Indian Statistical

Institute, Pune 6s

Improving Stakeholder's Satisfaction Level in a Hospital from 3.94 to 4.09.

Black-belt: Dr. Amit Bhartiya

Champion: Mr. Sudeep Macha
MBB Mr. Subrata Rath
Team Members: Mr. Girish Mahindrakar
Mr. Mohit Chaturvedi- Operations
 DMAIC
Industry/Function: xx
Project
Indian Statistical Enter date Progress
Institute, Pune Kick Off Date:
Sheet
Project Name: xx

Key Steps: 1 15th June-10 2 22nd June-2010 3 29th June-2010 4 10th July-2010 5 30th Sept-2010

Define Measure Analyze Improve Control

Step A: Identify Project Step 1: Select CTQ Step 4: Establish Process Step 7: Screen Potential Step 10: Define & Validate the
CTQs Characteristics Capability Causes Measurement System
on Xs

Step B: Develop Team Step 2: Define Step 5: Define Step 8: Discover Variable Step 11: Determine Process
Charter Performance Performance Relationships Capability
Standards Objectives

Step C: Define Process Step 3: Measurement Step 6: Identify Variation Step 9: Establish Step 12: Implement Process
Map System Analysis Sources) Operating Control
Tolerances

Overall Project Completion Percentage Enter %

Key Deliverables
Required
• List of Project CTQs
• Team Charter
• High Level Process Map
(COPIS)
Tools That May Help
• Project Risk Assessment
• Stakeholder Analysis
• High Level Project Plan
• In Frame/Out of Frame
• Customer Survey
Methods (focus groups,
interviews, etc.)
• Elevator Speech
Required
• Data Collection Plan
• CTQ Worksheet:
Operational definition,
Specification limits, target,
defect definition for Project
Y(s)
• Measurement System
Analysis
Tools That May Help
• QFD
• Gage R&R/Attribute R&R
• Detailed Process Map
• FMEA
• Pareto Analysis
Required Required Required
• Baseline of Current Process • List of Vital Few Xs • MSA Results on Xs
Performance • Transfer Function(s) • Post Improvement
• Graphical analysis of output • Optimal Settings for Xs Capability
(Y)
• Confirmation • Statistical Confirmation
• Statistical Goal Statement
for Project Runs/Results of Improvements
• List of Statistically • Tolerances on Vital Few • Process Control Plan
Significant Xs Xs • Process Owner Signoff
Tools That May Help Tools That May Help Tools That May Help
• Six Sigma Process &
• Design of Experiments • Control Charts
Product Reports • New Process Maps • Hypothesis Testing
• Benchmarking
• FMEA on new process • CAP Plan
• Fishbone Diagram
• Process Modeling • Documentation/SOP
• Hypothesis Testing
• Regression Analysis • Brainstorming
 Identifying Project CTQs Define
Indian Statistical
Institute, Pune
Step A

Customer Sample Comments Key Output Characteristics Key Questions

Important to Customer (CTQs)
What customer groups are the
Management We must be accepted by all S-Sat primary focus for this project?
the stakeholders. Patients

What methods were used to

understand customer
requirements?
Patient Treat well at lesser cost. Patient Satisfaction Rating Survey to each patient.

Which CTQ(s) will be the primary

focus for this project?
S-Sat

Employee I must get conductive Employee Satisfaction Rating

working environment

S-Sat is a unique
measure.
 CTQ Drilldown Tree Define
Indian Statistical
Institute, Pune
Step A

CTQ--> Y Y1 Y2 Y3 Y4 Y5 Y6 Y7 Y8 Y9 Y10 Y11 Y12

C-SAT Admission Guest Doctors Nursing House Food & Pharmacy Mantaine General Laboratory Physiotherapy ICU
relations keeping Beverages nce feedback
 Define
Indian Statistical Step B
Institute, Pune
Project Title Improving Stakeholder's Satisfaction Level in a Hospital from 3.94 to 4.09.

Business Case: Improved patients satisfaction will add to the revenue and effectiveness of
preventive and curative healthcares.
Reduced cost because of improving efficiaency.
Increased other stakeholder's satisfaction level to improve sustainability of the
business,
Problem Statement: Satisfaction level of overall stakeholders, termed as S-Sat, during the baseline of
April-09 to April-10 is: 3.937 and s.d. 0.05.
Goal Statement: To enhance S-SAT to >=4.09.
Benefit: Addressing overall sensitivity to all the stakeholders.
Scope: Patient
Doctors
Management
Employees
Parties
Process:
Process Starts with: Identify Stakeholders
Process Ends with: Retain satisfied stakeholders
Team:
Black-belt: Dr. Amit Bhartiya
Champion: Mr. Sudeep Macha
MBB Mr. Subrata Rath
Team Members: Mr. Girish Mahindrakar
Mr. Mohit Chaturvedi- Operations
Schedule:
Define 15th June-2010
Measure 22th June-2010
Analyse 29th June-2010
Improve 10th July-2010
Control 30th Sept-2010
Signature:

