Cancer Center Saves Lives With Six Sigma
Many health care leaders are beginning to see the benefits that Six Sigma tools can bring to not only solving current operational problems, but also creating long-term solutions. One example comes from the Sylvester Comprehensive Cancer Center at the University of Miami’s Miller School of Medicine. The cancer center’s Director of Clinical Operations Lauren Giolai, MBA, BSN, RN shared with Oncology Nursing News that “if you don’t set up the process so that it’s a sustainable win, people get tired and suffer from change fatigue. Creating collaborative solutions that make it better for everyone are the keys to success.” Giolai is an oncology nurse, a job that can be incredibly rewarding as well as challenging. Cancer care nurses develop close relationships with patients, as well as their families and caregivers, over months and years of treatment. In addition to providing treatment, they also teach them how to manage their symptoms and conditions. They get to be an advocate, cheerleader, supporter and encourager for patients facing one of the toughest times in their lives. They also keep tabs on a patient’s changing condition and coordinate needed therapies. They frequently are the liaison between patients and doctors, conveying important updates. Because of their compromised immune systems, cancer patients often encounter sudden, potentially life-threatening changes in their condition. Getting them to prompt medical care often can mean the difference between life and death. One area Giolai and her team found opportunities for improvement was in reducing wait times for cancer patients who come to the hospital’s emergency department with neutropenic fever, caused by low levels of infection-fighting white blood cells. Using Six Sigma tools, a multi-disciplinary team focused on cutting down the time it took from the time patients with neutropenic fever entered the emergency department to when they received intravenous antibiotics. It took input from many departments within the hospital, but eventually a systematic, data-driven approach paid off. The cancer center started giving patients a neutropenic fever alert card that they could share with ambulance personnel and emergency department staff when they entered the hospital. They also added a field on the emergency department’s sign-in form to allow patients an opportunity to indicate neutropenic fever. They then developed a neutropenic fever alert system that emergency department staff could use to trigger a team that would quickly respond to the bedside when such a patient was identified. Giolai credits these simple improvements with saving hundreds of lives. The task force won 2 awards, Overall Showcase and Greatest Customer Impact, at the 2017 Florida Sterling Conference Team Showcase competition. They then used a similar approach to reduce the wait time for lab results by 53% and overall wait time by 26% The results? Patient satisfaction scores went through the roof. Giolai said that breaking down silos and bringing together different departments that don’t normally interact to solve a problem is one of the key benefits of Six Sigma. She offered tips on how to go about lasting process improvement in health care, including: Picking a change that will impact patients Mapping out the process Getting input from the customers and stakeholders Forming teams with a variety of backgrounds and perspectives Defining clearly what you want to improve Defining clearly the steps you need to take Completing the steps and track the results, making changes as needed Kudos to the Sylvester Comprehensive Cancer Center team on a job well done. What tools have been helpful to create sustainable improvement at your workplace? How are you helping your employees to work smarter by reducing the amount of time they spend on non-productive activities and correcting...
Read MoreUsing Data to Turn the Tide of the Opioid Crisis
We’ve all seen the statistics: Drug overdoses, most of which are related to opioids, killed over 64,000 people in the United States last year — an increase of 21% over 2015, according to the Centers for Disease Control. The opioid crisis hit Indiana especially hard. In 2015, IV drug use in Indiana caused the nation’s worst HIV outbreak in 20 years, affecting rural Scott County. Let’s face it — the issue is complicated. There are challenges with both prescription and illicit drugs. Solutions must reduce the number of people who become addicts in the first place, as well as cure those who do. The underlying issue of pain management must be addressed. For all these reasons, the State of Indiana has recognized that understanding the data, and blending them with statistics from other agencies, is key to solving the complexities of the drug crisis in Indiana, and hopefully the nation. Issie Lapowsky described the state’s efforts to attack the problem in an enlightening articlethis fall in Wired magazine. Earlier this year, Indiana started an online opioid data center, where pharmacies, hospitals, mental health organizations, police departments and others can share data to help everyone see the big picture of what is really going on across the state. Working with the analytics-software provider SAP, the State of Indiana constructed a database that includes information on drug arrests, drug seizures, death records, pharmacy robberies, overdose-related ambulance calls, and the use of naloxone, an overdose-reversal drug. State officials also incorporated the data-visualization tools from Tableau, so agencies providing the data can log in and observe trends over time. This far-reaching data-sharing effort—including some 16 government agencies—is amazing in a country still struggling to keep up with the recent explosion of opioid abuse. The state’s efforts are beginning to pay off. To decide where to locate five new opioid treatment facilities, the team took a map of state’s existing treatment facilities and meshed it with a map of overdose cases and instances where paramedics administered naloxone. Then, they measured the distance from the areas with the most overdoses to the nearest treatment location to identify gaps where new facilities might be most helpful. They’ve also been able to monitor drug seizures real time, to monitor new drugs that are hitting the black market. This can help the state spot new drug outbreaks before they reach crisis levels. If you’d like to hear more about how big data is transforming public health and learn what’s next in the battle against the opioid scourge, check out the INconversation with Dr. Jennifer Walthall, Secretary of the Indiana Family and Social Services Administration on Jan. 24 from 4-5:30 p.m. at Indiana Humanities, 1500 N. Delaware. Dr. Walthall is leading the charge to use data to target the areas of the state most in need of treatment programs. Kudos to the team for their efforts to foster collaboration and data sharing to help agencies collectively address the opioid issue real...
