The Case for Change In December 1999, the Institute of Medicine (IOM) released a report that made health care providers and consumers alike sit up and take notice. The study by the IOM estimates 98,000 people die every year in the United States from medical mistakes made by healthcare professionals. In addition to the troubling…
With many issues facing the U.S. healthcare system the task of “fixing” it seems insurmountable, but the appropriate implementation With so many different issues facing the U.S. healthcare system the task of “fixing” it can seem insurmountable. Every healthcare executive knows the litany of challenges: rising costs, inadequate insurance coverage, capacity constraints, patient safety concerns,…
In 2006, the board, administration and staff at Louisiana’s Thibodaux Regional Medical Center (TRMC) decided their operating room (OR) suites represented an opportunity for improvement. Rising demand, costs and competition were all signals that the hospital would need to either invest in expansion or operational efficiency. Taking the less glamorous and more difficult path of…
Since 2001, Thibodaux Regional Medical Center (TRMC) in Louisiana has applied Six Sigma and change management methods to a range of clinical and operational issues. One project that clearly aligned with the hospital’s strategic plan was an initiative to reduce nosocomial or hospital-acquired pressure ulcers, because this is one of the key performance metrics indicating…
Until relatively recently, many quality professionals considered the term “Lean” to only be applicable to the manufacturing giants of industry. Lean, first created as a part of the Toyota Production System, is an operational approach and methodology embraced by world-class companies around the globe. With proven results, Lean has made its way into non-manufacturing industries,…
Excessive waiting and poor customer service at a hospital’s labor and delivery triage area had existed for years. But with a knowledge of Six Sigma, the hospital’s management knew it did not need to continue unabated. A process improvement project team attacked the problem systematically and began resolving it in a matter of months. Here…
Will Lean practices take root within an organization and lead to transformational change? That depends on the organization’s culture and the role that leadership plays. Within a traditionally structured organization, ideas and direction flow primarily from top to bottom, or executive to worker level. This may be expedient in some ways, but it also can…
Six Sigma leaders from three of America’s premier healthcare institutions – The Johns Hopkins Hospital, Mayo Clinic and New York-Presbyterian Hospital – recently shared their experiences with Six Sigma. These institutions are applying the method in order to improve operations and, ultimately, patient care. They offered the following advice for hospitals considering deployments of their…
As with most hospitals, labor is the largest budget expense at the Providence Alaska Medical Center (PAMC) in Anchorage. But benchmarking indicated that staff utilization at PAMC, a part of the Providence Health System, was above the 75th percentile of the national average. To remedy this, in October 2003, a multidisciplinary team (nursing, leadership, finance…
New London Hospital (NLH), a rural community hospital in New Hampshire, had been facing some long-standing challenges. In the radiology department, workflow and patient flow were not operating smoothly. Communication with the emergency department regarding patient preparedness was unclear, so patients often arrived unprepared and confused. Through a recent consulting engagement, the hospital received a…
Orthopedic and neurological spine surgery represents a competitive and profitable business for many healthcare organizations. Expanding this particular service line and ensuring efficiency in the operating room (OR) are among the strategic initiatives at Memorial Hermann Southwest Hospital in Houston, Texas, U.S.A., one of 16 hospitals in the Memorial Hermann system. Surgeons at the hospital…
In an effort to reduce costs, improve patient care, maximize resources and thrive in a highly competitive environment, healthcare providers are moving with increasing speed toward digitization – creating an environment that at some point in the future could become completely filmless, paperless and wireless. One aspect of going digital involves the use of a…
A patient management scorecard presents, in general, a comprehensive framework that helps healthcare managers to define strategies, track performance and provide information to show whether their institution is performing well in terms of its mission. By implementing this strategic management tool, hospitals can construct measures to aid performance measurements in areas essential to their strategies….