Name: BB Champion MBB

Designtaion
Date:
 High Level Process Map Define
Indian Statistical Step C
Institute, Pune

Supplier Input Code Processes Output Customer

Patients Requirements P Manage total healthcare business

Doctor Knowledge P1 Identify stakeholders other than

patients
Resources P2 Understand their generic requirements

Hospital Resources P3 Devise a mehanism to assess their

manageme specific requirements
nt
P4 Rate the satisfaction by each individual
belonging to the different stakeholders

P5 Devise the measures of satisfaction

level for overall and each stakeholders

P6 Measure and identify the gaps

P7 Improve, Control and automate Feedback Treated
Patients
 Detailed Process Analysis Measure
Indian Statistical
Institute, Pune Step 1

 11 stakeholders identified to have various input/ concerns/ impact over

the healthcare and hospital management processes.
 Their issues are identified, feedback collected, measured,
benchmarked, analysed, acted upon for improvements, controlled.
 Sample issues are as under:

Staff clearly
I was able to All my
Admissions explained to I had to wait I got the
easily find queries were
Staff was me the room for less than room of my
my way to answered
ADMISSION polite, helpful charges, 30 minutes choice at the
the patiently by
and friendly estimates to get a room time of
Admission the staff at
with me and billing allocated Admission
Desk the desk
procedures
 Data Collection Plan Measure
Indian Statistical Step 3
Institute, Pune

CTQ--> Y Y1 Y2 Y3 Y4 Y5 Y6 Y7 Y8 Y9 Y10 Y11 Y12

C-SAT Admission Guest Doctors Nursing House Food & Pharmacy Mantaine General Laboratory Physiotherapy ICU
relations keeping Beverages nce feedback

QC- UoM Rating Score

Support
System
Target > 4.09

1 3.90 3.89 3.78 3.121412 4.095653 4.092697 4.00342253 4.078974 4.035971 4.123517 3.96516393 3.986547085 3.993373
1 3.91 3.91 3.77 3.117217 4.117952 4.13997 4.01206606 4.127708 4.046538 4.129122 3.97848245 3.933450088 4.001331
1 3.85 3.88 3.74 3.083574 4.053688 4.052681 3.96218267 4.074922 3.928571 4.055247 3.8960499 3.896604938 3.95036
2 3.98 3.88 3.83 3.193684 4.202224 4.208782 4.11121928 4.196411 4.076923 4.238642 4.06155399 4.02559415 4.111491
2 4.07 3.95 3.83 4.163429 4.173319 4.162203 4.07255987 4.13986 4.011723 4.125538 3.95144509 3.914132379 3.920063
2 4.09 3.97 3.82 4.21459 4.215816 4.193111 4.05532182 4.17176 3.985248 4.21449 4.02547771 3.88225256 3.93472
2 4.08 3.93 3.84 4.157649 4.184519 4.163998 4.07524558 4.189274 4.006316 4.165264 3.98640167 3.948220065 3.994092
2 3.96 3.85 3.78 4.055172 4.06946 4.052575 3.9777883 4.055611 3.92323 4.061228 3.92087043 3.775811209 3.762676
2 4.08 4.00 3.92 4.162225 4.169545 4.164994 4.08445192 4.142442 4.005786 4.153289 4.04624277 3.911544228 3.958229
2 4.02 3.95 3.88 4.106476 4.123512 4.112383 4.01324892 4.078189 3.965874 4.09719 3.96388029 3.833070866 3.792308
2 4.07 3.99 3.90 4.165479 4.164776 4.167526 4.06803429 4.13306 4.004103 4.141445 3.99386503 3.856 3.909209
2 4.07 3.98 3.95 4.131559 4.143969 4.125792 4.0708943 4.142716 4 4.167082 4.02882704 3.966412214 3.960381
2 4.06 3.99 3.92 4.131736 4.148116 4.130713 4.08189503 4.106031 4.000975 4.143979 4.03384913 3.924731183 3.921326
 Establish Process
Capability Analyze
Indian Statistical Step 4
Institute, Pune

Seems to be
non-
representativ
ely low in the
baseline.
 Establish Process
Capability- Overall Analyze
Indian Statistical Step 4
Institute, Pune

Ppk= -0.32
Sigma level= 0.54
 Establish Process
Capability- Technical Analyze
Indian Statistical
Institute, Pune
Baseline Step 4

Process is not stable.

Ppk= -0.31
 Identify Variation Sources
FMEA Analyze
Indian Statistical Step 6
Institute, Pune

Code Processes and its Requirements Potential Failure Potential Severity Potential Causes of the failure Mode RPN
Mode of the Effect of the
processes Failure
Modes
P Manage total healthcare business
Address overall sensitivity to all the Not sensitive to Stakeholders 8 Stakeholders are not identified propoerly. 160
stakeholders. the stakeholders. dissatisfied

Revenue loss Stakeholders' requirements are not identified 240

propoerly.

