Foundations Control Training - Faculty Directory

Foundations Control Training - Faculty Directory

Six Sigma at Academic Medical Hospital 5 4 The following presentation was developed by Jane McCrea, Black Belt of the ED Wait Time Project at Academic Medical Hospital. 3 2 The presentation follows the DMAIC methodology. 1 0 D M A I C Six Sigma--DMAIC 5 4 3 2 1 0 D M A I C Define: Define and scope problem. Identify potential benefits and critical to quality (CTQ) factors. Measure: Identify the key internal process that influences CTQ characteristics and measure the defects generated relative to the identified CTQs. Confirm measurement system reliability. Know voice of customer. End result: team can successfully measure the defects generated for a key process affecting the CTQ. Analyze: Identify root causes of defects. Use statistical data tools to identify key process inputs that affect process outputs. End result: explain variables that are likely to drive process variation the most. Improve: Determine and confirm optimal solution (statistically re-analysis). Identify the maximum acceptable ranges of key variables. End result: modify the process to stay within the acceptable ranges. Control: Ensure that modified process now enables the key variables to stay within the maximum acceptable

ranges using tools such as metric dashboards and accountability reporting. ED Wait Time six sigma The Way We Work Project ProjectDescription Description Reduce Reduceand andconsistently consistentlymaintain maintainpatient patient wait waittimes timesfrom fromtriage triagestart startto tofirst firstphysician physician interaction at established thresholds. interaction at established thresholds. EXPECTED EXPECTEDBENEFITS BENEFITS Customer: Customer:Critical Criticalto toQuality Quality(CTQ) (CTQ) Reduce Wait Time Reduce Wait Time Internal: Internal:Critical Criticalto toQuality Quality(CTQ) (CTQ) Improve ImprovePatient/Staff Patient/StaffSatisfaction Satisfaction Enhance EnhancePatient PatientOutcomes Outcomes Increase IncreaseED EDcapacity capacityand and operational efficiency operational efficiency Arrival Arrival Triage Triage Register

Register Lobby Lobby Define Champion Champion Dr. Gerry Dr. GerryElbridge Elbridge Sponsor Sponsor Dr. Terry Dr. TerryHamilton Hamilton Black BlackBelt Belt Jane McCrea Jane McCrea Green GreenBelt Belt Dr. James Wilson Dr. James Wilson Foundations FoundationsTeam Team Nancy Jenkins, Bill Nancy Jenkins, BillBarber, Barber, Georgia Williams, Steve Georgia Williams, SteveSmall Small Tx TxRoom Room Nurse Nurse MD MD Measure What Whatwas wasthe theVoice Voiceof ofthe theCustomer? Customer? Acceptable Lobby Wait Time Patient PatientSurvey Survey N =

30; Priority N = 30; PriorityIIIIPatients Patients Random: all days, Random: all days,all allshifts shifts 14 12 < 10 10 10 - 20 8 20 - 30 6 30 - 60 4 > 60 2 0 < 10 10 - 20 20 - 30 30 - 60 Patient PatientSurvey SurveyResults Results Wait Time Expectations: Wait Time Expectations: 10-20 10-20minutes: minutes:43% 43% 20-30 20-30minutes: minutes:23% 23% > 60 Lobby Wait Satisfaction Rating Patient PatientSurvey SurveyResults Results Wait WaitTime TimeSatisfaction Satisfaction Very VerySatisfied: Satisfied:37% 37% Very

VeryDissatisfied: Dissatisfied:37% 37% 12 10 V. Sat. 8 S. Sat. 6 Neutral 4 S. Dissat. V. Dissat. 2 0 V. Sat. S. Sat. Neutral S. Dissat. V. Dissat. Baseline Measurements An observational prospective manual time study yielded baseline measurements for the total wait time Triage Triage Start Start to to MD MD Start Start 20 60 100 140 180 Mean: Mean: 62.5 62.5 min. min. Std. Std. Dev: Dev: 39.66 39.66 Z-Score: Z-Score: 1.79 1.79 Defect Defect Rate: Rate: 38.6%

