Case Report of Six Sigma at Academic Medical Hospital Essay

Six Sigma is a business management strategy designed to meet customer needs and process capability. Six Sigma seeks to improve the quality of process outputs by identifying and removing the causes of defects and minimizing variability in manufacturing and business processes. It uses a systematic project-oriented fashion through define, measure, analyze, improve, and control (DMAIC) cycle, including statistical tools, and creates a special infrastructure of people within the organization (like â€Å"Black Belts†, â€Å"Green Belts†, etc.) who are experts in these methods. Each Six Sigma project carried out within an organization follows a defined sequence of steps and has quantified financial targets (cost reduction, profit increase, etc). Overview: Project name: Six Sigma at Academic Medical Hospital (AMH) Problem: Patients with potentially life-threating injuries and illnesses are waiting for over an hour for treatment in Emergency Department at AMH! Although long wait times seemed to be readily excuses by many physicians due to complexity of managing emergency room and processes and clinical staff, it is still unacceptable for the patients. Targets: help Emergency Department (ED) at Academic Medical Hospital (AMH) to reduce the wait time Method: instituting Six Sigma at AMH and establishing a Six Sigma Foundations Teams, which undertake an application practicum on an assigned AMH project with, cooperate trainers acting as coaches. Six Sigma Foundation TEAM: Champion: Dr. Elbridge (establishes business targets and creates an environment within the organization to promote the Six Sigma methodology and tools) Sponsor: Dr. Terry Hamilton (key communicator and approves final recommendation) Owner: Nancy Jenkins (implementation and accountable for sustaining long-term gains) Black Belts: Jane McCrea (project leaders who are experts in Six Sigma methodology and statistical tool applications) Green Belts: Dr. James Wilson (trained by six Sigma methodology from hospital) The Foundations Team: (a group of local experts who participate in the project) &4 people (Nancy Jenkins, Patient Care Manager; Georgia Williams, ED registration Manager; Bill Barber, senior Clinician; and Steve Small, Senior Clinician and Quality Improvement Coordinator) Seven Process Steps and Activities for patients at the Emergency Department: Triage: The Nurse complete a preliminary assessment of the patient’s condition and ranks his criticality accordingly; Register: The Nurse obtain demographic and insurance information; Lobby: The Patient wait for the nurse call your name; Tx Room& Nurse: The patient do testing and get the results; MD: The patient wait for doctors. Questions: Q1.Describe how Six Sigma Methodology (DMAIC) is implemented in the â€Å"ED Wait Time Project.† As stated, Six Sigma is based on a 5 phase, step-by-step process that was used in the â€Å"ED Wait Time Project.† In the Define phase the team identified expected benefits of the project including expedited medical care delivery, improved patient satisfaction, reduced patient complaints, increased patient capacity and improved operational efficiency. Moving on to the Measure phase, the team determined the baseline measures and the target performance of the original process as well as defined the input/output variables. They collected 2 groups of data sets as well as administered a patient satisfaction survey, which produced the maximum wait times for pa tients. During the Analyze phase the team then analyzed the baseline study and found that two processes mainly influenced the wait time; the waiting room time and the time spent waiting on the MD. As the ED Wait Time Foundations team moved on to the Improve phase it was decided that they would improve: Patient flow, Care Team Communication and Streamlined Order Entry and Results Retrieval Process. By changing procedure by which the Priority Level II patients were moved, it resulted in less or no waiting room time and allowed patients to proceed to the examination room. Modifying ED zone assignments within the patient- care team and using new communication boards would reduce patient complaints and improve satisfaction. This change will also help with new central clerks that will help entering patients and decrease the amount of time that physicians and nurses are occupied. Lastly, in the Control phase the team ensures that the new standard operation procedures for moving patients through the ED are maintained. They compared the performance of the Emergency Department before and after in order to note their progress and set guidelines to preserve their advancement. Q2.Access the pilot results from the process changes. What should the team say to the Project Sponsor, Dr. Hamilton, and to the Project Champion, Dr. Elbridge about the results? According to the results, the pilot Lobby Wait Time mean value came in under the acceptable target of 15 minutes, and the MD Wait Time measure was improving(pilot mean was 8.9 minutes against a study 1 baseline of 16.1 minutes and a study 2 baseline of 11.2 minutes). Although pilot MD Wait Time didn’t reach the target set at 8.0 minutes, it was apparently improved. Pilot Lobby Times were better than established 15 minute target, the defect rate dropped, and the 95% confidence interval test on the study 1 median and study 2 median vs. pilot median validated statistical significance of the improvement in wait times. Results of MD Wait Times were stat istically significant in one of two Mood’s Median tests (study 1 vs. pilot). Positive trending was demonstrated in the