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James G. Springfield, FACHEJames G. Springfield, FACHEPresident and CEOPresident and CEO
Harnessing the Potential of Harnessing the Potential of Six Sigma in HealthcareSix Sigma in Healthcare
March 30, 2006
March 30, 2006
2
Rio Grande Valley
March 30, 2006
3
• Valley Baptist Medical Center - Harlingen– 611 Licensed Beds– Lead Level 3 Trauma Center– State of the Art Children’s Center– # 1 Rated Orthopedics Service– Heart & Vascular Institute– Teaching facility for the Regional
Academic Health Center of The University of Texas Health Science Center at San Antonio
• Valley Baptist Medical Center – Brownsville– 243 Licensed Beds– Level 3 Trauma Center– State of the Art Imaging Center– Center of Diabetes Management
• Other Entities– Golden Palms Retirement and Healthcare
Center– Valley Baptist Health Plans– Advanced Medical Supply (DME)– Valley Baptist Ambulatory Surgery Center– Clinical Pastoral Education Center– Licensed Vocational Nurse School– Family Practice Residency Program– Internal Medicine Residency Program– Home Health & Hospice– Rehabilitation & Wellness– Behavioral Health Services
Valley Baptist Health SystemValley Baptist Health System
March 30, 2006
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• Strategic Initiatives– Integration– Simplicity– Six Sigma Quality– Relentless Service– Expansion of Services & Regionalization
• Values– Disciplined– Entrepreneurial– Performance Oriented– Accountable
Valley Baptist Health SystemValley Baptist Health System
September
October
December
January
February
May
AprilMarch
July
August
June
November
1st Quarter 2nd Quarter
3rd Quarter4th Quarter
Execute Initiatives:Mgmt. Mtg. Marching Orders
Performance Reviews
Board Retreat
QOR
Aug. Board
Meeting (Present budget)
QOR
QOR
Valley Baptist Health System Valley Baptist Health System Operating CalendarOperating Calendar
QOR
Talent Review / Succession, HR
Planning
Initiatives Dev. & Review +
Sr. Mgmt. & Review and
Key Mgmt. Retreat
Performance Stds. Set
Budget
= Work product req.= Processes link
Sr. Mgmt. Mtg
Key Mgmt. Retreat
Guidance
VBHS Confidential & Proprietary Information
VBHS ValuesVB
Survey II
Strategic Planning
Integration
Simplicity
Service Expansion & Regionalization
Relentless Service
Six Sigma Quality
VBSurvey I
March 30, 2006
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• A comprehensive and flexible program for achieving, sustaining and maximizing business success that:
– Is a management methodology with three perspectives:• A Measure of Quality• A Process for Continuous Improvement• An Enabler for Cultural Change
– Is uniquely driven by a clear focus on the “Voice of the Customer”
– Is founded in a rigorous use of facts, data and statistical analysis
– Provides for diligent attention on managing, improving and reinventing business processes
What is Six Sigma?What is Six Sigma?
March 30, 2006
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What is Six Sigma?What is Six Sigma?
• Integrated part of management system
• Fact & data based decision making
• Knowledge transfer, learning process
• Value added focus on defect removal
• Utilization of technology tools
• A lasting infrastructure
• Not a cost reduction program
• Not a training program• Not a statistics program• Not a quality program• Not a quick fix
Six Sigma Advantage, Inc.
March 30, 2006
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• Six Sigma is a statistical measure that expresses how close a service process comes to its quality goal
• Six Sigma refers to a process that produces only 3.4 defects per million opportunities
Sigma DPMO Yield
2 308,537 69.1463%
3 66,807 93.3193%
4 6,210 99.3790%
5 233 99.9767%
6 3.4 99.9997%
What is Six Sigma?What is Six Sigma?
March 30, 2006
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DMAIC MethodologyDMAIC Methodology
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How did we begin How did we begin implementing Six Sigma?implementing Six Sigma?
