Director of Quality Outcomes Nidia Williams explains how the deployment in this three-hospital organization has evolved in the past two years.

Southcoast Health System, a not-for-profit group made up of three hospitals in Southeastern Massachusetts, began its Lean Six Sigma deployment in early 2009. Since then, the organization has realized about $20 million in cost benefits, Patrick Gannon, vice president and chief quality control officer, told the New England Business Bulletin earlier this fall.

Although a growing number of hospitals are implementing Lean, it is rarer to find a health system using the method in tandem with Six Sigma, a process improvement approach that relies on more advanced statistical analysis tools. Southcoast’s Director of Quality Outcomes, Nidia Williams, recently spoke with iSixSigma Senior Editor Kirsten Terry about the decision to use both methods, along with other aspects of the organization’s deployment. Williams has been with Southcoast for 23 years and was the group’s first Black Belt.

Terry: Southcoast Health System is employing Lean and Six Sigma in its improvement efforts. How did you decide to use both methods?

Williams: We actually started them both at the same time, if you can believe it or not. The thinking behind going with both and not just one or the other is that, first of all, they’re complementary in terms of what you’re trying to achieve – what the goals are. But also, they have very different aspects.

In Six Sigma, you’re going a mile deep, really digging into a problem from an analytical perspective in order to truly figure out what the critical issues are that you want to work on. But on the Lean side, you’re looking at waste and you’re going a mile wide. We were able to engage a lot more of the people in the hospital system with our Lean work right off the bat and build some momentum for the culture shift [that’s needed for process improvement]. At the same time, we were bringing Six Sigma in and training the first of the Green Belts.

Terry: How have you built the Lean Six Sigma deployment at Southcoast over the last two years?

Williams: At first we started with the assistance of a consultant. We knew that we wanted to bring Lean and Six Sigma into the organization, and we knew we were going to need some help. We’re a big organization – in the hospital group we have over 6,000 employees.

Initially, the consultant came in, and we did an analysis first and foremost that looked at the EDs [emergency departments]. And the analysis was looking specifically at issues of throughput from a business perspective…so that we could see what opportunities were there, and use the data to drive what decisions we were going to make. And from that [analysis] we saw opportunities that eventually became some of our first projects. In that first wave, we trained 12 people to become Green Belts and we also trained the leadership team.

We put project teams together, each being led by a Green Belt-in-training. On each project team we had a process owner – which is a leader within the department or someone with oversight and authority over one of the areas where the project was being conducted – and executive sponsorship. It was very structured in terms of what the leadership roles would be when they were supporting these teams. And then the teams started in on their projects, and basically ran through their projects over a 120-day cycle, with check-ins every 30 days, where they could present their work to all of the senior leaders and directors for the hospital system.

We used rapid-cycle change as part of our Six Sigma projects. As opposed to waiting until a year after the Measure phase and then starting your Analyze and Improve [phases] afterward, we started with rapid-cycle changes right up front as we were going through DMAIC. About every 30 days you were reporting on a different section, but you were already trying [improvements]. Every 30 days you were showing another part of the DMAIC [process], but you were also showing the Control chart to see the impact of some of these changes.

Now all of our training is done in-house. We still maintain a Lean and Six Sigma check-in every month, where senior leadership and leadership across the organization come in and they hear about all the different projects and all the different work people are doing.

Terry: What has the physician involvement been like?

Williams: Physician involvement has been really good. We’re a community hospital system, so we have physicians who work in their own practices, but we also have a hospitalist program that belongs to Southcoast, and we’ve trained some physicians in Six Sigma, particularly in the ED.

It’s an organization-wide endeavor to change the culture and to adopt these business philosophies, so everyone is engaged. On many of these project teams…there would probably be a physician on the team as well, or several. Anyone who was involved in the process was invited to come to the table and asked to commit to the project and to be a part of the Six Sigma project improvement team for that particular area.

Terry: Tell me about how Lean Six Sigma has improved patient care at Southcoast.

Williams: Some of the projects that we did were excellent projects for learning. Some of those dealt directly with issues of patient safety or some of our results in terms of areas where we wanted to make sure that our practice was consistent with best evidence for that particular element of care. Some of the areas that impacted patient care the most were projects where we looked at our accuracy and completion of the med reconciliation process, for example. A lot of our projects were also patient satisfiers, in that they decreased the amount of time patients spend waiting or focused on how quickly we can get someone, for example, from arrival to needle-in when they were coming in for cardiac catheterizations.

We also did projects where we looked at employee safety. For example, [we looked at] the use of safe patient handling equipment. We have all of this equipment on some of our units designed so that our employees don’t have to lift heavy patients, or lift anyone, basically – and employees were only using them 50 percent of the time. We were still seeing people get hurt or have strains or back injuries because of the lifting involved on the units, so one project specifically looked at increasing the compliance and the use of safe patient handling equipment among the employees. We do projects that pretty much run the gamut. We’ve done probably close to 30 projects already.

We have a very robust tracking system for all of the projects. Once they leave the active project phase, they’re turned over to the process owners. The process owners were the people who were on the team, working with the Belt, who actually had authority over some of these areas, and their job is to control and maintain and continue monitoring the processes to make sure the improvements have been hard-wired, and we follow up with them for as long as it takes to show us that the improvements have been sustained.

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