrasound exam scheduling and reduced overtime • Utilized special procedures inventory more efficiently • Augment radiology exam scheduling and preregistration process • Reduce CT order to taken time • Decreased IVP exam time • Improve utilization of Nuclear Medicine radio-pharma ceuticals Measurable improvements in radiology added up to greater efficiency and better quality. Staffing was reduced by 14 fulltime equivalents, entirely through attrition; identification errors were reduced through bar coding, and processes were improved.
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ΣXTRAOrdinary Sense March 2002
To date, Mount Carmel's Six Sigma projects have included: • Several claims-processing projects in the organization's Medicare HMO, employed primary care physician practices, and behavioral health business • Processing time in central scheduling • Claims denials due to patient type changes and long-stay observations • Discharging throughput to decrease bottlenecks in the emergency department • Implementing of a procedure-based delivery system in the surgery area to help ensure supplies are present when needed during an operation • Enhancing clinical documentation to ensure it matches the services rendered • Making clinical laboratory results available according to the requesting physician's needs, enabling the physician to make timely decisions for patient discharge or continued treatment • Reducing cycle time in various inpatient and outpatient diagnostic areas
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compete for capital and time resources, participants have to be able to count on unambiguous support from senior management. To be successful, Six Sigma has to be priority #1. Far more than just a financial engineering effort, the process involves measuring all relevant criteria and making sure the job is done right the first time, which ultimately has a positive impact on patient care and satisfaction. The fact that Six Sigma offers a truly evidencebased approach to operational and clinical improvement gives the initiative greater credibility and makes it easier to get buy-in and results. Persistence and a clear definition of your objectives are also important factors. Everyone must understand that this is a philosophy for doing business and requires active participation. Communicating this vision clearly to the organization is mandatory. Onward and Upward As it has had an impact on other industries, Six Sigma could positively affect public perception of healthcare delivery. Society has struggled to find a workable methodology to measure quality. Looking beyond the obvious indicators of mortality and morbidity, it’s tough to gauge. Using the methodology to carefully gather and analyze data can help providers accurately identify where problems exist and how best to correct them. Six Sigma provides a roadmap for process improvement, dashboards to let you know how well you’re doing, and process “cruise control” to keep the improvements on track. To carry this quality improvement forward at Commonwealth will require ongoing training and the generation of approximately 120 trained Green Belts within two years. Every CHC employee will receive a minimum of one full day’s training. Six Sigma is a sound philosophy of management and quality that gives companies a chance to reduce cost, increase productivity and improve quality. Effects are evident and long-term, and the approach can be adapted and applied throughout the organization. Jean Cherry is executive vice president at Commonwealth Health Corporation and is a fellow of the American College of Healthcare Executives. She holds a bachelor of science degree in business administration from Western Kentucky University and a master of science degree in healthcare administration from the Medical College of Virginia. Cherry has worked in healthcare administration for over 13 years. She oversees Commonwealth Health Corporation’s support functions which include quality resource management, information technology and facilities management, and is a licensed nursing home administrator. Cherry may be contacted at 270/7451527. Sridhar Seshadri is vice president and general manager with the Healthcare Solutions Group of GE Medical Systems Information
Technologies. He holds a bachelor of science degree in electrical engineering from Bangalore University in India, a master of science degree in electrical engineering from Drexel University, and a master of business administration degree from the University of Pennsylvania (Wharton) in 1993. He is widely published and has an extensive background including lead engineer with the University of Pennsyvania’s Radiology Department, where he developed and evaluated Picture Archiving and Communication Systems (PACS). Since then, he has held the positions of manager, new business development and director, product management and strategic planning in the medical technologies industry. Seshadri may be contacted at Sridhar.Seshadri@med.ge.com.
Breyfogle, F.; Cupello, J.; and Meadows, B. 2000. Implementing Six Sigma: Smarter Solutions Using Statistical Methods. New York, NY: John Wiley & Sons. Pande, P.; Neuman, R.; and Cavanagh R. 2000. The Six Sigma Way: How GE, Motorola and other top companies are honing their performance. New York, NY: McGraw-Hill Professional Publishing. Rath & Strong’s Six Sigma Pocket Guide. 2000. Lexington, MA: Rath & Strong, Inc. Slater, Robert. 1999. Jack Welch and the GE Way: Management Insights and Leadership Secrets of the Legendary CEO. New York, NY: McGraw-Hill Professional Publishing. Slater, Robert. 1999. The GE Way Fieldbook: Jack Welch’s Battle Plan for Corporate Revolution. New York, NY: McGraw-Hill Professional Publishing.
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Financial Return And Other Benefits To date, we have realized a financial return of $3.1 million, and we expect these financial returns to grow rapidly as more Six Sigma projects are completed. Another key benefit of Six Sigma has been increased employee and physician satisfaction as we have begun to fix problems in operational processes that have been a source of frustration and dissatisfaction for these important stakeholders as they do their jobs. For instance, employee retention has improved, which we believe is due at least in part to Six Sigma initiatives. While Mount Carmel has experienced its share of challenges in implementing Six Sigma, we strongly believe in its potential and value in the field of healthcare in improving financial performance, clinical quality and patient safety, and stakeholder satisfaction. Jeffrey Burnich, M.D. (614.234.5633 or email@example.com) is Mount Carmel's Senior Vice President of System Care Management and Chief Quality Officer. Tammy Weidner, R.N., MBA (614.234.5467 or firstname.lastname@example.org) is Vice President of Six Sigma.
ΣXTRAOrdinary Sense March 2002
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