Read MoreAn Rx from Pharma: Quality by Design
Several years ago, I spent a summer working for a company that manufactured communication antennas. I can still remember the quality control analyst coming by, twice a day, with a grocery cart full of parts that had been rejected for not meeting tolerance standards. I was amazed at the amount of work that went into creating these parts, just to have such a large volume returned because they did not meet quality standards. What a waste! The main problem with late-stage quality analysis is that it only detects and gets rid of substandard products or parts—it doesn’t prevent them from being created in the first place. As manufacturing has evolved over the years, companies have put in place a variety of techniques to evaluate quality more rigorously, and in many cases, to embed quality control throughout the manufacturing process. In a recent article in Pharmaceutical Technology, Hermes Pharma‘s Analytical Development Senior Manager Martin Koeberle, Ph.D. and QbD & Drug Regulatory Affairs Senior Manager Wolfgang Schiemenz discuss the use of quality by design in pharmaceutical manufacturing. By utilizing quality by design techniques, pharmaceutical companies like Hermes Pharma are able to determine critical quality attributes (CQAs) that may significantly affect the quality of their final product. By honing in on these CQAs in advance, the team can identify the key variables that affect the production process, or critical process parameters (CPPs). These can be actively monitored to avoid any deviation in the manufacturing process, ensuring product quality and that CQAs are met. Techniques such as this also may enable the company to simplify regulatory compliance. By making early adjustments to the manufacturing process, they can avoid costly late-stage adjustments that have to be formally registered with regulatory bodies after large scale production has begun. As pharmaceuticals become increasingly complex to manufacture, it’s more important than ever that quality is designed into the them from the beginning to ensure patient safety. And ultimately, to deliver a better product that improves lives and better patient outcomes. If you haven’t checked out the article, it’s worth the read. The lessons learned can be applied across many industries that are working to boost production output, reduce throughput times, lower costs, and deliver an amazing products that meet the needs of customers. How are you helping your employees to work smarter by reducing the amount of time they spend on non-productive activities and correcting errors? If your business processes need a “check-up,” please email me at michael@leadingchangeforgood.com! I’d love to help you get back to a healthy, productive...
Read MoreModel Cells to Start a Lean Journey
ThedaCare Center for Healthcare Value recently shared an interesting case study about a large California hospital system that found a unique way to replicate exceptional patient care across its many service sites. The Palo Alto Medical Foundation for Health Care, Research and Education (PAMF) is a well-respected health care organization serving the health needs of more than a million patients who live in four counties in the San Francisco Bay area. PAMF employs 1,500 physicians and approximately 5,000 employees across more than 40 different locations. Like many large health care organizations, PAMF’s rapid growth in recent years led to consistent care quality across the organization, but the patient experience varied. Yet patient satisfaction surveys showed that patients wanted the same experience no matter what location they went to for care. As these service conundrums continued to develop, PAMF’s leaders soon discovered that Lean Six Sigma tools could help them create a model of care that meets patient expectations and replicate it at their many locations. After benchmarking with ThedaCare and hiring leaders experienced in LSS, PAMF’s management team began to realign its primary care delivery system at 40 locations using lean principles. Borrowing from ThedaCare’s success, they started with the “model cell” concept to align everyone with the goal of improving the patient experience. What is a “model cell”? Let’s say you’re a large hospital system like PAMF. Is it realistic to find the training and financial resources to help the entire organization “go Lean” all at once? Probably not. But if you start with one department where the leaders are excited and eager to be the first, you can set a model for the rest of the system to learn from. The cell model becomes a demonstration project, a proof concept, that shows real change and real results. Otherwise, if you try to implement LSS across an organization without adequate training and support, you run the risk of spreading yourself too thin and accomplishing little. That is how LSS fails – by not showing results. PAMF found that the model cell was the best way to help staff learn about LSS principles. The leadership team used this approach to show the rest of the organization what “exceptional care” looks like. This generated excitement among staff, and best practices from the model cell began to spread organically. Ironically, one of PAMF’s initial successes had more to do with staff satisfaction than with bottom-line improvements. It turns out that juggling a million priorities was creating staff burnout. LSS helped alleviate the problem and get team members home for dinner with their families. They teamed up nurses and medical assistants to work more closely with physicians to quickly and efficiently identify patient concerns, communicate the concern with the physician and speed the process of actual patient care. This improved not only staff satisfaction, but patient satisfaction as well. If you haven’t read the case study, it’s definitely worth the read. Today, PAMF’s lean initiatives are focused on continuous improvement with a concentrated effort to bring daily engagement into the organization’s specialty care areas. Kudos to the PAMF team making LSS applicable in day-to-day work and improving care for its patients. How are you helping your employees to work smarter by reducing the amount of time they spend on non-productive activities and correcting errors? If your business processes need a “check-up,” please email me at michael@leadingchangeforgood.com! I’d love to help you get back to a healthy, productive...
