Lean Six Sigma - Massachusetts Association of Healthcare Access

6/28/2012
LLean Six Sigma
Si Si
A Tool Box for Healthcare
Problem Solving
Alexis Keeler, Black Belt
Director Process Engineering
Berkshire Medical Center ‐Pittsfield, MA
Agenda
• What is Lean Six Sigma
– Six Sigma vs. Lean – What the Difference? • Lean Overview
Lean Overview
• Six Sigma Overview
• The Berkshire Health Systems Lean Six Sigma Journey
– Pick a Partner
– Project Selection Criteria
• Prioritization Matrix
• Building Winning Teams (Tollgates/Check Ins)
– Build a Critical Mass – Organizational Change
• Certification & Participation
• Project Success
Project Success
– Geographic Pt Assignment
– Denials
• How we engage employees
– Employee Portal
– Front line participation
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Why “Lean Six Sigma”
• SIPOC
• Staffing to
Demand
LEAN
SIX SIGMA
• Reduction of
Waste/Non-Value
Added Process
Steps
• Data Driven
“Lean”
Superficial
“An inch deep and a mile wide”
Finding out very little about many things
Depth
of Analysis
Very Deep
Few
Number of problems investigated
Many
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“Six Sigma”
Superficial
“An inch wide and a mile deep”
Finding out very much about a few things
Depth
of Analysis
Very Deep
Few
Number of problems investigated
Many
Why “Lean Six Sigma”
Why do both Lean & Six Sigma?
• Improve the way we do things – not just to generate cuts/savings
• Create immediate savings through elimination of waste using Lean & hard wiring improved
of waste using Lean & hard‐wiring improved processes with Six Sigma
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Getting at What the Customer Really Needs/Wants.
Customer Need/Wants
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Customer Need/Wants
3 Months Later……
Customer Need/Wants
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Customer Need/Wants
Customer – Patient Focused
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Customer – Patient Focused
Customer – Patient Focused
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Customer – Patient Focused
Lean
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8 Categories of Waste
(Remember acronym DOWNTIME)
1. Defects – mistakes, rework, etc.
2. Over-production – generating more than what is needed
3. Waiting – idle time
4. Non-utilized Talent/People – not tapping into the talents, ideas
and creativity of staff
5. Transportation – excessive movement of materials and people
6. Inventory – incorrect quantities, too much, too little, outdated
7. Motion – looking for information, materials, people, equipment
8. Extra processing – steps that don’t contribute or add value
Patients and Waste
Transport
Evaluation
Procedure
Discharge
Radiology
Transport
Patient Arrives
Waiting
Transport
Waiting
Time
Unserved Patient
= Value
Added Time
Transport
Served Patient
= Non-ValueAdded Time
and WASTE
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Patients and Waste
= Improved Patient Experience
Lean Success
447 Ideas = $5.5 Million Dollars in Savings
(Additional revenue generating ideas being pursued)
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Six Sigma
Why “Six Sigma”
Data Driven Decisions
99% is not good enough for our Patients
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Why “Six Sigma”
99% Quality (2.8 )
5000 incorrect surgeries per week
No electricity for 7 hours per month
200,000 wrong prescriptions per year
20,000 lost articles in mail per hour
Two short or long landings at Chicago O’Hare per day
Unsafe drinking water for 15 minutes per day
Why “Six Sigma”
99% Quality (2.8 )
99.9996% Quality (6)
5000 incorrect surgeries per week
1.7 incorrect surgeries per week
No electricity for 7 hours per month
No electricity for 1 hour out of 34 years
200,000 wrong prescriptions per year
68 wrong prescriptions per year
20,000 lost articles in mail per hour
7 lost articles in mail per hour
Two short or long landings at Chicago O’Hare per day
One short or long landing in five years
One short or long landing in five years
Unsafe drinking water for 15 minutes per day
Unsafe drinking water for one minute
every seven months
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New Set of Tools
What’s wrong with our current tool set?
