Project Scoping in Healthcare: An Exploration and Tips

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y Mike Case, Aidan Cardella and Michael Toomey

An important factor contributing to the success of a Six Sigma healthcare project is the initial defining or scoping of the project.

After the primary focus area of a project has been identified, scoping is the activity of breaking down the focus area into the many specific processes, sub-divisions of the business and/or segments that drive the performance of the focus area. It is done by Black/Green Belts with assistance from a Master Black Belt and the focus area Sponsor. Scoping can uncover multiple potential processes requiring improvement.

Scoping ensures that the team is concentrating on the best opportunity for improvement. Projects often have a greater success rate if the scoping session includes understanding where the financial benefits may be found ("mapping the cash"). Scoping also helps to set clear parameters and determine what is in scope or out of scope for a particular project, what resources and skills will be required and a time frame for completion.

To ensure the project is based on valid analysis rather than assumption, it's important to invest sufficient time up front to define the primary objectives. Without this process, a project may be too nebulous or unwieldy for the team to manage, and therefore will not produce the desired results.

During scoping, the team may discover several smaller sub-projects that should spin off from the central effort. In some cases, the team may find that what was originally thought to be a Six Sigma project may not warrant that level of statistical rigor. Instead, the issue could be resolved more appropriately as a Work-Out session, applying facilitation tools and assembling the right stakeholders to propose solutions. The complexity of the issue, stakeholders involved and analysis of the data will drive this decision.

Without taking the scoping process further into the Define phase, it's important to spend time brainstorming factors that may help shape the project. For instance, if the project relates to medical record completion, will the team include or exclude certain units in the hospital, outpatients or inpatients, and will they make distinctions by acuity level, and so on.

Questions to Drive the Scoping Process

Here are questions to ask during project scoping:

• What is the product/process/service being designed?
• What are the boundaries? What falls outside the boundaries?
• Where are the starting and ending points?
• Is there a subset you will focus on?
      customers
      offices
      locations
      plants
      products
• Are there design aspects that will not be addressed in this project?
• Are there circumstances beyond the team's influence or resources?

There are useful techniques, such as Change Acceleration Process (CAP), that can be applied within the framework of a Six Sigma project. As part of the scoping process, the team may participate in a CAP exercise to determine elements that will be included or excluded in the project. This will allow the project to be modified as appropriate and the output can be used as a communication tool with other stakeholders.

Developing Process and Sub-Process Maps

During the Define phase of a Six Sigma DMAIC project, the team will develop a high-level or SIPOC (Suppliers, Inputs, Process, Outputs, Customer) process map to evaluate customer needs and supplier inputs, and determine initial measurement objectives. The next step is to examine in greater detail the various sub-processes defined in the SIPOC map. Here is an example of a process map to define the steps involved with bed capacity for patients.

Example of SIPOC Process Map: Patient Throughput and/or Bed Capacity

                                                                                                                                                                                                       Source: Nebraska Medical Center

Sub-process maps provide specifics on the flow of a particular process, and that information can then be further analyzed. Selecting which sub-process steps to map will be determined by evaluating which of the major steps in the SIPOC have the biggest impact on the output (Ys). Carrying the previous example forward, a sub-process map has been created to look at the details involved with creating a patient booking and searching for an available hospital bed.

Example of Sub-Process Map: Patient Throughput and/or Bed Capacity

                                                                                                                                                                                                      Source: Nebraska Medical Center

Process mapping and analysis will help to scope the project and determine if one initial focus area should actually become several different Six Sigma projects, with specific metrics associated with each initiative. Data should validate and help to shape the project, regardless of the focus area – whether it is targeting medication errors, laboratory turnaround time, throughput in radiology, billing processes or any other focus area.

Neglecting to pay proper attention to the scoping process on the front end can lead to frustration, lost time and disappointing results.

Project Scoping Tips

Here are some tips for scoping Six Sigma projects:

• Find out if other projects or initiatives might complicate the success of a particular project. For instance, a newly purchased software program may negate the need for a particular charge capture project.
• Use qualifiers to help validate project potential. Look for data that can be put in a time series plot.
• Provide worksheets ahead of time and engage the team in developing a Project Charter to initiate the application of Six Sigma methodology.
• During scoping session:
      – MBB should coach the project team to think about the information needed.
      – Start at a high level to help focus on manageable areas.
      – Sponsor should state in their own words the potential project area and what needs to be improved.
      – Challenge the sponsor to acknowledge if data is available, and if not, whether it can it be collected manually to support the project.
      – Clarify expectations for the project. Is it financial, or patient, staff or physician satisfaction? Make sure the expectation is linked to the organization's top-level objectives. If not, move on to something else.
      – Get participation from a Green Belt or knowledge source within the focus area. This facilitates the SIPOC or In/Out of Frame tools.
• Watch for competing metrics in the scoping process. These are land mines.
• Avoid having two sponsors for a single project, as this can create conflicts and problems later.
• Be sure that the project has a clear line of sight to a business Y. This would be to those top-level initiatives that the customer's organization would be working towards (financial, satisfaction, patient safety, clinical improvement, compliance).
• Don't let projects cross boundaries; make scope clear.
• Get the CFO involved early to ensure understanding about the process. This greatly enhances the commitment to calculating and signing off for financial benefits.
• The most successful projects tend to correlate with scoping sessions that carefully quantified financial benefits up front (process is referred to as "map the cash").
• Make sure the scoping session differentiates between a soft and hard metric (subjective vs. objective, satisfaction vs. cycle time).
• Avoid projects with limited data. Validate data availability before moving into Define. Watch out for data points that have a long cycle time to obtain.
• A clear elevator speech at the end of the scoping session make clear the consensus on the project scope, provides something to which all participants can speak, and prevents any hidden agendas.

About the Authors

Mike Case is a senior member of GE's Performance Solutions group. He was the first Master Black Belt to complete the rigorous training program for GE employees working with hospitals in the application of Six Sigma and GE leadership practices. His successful projects include length of stay reduction for specific patient populations, high-cost device acquisition cost reduction, in-vitro fertilization clinic quality improvement leading to increased pregnancy rates, numerous cycle time projects, and increased throughput in procedural and patient point-of-contact areas. Mr. Case, who has a bachelor's degree in biology with honors and a master's degree in economics, is based in Denver and can be reached at mike.case@med.ge.com.

Aidan Cardella is a Master Black Belt and performance outcomes manager with GE's Performance Solutions group. His involvement in Six Sigma dates to the initial GE initiative with a focus on implementation, course development and instruction. He has significant experience developing Master Black Belts, Black Belts and Green Belts and leading Six Sigma projects. Mr. Cardella has more than eight years experience in Six Sigma and change management. He has a technical background in mathematics and computer science with a master's degree in statistics. He is based in Annapolis, Md., and can be reached at aidan.cardella@med.ge.com.

Michael Toomey joined GE Medical Systems in 1975 and has more than 25 years experience in the delivery of healthcare and customer satisfaction. He has held positions in diagnostic imaging field service, installation support, technical support, training, management and operations, and Six Sigma. Mr. Toomey received his Master Black Belt certification in 1997. He was one of the first GE Medical Systems Master Black Belts to successfully mentor and close 100 Six Sigma projects. Mr. Toomey has a bachelor's and a master's degree in biomedical engineering. He is a guest lecturer on quality methodology for operations courses at Seattle University. He can be reached at michael.toomey@med.ge.com.

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