38.6% USL: USL: 37.1 37.1 min. min. Measure What Whatdid didwe wemeasure? measure? Y: Y: ##of ofMinutes, Minutes,from fromTriage TriageStart Startto toFirst FirstPhysician PhysicianInteraction Interaction Specification SpecificationLimit: Limit: 37 37minutes minutes Specification SpecificationValidation: Validation:Internal Internalexperts experts&&data, data,External External benchmarks benchmarks Defect: Defect: Wait Waittime time>>37 37minutes minutes Unit: Unit: One Onepriority priorityIIIIpatient patientvisit visitwith withone onedefect defectopportunity opportunityeach each Measurement MeasurementSystem: System: Patient PatientSurvey, Survey,Manual ManualData DataCollection, Collection, Chart ChartReview, Review,Quality QualityReports, Reports,Registration Registration&&Staffing StaffingReports Reports Impact Impacton

onBusiness: Business: 25 25min. min.Line Lineof ofSight SightReduction ReductionPer PerPatient PatientResulting Resulting==Capacity Capacity Opportunity Opportunity Improved ImprovedPatient PatientSatisfaction, Satisfaction,Reduced ReducedComplaints, Complaints,Enhanced Enhanced Outcomes Outcomes Improved ImprovedStaff StaffSatisfaction Satisfaction&&Reduced ReducedTurnover Turnover Improved ImprovedDaily DailyED EDOperational OperationalEfficiency Efficiency Key KeyTakeaway: Takeaway:40% 40%Wait WaitReduction Reduction&&Operating OperatingMargin MarginGains Gains What critical Xs were tested as being root causes of the problem? Environment People ED patient volume Analyze Staffing levels ED patient acuity Experience & skill level Influx of squad patients Resident specialty Referral volume Family needs

OR volume Role clarification Hospital patient volume Match of skill sets and assignments ED tx room limits/facility constraints Variation of practice Triage process Availability of diagnostic equipment Registration/Chart prep process Availability of trams, pumps, etc. Charting procedures Non-optimization of Tracking system Communication Inadequate IS system for tracking/trending No Physician Prescription Writing system Availability of supplies Volunteer/greeter utilization Clinics schedules Utilization of minor emergency unit Ancillary services levels No integrated, on-line charting system Specialty testing delays ED used as admission unit ED discharge practice Machines Materials Hospital discharge process/timing Consult responsiveness/practices Use of ED for boarding Segmentation/delineation Sequential care vs. parallel processes Improvement implementation/maintenance ownership Methods Quality of measurement Are we measuring the right things? What do we do with what we measure? Need to do more than track Feedback systems to quality auditing Need for Improved flow sheet format Lack of on-line charting system for automated monitoring Measure 23 &&18 23variables variables

18time timestamps stamps nd Analyzed via 2 . wave of data nd Analyzed via 2 . wave of datacollection collection Patient Volume-Related: 10 Patient Volume-Related: 10 Staffing Volume-Related: 5 Staffing Volume-Related: 5 Staffing Mix-Related: 5 Staffing Mix-Related: 5 Misc: 3 Misc: 3 Improve What Whatcritical criticalXs Xswere weretested testedas asbeing beingroot rootcauses causesof ofthe theproblem? problem? 23 23variables variablesselected selected&&analyzed analyzed through throughsecond secondwave waveof ofdata datacollection collection Census-Related: 10 Census-Related: 10 Staffing Related: 5 Staffing Related: 5 Coded: 5 Coded: 5 Miscellaneous: 3 Miscellaneous: 3 What Whatroot rootcauses causeswere wereconfirmed confirmedand andtested testedin inthe thepilot? pilot? Patient Flow Direct-to-bed flow & bedside registration Patient relocation to semi-private space when appropriate Flow Facilitator

Care Team Communication Modified Zoning Communication Board Clinical Protocols Streamlined Order Entry & Results Retrieval Process Pilot Design Fishbone diagramming, data collection and statistical analysis determined the Critical Xs (contributing factors) as key components for the randomized pilot. 1. Patient Flow Direct-to-bed flow; Relocation to semi-private space 2. Care Team Communication Zoning; Communication board; Clinical protocols 3. Streamlined Order Entry & Results Retrieval Uses central clerk What Whatwere werethe thepilot pilotfactors factorsand andresults? results? Improve Patient Flow Direct-to-bed flow & bedside registration Patient relocation to semi-private space when appropriate Flow Facilitator Care Team Communication Modified Zoning Communication Board Clinical Protocols Streamlined Order Entry & Results Retrieval Process Lobby Target 15 min. Study 2 N = 129 Pilot N = 172 MD Target 8 min. 11.2 min. 8.9 min. 42% 34.9% Wait Time 34.5 min. 12.6 min. Wait Time % Defect

51.2% 22.8% % Defect Study 2 N = 129 Pilot N = 172 PILOT RESULTS Lobby WT Study 1 N =30 Lobby WT Study 2 N = 129 Lobby WT Pilot N = 158 MD WT Study 1 N = 30 MD WT Study 2 N = 127 MD WT Pilot N = 172 31.2 34.5 12.6 16.1 11.2 8.9 Standard Deviation 26.65 16.02 11.69 18.70 46.76 16.68 % Defect 56.7% 51.2% 22.8%