Sometimes we can identify
It’s broken
We want to fix it
We know what good/great would looks like
We might even have LOTS of good idea on how to fix it
But…..we just don’t know where to start
DMAIC Project Methodology
D
M
A
I
C
Define Measure Analyze Improve Control
Rapid Cycle Testing
Using Lean Concepts
30 Day
60 Day
90 Day
Project Closure
Hardwiring using Control Plans
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BMC’s Lean Six Sigma Timeline
Six Sigma Wave II
Lean – Waste Walk
Six Sigma Wave II
Six Sigma Wave II
Six Sigma: Wave I
How we got started
1. Brought back a success story from a conference.
f
2. In line with senior leaderships data driven, evidence based decision making process.
3. Select the right partner for your organization.
1 Lynne Sisak, lynne@lynnesisak.com
1.
Lynne Sisak lynne@lynnesisak com
4. Select Projects & Candidates
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How we got started
How we got started
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Wave 1 Six Sigma Projects
Wave 1 Six Sigma Projects
Green Belt Projects
Endoscopy Turn Around Time
ED Ready Status to Admit
Outpatient Rehab 3 Day Eval
Operating Room Inventory
Outpatient Lab Reg. Arrival to Stick
11am Discharge 5 West
Post Op Resp. Failure
BFS Cardiology
Wave 2 Six Sigma Projects
Wave 2 Six Sigma Projects
Black Belt Projects
In Patient Lab Utilization
Pre Surgical Process
DC to Dropped Bill Days
Pt. Flow Geographic Assignment
Green Belt Projects
H l D kT
Help Desk Turn Around Time
A
d Ti
Med Rec (Updated Med List)
OR Turn Around Time
Denials
Discharge Process
Pressure Ulcers
Pharmacy Waste
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Wave 3 Six Sigma Projects
Wave 3 Six Sigma Projects
Wave 3 Six Sigma Projects
Green Belt Projects
Reduce Test/Procedure Times for M.I. s Reduce Expired Items in OR
Decrease ED Arrival to DC Home Time
Increase Case Cart Accuracy
Reduce Patient Room Turn Around Time
gy
Reduce In‐Patient Radiology Costs
Decrease Late Discharges 4‐West
Decrease ED Arrival to Provider Time (Fairview Hospital)
A few Examples
Geographic Patient Assignment
Eligibility
g b ty Denials
e as
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Geographic Patient Alignment
Lack of geographic alignment of hospitalist, housestaff, nursing, case
management, pharmacy and patients impairs teamwork, care coordination
and communication. Lack of teamwork leads to more adverse events,
higher cost and longer length of stay.
The current rate of patients on the wrong geographic unit is 27.49%. Our
team facilitated improved geographic alignment through four sequential
and additive interventions including: 1. Better adherence through intent to
discharge 2. Early discharge order 3. Relocation of observation patients
to Telemetry 4. Night huddle between hospitalist and supervisor.
These changes were associated with improved geographic alignment of
teams from a baseline of 27% of pt’s placed on wrong geographic unit to
14-17 % over the 30 day measurement periods. This improved
geographic alignment was associated with a decrease in Medicine
geometric LOS from a baseline of 5.5 days to 4.3 days. The decreased
LOS was associated with a cost reduction of $158,196 during the project
period.
Geographic Patient Alignment
5 West
Reopened
5 South closed
over weekend
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Eligibility Denials
After analysis, two specific areas in denials management were targeted p
g
y
for improvement. First, denials for eligibility issues in BMC’s Emergency Department (ED) were averaging $108,470 in gross revenue per month. Second, of the Blue Cross / HMO Blue coordination of benefit denials that were re‐paid, the average time to do so was 100.6 days. Subsequent to process implementations and improvements, latest data demonstrates that denials for eligibility in BMC’s ED were at $97,494 in gross revenue per month and the average time to re‐pay
average time to re
pay Blue Cross / HMO Blue coordination of benefit Blue Cross / HMO Blue coordination of benefit
denials was reduced to 43.56 days. Financial data indicates that if the current ED eligibility denial rate is maintained, approximately $20,500 in yearly net revenue would be prevented from being denied on first claim and there is the potential for ~$22,000 in additional yearly gross revenue.
Eligibility Denials
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Eligibility Denials
How we got started
5. Begin to Create a “Critical Mass” .
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BHS Karate Team?
Six Sigma Project Team
Process Owner & Executive Champion
Yellow Belts (Managers)
Green Belt
Black Belt
MBB
How we got started
6. Go for the Culture Change…
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Get Info/Involved
Get Info/Get Involved
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Questions
jslattery@bhs1.org
akeeler@bhs1.org
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