Read MoreSix Sigma Approach Improves ICU Bed Turnaround Time
These days it seems every organization is being told to work smarter, due to unprecedented pressures in funding, staffing and supply costs. No place can this be seen more clearly than in the hospital setting. With all the changes in the American health care system, every hospital is struggling to maximize the use of whatever it has, be it equipment, staffing, or patient rooms. In the May 2017 issue of ISE Magazine, Patrice Batamack, PhD and Christine A.N. Ndjee, MD discuss an effort by a Los Angeles academic acute care medical center to improve bed turnaround time in its 32-bed Intensive Care Unit (ICU), to better meet patient needs and control costs. The hospital noticed that bottlenecks occurred when staff discharged or transitioned patients to lower acuity units. Leaders assembled a team to evaluate the situation using Six Sigma methodology. The team focused on both the voice of the customer, i.e. patients desiring less wait time between transfers into and out of the ICU, and the voice of the business, i.e. the hospital, needing a faster turnover rate for these rooms. The team went through the DMAIIC process (define, measure, analyze, improve, implement, control). Instead of jumping to the conclusion that the hospital needed more ICU rooms, the team collected data about the cause of delays surrounding the turnover of these rooms, such as cleaning and preparing the room for the next patient. The cleaning process was owned by the Environmental Services Department. The team established turnover rates for these rooms. After collecting data for 6 months, they discovered that the process was out of statistical control. The main causes for the delays centered on the availability of managers; their trust in the hospital information system; the availability of the nursing floor staff; their ability to use the hospital info system consistently; availability of supplies; and staffing levels. The team recommended several improvements, not the least of which was to promote and reinforce better teamwork, emphasizing collaboration, cooperation and staff flexibility. The team developed a detailed implementation plan and a Visual Basic tool to monitor the process. By decreasing the median cleaning turnaround time from 67 minutes to 60 minutes, the project team anticipated an annual savings of at least $24,000 in the ICU alone! Too often a problem such as this is addressed by trying to increase staffing, and/or facilities. Six Sigma tools helped this team use data to identify the root causes of delays, make informed decisions and implement solutions. This team proved that by improving the cleaning process, they could achieve better ICU room utilization, meeting the needs of both the customer (patients) and the business (hospital administration). Kudos to the team on a job well done! How are you helping your employees to work smarter by reducing the amount of time they spend on non-productive activities and correcting errors? If your business processes need a “check-up,” please email me at michael@leadingchangeforgood.com! I’d love to help you get back to a healthy, productive...
Read MoreSaving Lives, and Costs, With Lean Six Sigma
Like most people, I enjoy a good story. I especially like stories that have happy endings. While I usually read fiction for pleasure, I particularly enjoy true business case studies that showcase successful workplace problem solving. In the February 2017 issue of the ISE Magazine, Navicent Health’s Casey Bedgood tells a great story about the use of performance improvement techniques (PI) to save lives, as well as save costs. Georgia-based Navicent Health’s EMS department operates ambulance services in both rural and suburban settings across a four-county area. Their 911 call volume exceeds 40,000 calls a year! While Navicent has long been a well-respected provider with a strong reputation for clinical excellence, the organization was experiencing a variety of operational inefficiencies in 2013. The PI team identified several areas for improvement, including an outdated pay and staffing model, response times, and the number of emergency calls lost to competitors due to these problems. The team collected data to establish baselines and develop control charts. This information was then used to set key performance indicators (KPIs) for operational problems. The team also recommended changes to pay scales and shift lengths, allowing for better coverage in both rural and suburban settings. One year later, the results of these efforts were quite significant. Navicent Health EMS saved almost $800, 000 per year while reducing emergency response times by more than 37,000 minutes, a 12% improvement. Bedgood states that well-defined goals and KPIs, measurable in real time, were essential in obtaining long-term, sustainable change. For most companies, time is money. But for the patients of Navicent, quicker response times truly mean the difference between life and death. This is just one of many success stories being written by the 6,000 employees at Navicent. The health system/academic medical center serves 800,000 residents in Central and South Georgia with 830 beds for medical, surgical, rehab and hospice care in more than 30 locations. In 2015, the hospital system created its Center for Disruption and Innovation, in partnership with Mercer University. The Center, where Bedgood is now a black belt leadership fellow, focuses on creative thinking and problem solving using Lean Six Sigma and other techniques to develop successful strategies — just like in the EMS case study — that ultimately will significantly improve care for patients. How are you helping your company to work smarter by reducing the amount of time spent on non-productive activities and correcting errors? If your business processes need a “check-up,” please email me at michael@leadingchangeforgood.com! I’d love to help you get back to a healthy, productive...
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