Stake holders

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    I am trying to apply some process improvement techniques in a healthcare environment so I would like help in identyfying all the stake holders that would be linked with my work and right now my concentration is limited to ED(emergency dept.) so I need certain more help in this regard as well and I want all the suggestions that can lead to completion of my work with a considerable amout of improvent in the function of the ED.


    Bob J

    You don’t seem to be getting a lot of response so I’ll give it a shot…  My apologies for the length of the post…
    I recommend that you first consider what “improvement” means for your area…  What is important to your customers…  For example, I would assume that for an emergency process one thing that would be very important is the amount of time it takes from patient arrival to triage.  Another important consideration is accuracy of triage assessment.  Etc.  I like to approach this using a tool called an affinity diagram in a session composed of a broad cross section of folks that are familiar with the dept.
    In Six Sigma these are called CTQ’s….  Critical to Quality…  These are very important because they become the “keep the eye on the ball” focus that keeps your eventual project aligned with the overall business drivers…  Once you have a good idea of your CTQ’s, I like to gather data that shows how we are doing on each of these…  This assessment should be kept as simple as possible…  This data should then be reviewed with your organizational leaders with a focus on coming away with which CTQ you should be working on that will have the greatest impact on the operation…  It’s important here to come away with a defined ranking and not a “everythings important” response.  You want the one thing you should be working on…  Not a huge laundry list…
    With this understanding you should be able to come up with a project charter and get it signed off.  There are lots of threads and templates available in the forum for this if you need….  This is important so that you have a solid understanding of the scope and focus of your project to help prevent “scope creep” later…
    With this in hand I like to “walk” the process…  I find this works better than starting off with a team consensus of the process because sometimes things are not exactly what everyone thinks they are…  In your case (assuming you are working to improve time to triage) I would sit in the ER in a quiet out of the way corner and watch (and note) what steps occur when a patient arrives…  If time is your metric, note how long they wait before someone initially sees them and then how long they wait before being seen by triage….  Observe the flow and use this observation to help you define your primary process steps.  Be sure to capture the full range (assuming this is in your project scope) of patient situations (hurry cases to minor problems).
    Once you’ve defined your process and noted the key activities involved, this is where (finally) you can do your stakeholder analysis.  Ask yourself (or your team) to list everyone who either is directly involved with the process you just defined as well as anyone who might have an interest in how efficient that process is.  That list will be your stakeholders…
    What I just described for you is Define and part of Measure in the DMAIC process…
    Hope this helps…..
    Best Regards,
    Bob J


    Mark Robledo

    The stakeholders involved will be driven by the process which you are seeking to improve.  Any function which impacts the process should be represented on your cross-functional team.
    I have done extensive process improvement work for EDs and often a high-level patient flow improvement team will involve MD representatives, Charge RNs, ED staff, Regisration, Diagnostics Imaging, and Inpatient Bed Placement staff.  However, a more focused effort may involve different stakeholders.  The process being worked on will dictate which stakeholders to use. 
    If you have any questions, feel free to contact me at [email protected].  Mark

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