55% 42% 34.9% Z-Score 1.33 1.47 2.25 1.37 1.71 1.89 Mean WT (minutes) (Attribute) Improve PILOT CONCLUSIONS Moods Median Test P-value 95% C.I. Lobby WT Study 1 to Pilot 0.001 2.7 to 31.8 Lobby WT Study 2 to Pilot 0.000 4.8 to 13.2 MD WT Study 1 to Pilot 0.016 1.0 to 16.0 MD WT Study 2 to Pilot 0.772 -2.00 to 3.00 Lobby WT N MD WT N Study 1 30 30 Study 2

129 127 Pilot 158 172 Pilot lobby wait times were better than the established 15 min. target, the defect rate tumbled, and the C.I. validated statistical significance. Results for MD wait times were statistically significant in one of two Moods median tests. Positive trending was demonstrated in the comparison of Study 2 to the Pilot. Stakeholders supported department-wide, multipatient population implementation. Control What Whatare arethe thebuilding buildingblocks blocksof ofControl? Control? Guidelines Guidelines&&Assigned AssignedResponsibility Responsibility New NewStandard StandardOperating OperatingProcedure Procedure Detailed DetailedWho, Who,What Whatand andWhen Whenplan plan Data DataReview, Review,Reporting Reporting&&Accountability Accountability Quarterly Quarterlymanual/automated manual/automateddata dataanalysis analysis Monthly Monthlyreports reportsand

andcontrol controlcharts charts Use Useof ofCorrective CorrectiveAction ActionLog Logper perguidelines guidelines Monthly Monthlyreports reports Scheduled Scheduledreporting reportingto toexecutive executiveleadership leadership Quarterly Quarterlyreview reviewto toowner ownerpeers peers&&executives executives Communication Communication&&Recognition Recognition Monthly Monthlyupdates updatesto todept. dept.communication communicationcenter center&&newsletter newsletter Monthly Monthlyupdates updatesat atstaff, staff,faculty faculty&&resident residentmeetings meetings Incorporation Incorporationof ofstaff staffrecognition recognitionfor forongoing ongoingpositive positiveresults results

Recently Viewed Presentations

  • Minerals - studentorg

    Minerals - studentorg

    Tell students they will explore some of uses for the other minerals at the end of the lesson. Tell students they will identify minerals through different tests. Write the names of the unknown minerals: talc, rose quartz, smoky quartz, halite,...
  • Training Session - Quia

    Training Session - Quia

    Accommodations should not advantage the ELL unfairly and thus compromise the validity of the test results. Accommodations used during testing should be similar to those used by the ELL to complete classroom activities and assessments. Accommodations must be necessary for...
  • Investigation: Investigate similar products to your ideas (internet,

    Investigation: Investigate similar products to your ideas (internet,

    Bryn Kelly. We picked this picture because we thought that the slide mechanism would make it easier to get a gumball. Andrew Fagan . We picked this picture because to dispose one m&m at a time instead 10 coming out....
  • October 14, 2008

    October 14, 2008

    Q: What's an atom? The smallest piece of matter that still has all the properties and characteristics of that type of matter EX. An atom of gold still has the same chemical and physical properties as a chunk of gold
  • Corporate PPT Template - MRC Biostatistics Unit

    Corporate PPT Template - MRC Biostatistics Unit

    Adaptive Design: Definition. An Adaptive Trial usesaccumulating data to decide how to modify aspects of the study without undermining the validityandintegrityof the trial.(PhRMA) Validity. providing correct statistical inference: adjusted p-values, estimates, confidence intervals. providing convincing results to a broader scientific...
  • Statute of the ICJ, Article 38

    Statute of the ICJ, Article 38

    Statute of the ICJ, Article 38. The Court, whose function is to decide in accordance with international law such disputes as are submitted to it, shall apply: a. international conventions, whether general or particular, establishing rules expressly recognized by the...
  • Apresentação do PowerPoint - Catholic

    Apresentação do PowerPoint - Catholic

    This photo is not a montage Wow! What else to say? The statue of the Christ is 125 ft (38 m) tall and is located at the peak of the 2,330 ft (710 m) Corcovado mountain. Happiness is... Soapstone was...
  • Domain 3  Security Engineering  Objectives  Security Engineering  Architecture

    Domain 3 Security Engineering Objectives Security Engineering Architecture

    Zachman Framework. Section breaker slide with customer logo. Section heading - Arial Headings, 34, Bold. Sub head - Arial Headings, 18, normal. Used for a section heading. You may add a sub heading not exceeding one line also here. Section...