Margin loss Awareness of customer requirements to the 192

hospital staff, doctors & management is poor.

Business not Actions are not focused to the customer 128

sustainable. satisfactions.

P1 Identify stakeholders other than Lack of training and development 336

patients

P2 Understand their generic requirements Awareness to patients of consequences of 160

lack o compliance medical advice.

P3 Devise a mehanism to assess their Consultants' approach/ attitude towards 168

specific requirements patient is not propoer.
P4 Rate the satisfaction by each individual
belonging to the different stakeholders

P5 Devise the measures of satisfaction

level for overall and each stakeholders

P6 Measure and identify the gaps

P7 Improve, Control and automate
 Identify Variation Sources
High Risk Causes Analyze
Indian Statistical Step 6
Institute, Pune
 Action Plan
FMEA Follow up Improve
Indian Statistical
Institute, Pune
Step 7

Residual
Proposed Actions Responsibilit Target date Actual Actions S O D RPN
y of Taken
Completion

Survey format was BB May-10 Routinely 8 3 3 72

designed. onwards. done.

Patients First GM- Apr-10 Weekly once 8 4 3 96

Campaign. Operations onwards. covering 20-30
staff covered.

Patients First GM- Apr-10 Weekly once 8 4 3 96

Campaign. Operations onwards. covering 20-30
staff covered.
 Confirmation of
Improvement Improve
Indian Statistical
Institute, Pune
Step 8

Mood Median Test: S-Sat versus Stage

Mood median test for S-Sat

Chi-Square = 7.37 DF = 2 P = 0.025 : Significantly improved!!!!

Individual 95.0% CIs

Stage N<= N> Median Q3-Q1 ---------+---------+---------+-------
1 3 0 3.895 0.058 (---*)
2 6 4 4.067 0.074 (----*)
3 0 4 4.163 0.122 (-----*-----)
---------+---------+---------+-------
3.96 4.08 4.20

Overall median = 4.068

* NOTE * Levels with < 6 observations have confidence < 95.0%
 Confirmation of
Improvement Improve
Indian Statistical
Institute, Pune
Step 8

One-Sample T: Improved S-Sat

Test of mu = 4.09 vs > 4.09

95% Lower
Variable N Mean StDev SE Mean Bound T P
Improved S-Sat 4 4.1643 0.0644 0.0322 4.0885 2.31 0.052
 Process Capability- After
Improvement Control
Indian Statistical
Institute, Pune
Step 8

Ppk= -0.32
Sigma level= 0.54
Before

Ppk= 0.38
Sigma level= 2.65
Before
 Control Chart:
Before-After Control
Indian Statistical
Institute, Pune
Step 8
 Establish Control Plan Control
Indian Statistical
Institute, Pune

CTQ--> Y Y1 Y2
C-SAT Admission Guest
relations

QC- UoM Rating Score

Support
System
Target > 4.09

Min. freq. Each patient/ and

of all stakeholders
measure
ment
Record HMIS- Excel file
Ref.
Current HMIS- Excel file
Controls
Measure Measure Questionnaire
ment ment
Support device
System
L.C. 0.01
Calibratio Not required as
n of Rater of date

Kappa Not required as

Value of date

Weightage 0.044 0.058

Total number of
patients(feed back
forms)

Total 16822
Average 989.5294118
Standard deviation 55.99120204
Process capabitity 335.9472122
LSL
UCL 1157.503018 0 0
LCL 821.5558056 0 0
 Control Summary Control
Indian Statistical
Institute, Pune
Control/Response Plan Highlights Benefits of Project

Control Plan established. Customer and Stakeholders’ satisfaction levels

significantly improved.

Sigma Levels/Improvement Communication & Translation

Explain what is being done to:
Project Y:
Baseline Improved • Documented the project
___________
• Provided any necessary training
Mean (continuous) or
4.01 4.16
• Translated project within/ outside of
Defects (discrete)
business
Std Dev. (continuous) or
0.08 0.06
• Communicated project results to the
DPMO (discrete)
management trusty.
Z-ST: 0.54 2.65

Z-LT: -0.96 1.15

 Project Sign-Off
Indian Statistical
Control
Institute, Pune

Improving Stakeholder's Satisfaction Level in a Hospital from 3.94 to 4.09

CONTROL HAND-OFF SHEET

Core Process: Overall healthcare and hospital management Owner: GM-Operations

Subprocess: Same GM- Operations

Owner:
• Policies & Procedures were documented and communicated on 22-11-2010

• I understand the New Policies and Procedures

• I understand and take responsibility for monitoring the Defect Measurements as delineated
by the Project Team

• I will report the progress on this subprocess on a regular basis to the Quality Promotion Council

• I have reviewed this project’s isolated financial benefits with the Project Champion

• I understand the corrective action procedure and am responsible for ensuring that action
items are completed to hold the gains and capture the financial benefits

BB MBB
22-11-2010 22-11-2010