By Terra Vanzant-Stern Manufacturers face numerous challenges within their markets as the number of competitors grows and increasing material costs impact margins. Business methodologies such as Lean Six Sigma working in tandem with industry-specific approaches can increase the opportunity for success. An example of that is in the pharmaceutical industry, where an approach called process…
Process Improvement Drives Greater Efficiency and Higher Satisfaction Delays are common within the perioperative environment. Lengthy turnover times between surgical cases can impact surgeon satisfaction and timely access to services. At Louisiana’s Thibodaux Regional Medical Center (TRMC), surgeons expressed frustration with the length and variability of operating room (OR) turnover time (T0T). Maximizing efficiency in…
The healthcare industry is going through mergers and acquisitions and facing new economic struggles. As hospitals realize the need to consolidate resources regionally, a big challenge takes shape: handling the information necessary to manage cash flow efficiently. Cash flow management is vital for hospital systems to sustain their daily operations. Our team used DMAIC to…
Personnel and Readiness Information Management (P&R IM), Office of the Under Secretary of Defense (Personnel and Readiness), led an in-depth analysis of the Health Treatment Record (HTR) life cycle management process. The HTR is the chronological documentation of medical, dental and mental health care received by a service member during the course of his or…
Rising implant costs continue to impact hospitals across the nation. As technology expands, physicians are given new opportunities to try the most advanced implantable devices manufacturers have to offer. This was no different at Memorial Hermann Southwest Hospital in Houston, Texas, USA. The hospital has one of the largest cardiology programs in Houston offering complete…
Public health is tackling a broad range of challenges, from smoking, obesity and alcohol abuse to mental and sexual health. While the majority of public health departments and community-based healthcare providers are racing to meet the Healthy People 2010 objectives, disasters such as Hurricane Katrina have brought concerns related to a lack of systematic processes…
One of the participants in our Six Sigma Black Belt training program expressed concern about a lack of buy-in for Six Sigma in her organization. With little inquiry into the matter, we discovered that the means she adopted to gain buy-in were not apt for selling the philosophy. A lack of buy-in is most common…
Making the decision to bring Six Sigma into an organization is the first step on a long journey. Although this decision has proven successful for a variety of industries (including healthcare), the best-laid plans may go awry if the focus is solely on the technical side, without considering the cultural and communication aspects of the…
In a recent speech to a local chapter of the American Society for Quality, the speaker stated that in a typical work site as many as 15 percent of the employees actively work to subvert the goals of the organization. Their activities obviously have a negative effect on the clients of the organization and the…
“We’re the largest company you’ve never heard of.” That description of McKesson Corp. by Master Black Belt Bob Gooby underscores the relative anonymity of the organization that is the largest – and also the oldest – healthcare services company in the United States. McKesson has been providing medical products for more than 175 years, yet…
Competition in the outpatient imaging center market is intense. New imaging centers are springing up everywhere. Faced with decreasing reimbursements, ever-changing technology and the expectation of spa-like atmospheres, how can an outpatient imaging center remain profitable? The answer lies with the customer. Having a pulse on the customer experience and continually eliciting and acting on…
To accommodate growth in surgical service without adding resources, a Six Sigma team at Deaconess Hospital takes aim at reducing the number of same day surgical cancellations.
Special radiology procedures can be some of the most difficult to manage in healthcare. Their production relies on the chorus of a multidisciplinary team working within a limited time frame. Ancillary department performance can directly affect outcome performance for the unit. Defects such as missing orders, missing history and physicals or problems with patient flow…
At a high level, there is usually agreement on the big issues in any healthcare organization. Through observation and feedback alone, key stakeholders may realize there are problems with excessive wait time in the emergency department, or that the first surgical case of the day rarely starts on time, or that it is taking too…
Demonstrating clear alignment between Six Sigma projects and a healthcare organization’s strategic imperatives, vision or mission has been an elusive exercise for many organizations. Judging from a random sampling of web sites and hospital lobbies, most mission statements represent variations on a theme and relate to common issues such as clinical quality, cost management, service…
A lengthy and inefficient process for discharging in-patients is a common concern of hospitals, as well as patients and their families. A solution to that problem can be found in the application of Lean Six Sigma methodology.
At Providence Hospital in Detroit waiting times to see physicians in the emergency department (ED) ranged from 11 minutes to 4 hours. The hospital implemented Six Sigma and Lean to make an enormous improvement in its ED and express care program.