• CEO Commitment– Vision– Leadership– Resources (time, money, people)
• Partnership with General Electric Medical Systems– Guidance– Expert Knowledge– Training – Six Sigma, CAP, Work-Out™– Project Mentoring– Transition Assistance
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Roles at VBHSRoles at VBHS
• Master Black Belt – 6 Sigma mentor and educator• Black Belt – 6 Sigma trained specialist who works on 6
Sigma improvement initiatives on a full time basis• Green Belt – 6 Sigma trained specialist who uses the Six
Sigma methodology to solve problems as a function of their normal work
• Yellow Belt – Physicians and Executives trained in basic 6 Sigma methods who assist with problem solving, initiative sponsorship and solution implementation
• Sponsor – Executive with responsibility to identify 6 Sigma initiatives, assign resources and remove barriers
• Change Agent - Expert in the application of CAP and Work-Out™ tools
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Six Sigma Practitioners at VBHS
• Master Black Belts (5)– 3 Certified– 2 Seeking Certification
• Black Belts (4)– 3 Harlingen– 1 Brownsville
• Green Belts (61)– 31 Certified – 30 Seeking Certification
• Yellow Belts (34)– 15 Executives– 19 Physicians
• Master Change Agents (2)• Change Agents (237)
– 190 Harlingen– 47 Brownsville
• Future– All Executives will be trained to Yellow Belt level– All Directors and Managers to Green Belt certification
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Physician Yellow BeltsPhysician Yellow Belts
• Jose Ayala, DPM• Maria T. Camacho, MD• Miguel Cintron, MD• Chandler E. Deal, MD• Luis Gaitan, MD• Alfredo Garcia, MD• Giovanna Ghafoori, MD• Khadim Hussain, MD• Garner Klein, MD• Robert A. Lozano, MD
• Raul Maldonado, DPM• Juan Mancillas, MD• Carlos Medina, MD• John A. Partin, MD• Eric Six, MD• Adela S. Valdez, MD• Daniel F. Villarreal, MD• Gerald Witson, DDS• Robert T. Wright, DO
March 30, 2006
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Six Sigma Six Sigma Physician Council MembersPhysician Council Members
• Miguel Cintron, MD• Lisa Dix-Emperador, MD• Luis Gaitan, MD• Giovanna Ghafoori, MD• Tomas A. Gonzalez, MD• Christopher Hansen, MD• Khadim Hussain, MD• Garner Klein, MD
• Bruce Leibert, MD• Juan J. Mancillas, MD• Clay W. Ross, MD • Michael Simpson, MD• Eric Six, MD• Adela S. Valdez, MD• Gerald Whitson, MD• Robert Wright, MD
March 30, 2006
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VBHS TimelineVBHS Timeline
• May 2002– Engagement with GEMS– Wave 1: 6 initiatives– Green Belts trained
• March 2003– Wave 2: 6 initiatives– 3 Full Time Black Belts appointed
• April 2003– 3 Full Time Master Black Belts appointed and trained
• June 2003– Wave 3: 8 initiatives– Green Belts trained– 2 Master Change Agents trained
• March 2004– Wave 4: 15 initiatives – Green Belts trained
• July 2005– Wave 5/1: 13 initiatives – Green Belts trained
• September 2005– Wave 6/2/1: 14 initiatives; Wave 6 at VBMC-H, Wave 2 at VBMC-B, Wave 1 at System– Green Belts trained
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72 Completed Training and 72 Completed Training and Translation Initiatives Translation Initiatives
Wave 11. ED Wait Times2. Diabetes Management3. Pharmacy Order Verification4. OR Turnaround Time5. Staff Scheduling6. Nursing Order Activation
Wave 21. ED Wait Times2. Laboratory Turnaround3. Admissions Process4. OR Turnaround Time5. Radiology Turnaround
6. Discharge Process
Wave 31. ED Wait Times
2. Surgery Patient Preparation & PATT
3. DRG Assurance of Accuracy
4. RN Admissions Assessment
5. Patient Registration Accuracy
6. Outpatient Service Redesign
7. Performance Management
8. RN New Hire Process
March 30, 2006
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1. Timely Utilization of Ancillary Services in the ED