comparison of study 2 to the pilot which showed that the MD Wait Time became shorter and the detect rate decreased. The outcome looked promising. However, the Hawthorne effect came into play, particularly in the study 2 data collection activities. Due to unreliable automated data-gathering procedures in the ED’s information systems and the need to use intra-departmental manual data surveyors, the presence of bias was recognized. The team needed to decide whether to redo some aspects of their work in the Improve phase. The data was not convincing enough, and the result of improvement in MD Wait Time was not very apparent. Q3.What are the obstacles to AMH adopting Six Sigma? The equation [Q*A=E] is the cornerstone of successful Six Sigma improvement implementation. It infers that the quality of process solutions multiplied by the Acceptance level of stakeholders is equal to the effectiveness of those results. In this case, the primary obstacle is the acceptance level of the hospital. NO matter which solutions result from the analysis, the potential for success will be limited without the acceptance of the people affected and involved. Getting people to embrace six Sigma reforms in ED was going to be an uphill battle. There are 3 reasons: 1) Physicians are not hospital employees, but independent contractors of a sort from the Medical school. It is almost a disincentive to participate since their incentives lie with research, education, and patient care specialty. 2) Dr. Hamilton who is the sponsor of the project was hesitant to get involved in anything that he was unfamiliar with or which would add to his already full plate. Also, Nancy Jenkins, who is the project owner, implementing significant process and behavior change were not among her strengths. 3) Last, it was noted that the Hawthorne effect came into play. The Hawthorne effect refers to a phenomenon in which participants alter their behavior as a result of being part of an experiment or study. It is hard for the team to get reliable automated date-gathering procedures. Q4.Consider whether or not the team should recommend a change in the Project Sponsor even at this late phase of the project. The project sponsor is supposed to be the reque stor of the project and is committed to its solutions. He/She should also be responsible to identify project goals, objectives and scope; remove barriers and aligns resources; serve as a key communicator of project progress and status and approves final recommendations. However, in this case, Dr. Terry Hamilton, the project Sponsor, had a lot of work in his own domain to focus on (busy vice-chair of the Medical School’s Emergency Medicine Department, active in several other department initiatives and responsibilities) and he was also an involved father and husband. As a result, he was so reluctant and kind of indifferent to this project. We would like to recommend the project team to change the Sponsor. Who’s elective? Dr. George Calhoun, the Emergency Medicine Department Chair, had remained at arm’s length throughout the team’s work. As the chair, Dr. Calhoun was in a position of influence over faculty and long-term changes that could result from the ED Wait Time Project. And we also learned that Dr. Calhoun’s interests and incentives were linked to achieving national emergency medicine program recognition and publications. So Dr. Calhoun is the appropriate candidate for the Project Sponsor. Q5.Based on what you k now of the project’s results, limitations, and key stakeholders, what would you recommend as the next step for McCrea in her role as the Black Belts of the ED Wait Time Project? According to the results and the analysis, there are many improvements we can do. There are four aspects of improvements: Eliminating interference factors They should reduce the Hawthorne effect recording the Wait Time without being observed by the staff. They should think of new methods to record the MD Wait Time more accurately because there were some bias and errors in the measurement. Perhaps we can use video camera to observe staff’s actions to make sure they comply with the rules of Six Sigma and to record the MD Wait Time. 2.Increasing the Acceptance level The equation, Q x A = E, is the cornerstone of successful Six Sigma improvement implementation. No matter which solutions result from the analysis, the potential for success will be limited without the Acceptance of the people affected and involved. I think increasing the Acceptance level is the most important mission for the next step. The tools and techniques are referred to as â€Å"The Change Acceleration Process,† or CAP. Several CAP techniques were used throughout the ED Wait Time project, including Process Mapping, Elevator Speech, Extensive and Creative Communication Plans and The Stakeholder/Resistance Analysis. 3.Quality Improvement Considering that the Pilot MD Wait Time apparently didn’t decrease, I suggest the team should look for some other methods for improvement. The current methods seemed not very effective. Changing some key members As the article mentioned, the project Sponsor, Dr. Hamilton, was not very active. He was very busy and was not interested in Six Sigma project. The project Owner, Nancy Jenkins, was not good at implementing significant process and behavior change. It’s less likely that the implementations will be sustained after the Six Sigma experts leave. Perhaps the two members mentioned above should be replaced by more competent people. As mentioned above, Dr. Calhoun may be the right person for the Sponsor. I also think that Dr. Elbridge should be more positive in this project.