A Tool Box for Healthcare Problem Solving

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1 Lean Six Sigma 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 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 Geographic Pt Assignment Denials How we engage employees Employee Portal Front line participation 1

2 Why Lean Six Sigma SIPOC LEAN Staffing to Demand Reduction of Waste/Non-Value Added Process Steps Data Driven SIX SIGMA Lean Superficial Depth of Analysis An inch deep and a mile wide Finding out very little about many things Very Deep Few Number of problems investigated Many 2

3 Six Sigma Superficial Depth of Analysis An inch wide and a mile deep Finding out very much about a few things 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 ofwaste using Lean & hard wiring improved processes with Six Sigma 3

4 Getting at What the Customer Really Needs/Wants. Customer Need/Wants 4

5 Customer Need/Wants 3 Months Later Customer Need/Wants 5

6 Customer Need/Wants Customer Patient Focused 6

7 Customer Patient Focused Customer Patient Focused 7

8 Customer Patient Focused Lean 8

9 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 Inventory incorrect quantities, too much, too little, outdated 7.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 Patient Arrives Evaluation Waiting Transport Procedure Transport Waiting Radiology Transport Discharge Unserved Patient Time Served Patient = Value Added Time = Non-Value- Added Time and WASTE 9

10 Patients and Waste = Improved Patient Experience Lean Success 447 Ideas = $5.5 Million Dollars in Savings (Additional revenue generating ideas being pursued) 10

11 Six Sigma Why Six Sigma Data Driven Decisions 99% is not good enough for our Patients 11

12 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 ) % 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 Unsafe drinking water for 15 minutes per day Unsafe drinking water for one minute every seven months 12

13 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 13

14 BMC s Lean Six Sigma Timeline 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. 2. In line with senior leaderships data driven, evidence based decision making process. 3. Select the right partner for your organization. 1. Lynne Sisak, 4. Select Projects & Candidates 14

15 How we got started How we got started 15

16 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 Hl Help Desk kturn Around dtime Med Rec (Updated Med List) OR Turn Around Time Denials Discharge Process Pressure Ulcers Pharmacy Waste 16

17 Wave 3 Six Sigma Projects Wave 3 SixSigmaProjects Sigma 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 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 gb Denials as 17

18 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 % 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 18

19 Eligibility Denials After analysis, two specific areas in denials management were targeted 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 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 Blue Cross / HMO Blue coordinationofof benefit denials was reduced to 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 19

20 Eligibility Denials How we got started 5. Begin to Create a Critical Mass. 20

21 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 21

22 Get Info/Involved Get Info/Get Involved 22

23 Questions 23

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