2. Inpatient Floor to Floor Transfers
3. Event Response
4. Golden Palms MDS Coding Accuracy
5. CHF
6. Stroke Care
7. AMI
8. Forms Management
9. Pain Management
10. STO Turnaround Time
11. Patient Identification
12. Outpatient Services Integration
13. Timely & Safe Medication Turnaround
14. Abbreviations
15. Pathology Process Flow Improvement
Wave 4 InitiativesWave 4 Initiatives
March 30, 2006
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VBMC-HarlingenWave 5
1. ED Registration & Accuracy2. Pneumonia Core Measures3. Interdisciplinary
Communication4. VBMC-H Accessibility5. Ancillary Departments Results
Availability6. Physician Pay for Performance7. ED Charges
VBMC-BrownsvilleWave 1
1. Emergency Department Hold Time2.2. MeMedical Records / Transcription
Turnaround Process3. ICU Care Management Process4. Outpatient Registration Turnaround
Time5. Length of Stay Planning & Mgmt
Process6. Radiology Turnaround Time
Wave 5/1 InitiativesWave 5/1 Initiatives
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Wave 6 (Harlingen)1. Cardiac
Catheterization Lab Capacity
2. Medication Reconciliation
3. On-Time Discharges
4. Critical Care Glucose Management
5. Coronary Bypass Graft Core Measures
Wave 2 (Brownsville)1. Wound Care2. Women’s
Services Throughput
3. Respiratory Care Management
4. Surgical Case Time Management
5. Critical Care Medication Administration Turnaround Time
Wave 1 (System)1. Decision Support
Turnaround Time
2. Advance Directives
3. Family Practice Residency Program Patient Throughput
4. Event Response
Wave 6/2/1 InitiativesWave 6/2/1 Initiatives
March 30, 2006
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Translation InitiativesTranslation Initiatives
1. Acute Myocardial Infarction 2. Heart Failure Management3. Patient ID (Mother Baby)4. Patient ID (Ancillary Services)5. Surgical Preparation (Inpatient)6. Surgical Preparation (Day Surgery)7. Abbreviations8. Pharmacy Order Verification9. Nursing Activation of Orders10.DRG Assurance of Accuracy
March 30, 2006
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Examples of the Examples of the VBHS application of VBHS application of
Six SigmaSix Sigma
March 30, 2006
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61 minutes on average in
2002
Operating RoomOperating Room(Harlingen)(Harlingen)
Amount of time it takes to turnaround surgical suites from
one case to the next
Decreased
34%
40 minutes
on average in
2006
March 30, 2006
23
110 minuteson average in
2002
PharmacyPharmacy(Harlingen)(Harlingen)
Amount of time it takes the pharmacy to verify a
physician order
Decreased
80%
22 minutes
on average in
2006
March 30, 2006
24
Accuracy rate of75% in2003
Diagnostic Related GroupDiagnostic Related Group(Harlingen)(Harlingen)
Code assignment on 16 DRGs
Improved
33%
Six Sigma
performance in
2006
March 30, 2006
25
Compliance rate96.8% in
2004
Patient IdentificationPatient Identification(Harlingen) (Harlingen) & & (Brownsville)(Brownsville)
Proper patient identification prior to medical procedures
Six Sigma
performance in
2006
March 30, 2006
26
42 hours onaverage in
February 2005
RadiologyRadiology(Brownsville)(Brownsville)
Amount of time it takes for the final report to be posted in the patient’s chart after the
radiological exam is ordered
Decreased
64%
15 hours on
average in
January 2006
March 30, 2006
27
566 minutes onaverage in
March 2005
Emergency DepartmentEmergency Department(Brownsville)(Brownsville)
Amount of time it takes a patient to leave the ED after the MD order
for admission is written
Decreased
69%
177 minutes on
average in
January 2006
March 30, 2006
28
33 minutes onaverage in
2003
Emergency Department Emergency Department (Harlingen)(Harlingen)