Recognition is growing among healthcare leaders of the need for a culture change within their organizations. Moving from recognition to reality, however, is more difficult. The problem lies in the perception – or misperception – of what a culture change actually entails. Culture change is not a program with a completion date, nor is it a quick…
Research has shown that 95 percent of diets fail over the long term. Oddly enough, various studies show that 60 to 80 percent of major change initiatives also fail. In both cases, it is certainly not for lack of good intentions. For a person who has been on a successful diet, it is frustrating to…
During the last two decades, process improvement was a dominant movement in the manufacturing industry. However, pharmaceutical and biopharmaceutical companies did not broadly recognize how breakthrough process improvement methods could be integrated with clinical research practices. Although Six Sigma is interdisciplinary, its internal structure and the nature of its interactions with other disciplines in clinical…
Remaining within a hospital management role for more than two years is an uncommon achievement today, but a resume with multiple job changes is not as detrimental as it used to be. A new organization, or even a new role, offers the advantages of learning new skills and discovering the contributions leaders can make. So…
A recent study by the National Center for Health Statistics found that, on average, an ambulance in the United States is diverted every minute to another hospital due to emergency room overcrowding. The study underscores the fact that this is a nationwide problem, and that emergency department (ED) diversions often produce a negative chain reaction…
The nuclear medicine department located in the Ospedale Santa Croce e Carle in Cuneo, Italy, has always been recognized as a national and international reference site for its clinical compentencies and innovative facility design. When originally opened, the nuclear medicine department was structured to provide the best possible service to patients. This included a focus…
More than 70 million Americans have some form of cardiovascular disease, including stroke, high blood pressure, congestive heart failure (CHF) and acute myocardial infarction (AMI). The numbers continue to rise as the population ages, and improving the timeliness and quality of cardiovascular care continues to be a critical area of focus for healthcare providers. Some…
Since launching its Six Sigma program in 2001, Decatur Memorial Hospital has trained a team of Green Belts, Black Belts, Master Black Belts and change agents, and completed projects that have led to increased quality and efficiency across the organization. And despite being four years old, the program remains vital with a high energy level….
There is no need for another survey to confirm what healthcare professionals already know – healthcare delivery is overdue for a major renovation. New management models and strategies must be adopted that will: Enable quick, sustainable results around immediate issues. Equip teams with solid problem-solving skills and proven best practices. Empower the organization with a…
A hospital must create a quiet, calm environment for patients by providing a physical setting conducive to recovery and an organizational culture that supports patients and families through the stresses imposed by illness, hospitalization, medical visits, healing and bereavement. To accomplish this hospital employees must identify internal and external noise factors – is it voices,…
After embarking on a Six Sigma journey, many organizations soon realize that one of the most significant benefits is also one of the most difficult to quantify. It cannot be measured in terms of “Z” scores or analyzed using a box plot. This benefit is the “people value” (no relation to p-value). It is the…
A distinguished panel of healthcare executives recently shared their thoughts on the importance of leaders taking an active and visible role in their organization’s quality initiatives. They also agreed on the need for organizations to develop the right management systems and structures to adequately support their quality efforts, measure outcomes and encourage accountability. Speaking on…
When a Houston hospital found it had a 12 percent incidence of pressure ulcers – exceeding the 7 percent national average – it put a team in place and launched a project to reduce the incidence of pressure ulcers by half within a nine-month period. By Senaida (Cindy) Garza, Veronica Okere, Jackson Igbinoba, Kristi Novosad…
Cardiovascular disease is the leading cause of death in the United States, and more than 900,000 people annually are diagnosed with acute myocardial infarction (AMI). The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Centers for Medicare and Medicaid (CMS) have identified AMI as one of the early priority focus areas for hospital…
Little more than five years after launching an ambitious, system-wide Six Sigma improvement initiative, Virtua Health in New Jersey, USA, is now considered a high-performing healthcare organization and a model for others to follow.
When confronted by concerns of some physicians about frequent lengthy delays that they experienced admitting patients, Memorial Hermann Southwest Hospital in Houston, Texas, assembled a cross-functional Six Sigma team to identify and address any underlying issues that might be causing the delays. The business case for pursuing the project was clear. Improving bed management and…
What happens when an emergency department (ED) undergoes major upheaval in the midst of a Six Sigma project? Just such a situation befell a newly trained Black Belt who was working on her first project at Memorial Hermann Southwest Hospital in Houston, Texas, USA. One month into the project to reduce cycle times, the ED…
With a robust quality improvement program in its emergency department (ED) since 1998, LDS Hospital in Salt Lake City, Utah, USA, has frequently used the routine analysis of operational data to improve its care for subsets of patients. Initiatives have successfully addressed pediatric patients with fever, acute coronary syndrome patients, endotracheal intubations and pain management,…
Reactions from healthcare professionals to Six Sigma can vary greatly, from “It’s the most reliable approach to process improvement we’ve found,” to “It’s just one of several tools we use to solve problems,” and even “Hate it…not interested…too hard…just another management fad.” Six Sigma is probably not for everyone and it is certainly not a…
It is time to shed some light on and refute some of the claims about the power of bar codes to deliver gains in patient safety. And, at the same time, the value of Lean and Six Sigma as significant tools in improving processes that actually can ensure patient safety needs to be reinforced. The…
Donna Seecof
Carolyn Pexton
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