Amount of time it takes to discharge a patient after the doctor has determined
the discharge disposition
Decreased
30%
23 minutes on
average in
2006
March 30, 2006
29
226 minutes onaverage in
2004
Emergency DepartmentEmergency Department(Harlingen)(Harlingen)
Amount of time it takes a patient to arrive to an inpatient bed from the ED
after the doctor has written the admission order
Decreased
49%
116 minutes on
average in
2006
March 30, 2006
30
102 minutes onaverage in
2003
NursingNursing(Harlingen)(Harlingen)
Amount of time it takes to complete the Nursing Assessment
on inpatients at VBMC-H
Decreased
70%
30 minutes on
average in
2006
March 30, 2006
31
Compliance rate73% in
2004
NursingNursing(Harlingen)(Harlingen)
Pain Management assessment and follow up
Compliance rate
90% in
2006
Improved
23%
March 30, 2006
32
88 minutes onaverage in
2002
NursingNursing(Harlingen)(Harlingen)
Amount of time it takes the nursing department to activate
physician orders
Decreased
73%
24 minutes on
average in
2006
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94.6% in
2004
Compliance with the JCAHO’s core measures for
Acute Myocardial Infarction
Improved
5.4%
Six Sigma
performance in
2006
Evidence Based MedicineEvidence Based Medicine (Harlingen)(Harlingen)
March 30, 2006
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81.4% in
April 2005
Compliance with the JCAHO’s core measures for
Acute Myocardial Infarction
Improved
23%
Six Sigma
performance in
January 2006
Evidence Based MedicineEvidence Based Medicine (Brownsville) (Brownsville)
March 30, 2006
35
58% in
2004
Compliance with the JCAHO’s core measures for
Heart Failure Management
Improved
72%
Six Sigma
performance in
2006
Evidence Based MedicineEvidence Based Medicine (Harlingen)(Harlingen)
Displayed with Permission of Modern Healthcare. Copyright Crain Communications, Inc., 2005 Modern Healthcare Magazine
“Right on the Money”November 14, 2005
•Launched October 2003 with 268 hospital participants
•Cash rewards for total of $8.85 million to 123 hospitals the top 20% performers in five clinical areas:
–heart failure, pneumonia, bypass surgery, heart attack and hip and knee replacement.
•Hospitals graded on quality measures, earning a composite quality score in any given focus area.
CMS Pay for Performance
March 30, 2006
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53% in
April 2005
Compliance with the JCAHO’s core measures for
Heart Failure Management
Improved
89%
Six Sigma
performance in
January 2006
Evidence Based MedicineEvidence Based Medicine (Brownsville) (Brownsville)
March 30, 2006
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Stroke Care Stroke Care (Harlingen)(Harlingen)
Letter dated September 27, 2005 from Joint Commission’s Executive Vice President, Russell P. Massaro, MD, FACPE:
The Joint Commission is pleased to award Disease – Specific Certification to your organization’s primary stroke center as a result of the September 2, 2005 review at Valley Baptist Medical Center
This certification is effective for two years from September 3, 2005, and is indicative of your program’s compliance with consensus-based national standards; effective use of established clinical practice guidelines to manage and optimize care; and performance measurement and improvement activities.
March 30, 2006
39
Initiatives Achieving Initiatives Achieving Six Sigma PerformanceSix Sigma Performance
VBMC – Harlingen1. Acute Myocardial Infarction2. Heart Failure Management3. Inpatient Identification Process –
Mother Baby Unit4. Inpatient Identification Process –
Ancillary Departments5. Surgical Preparation –
Day Surgery6. CT turnaround time to ED7. Inappropriate Abbreviations
VBMC-Brownsville1. Acute Myocardial Infarction2. Heart Failure Management3. Inpatient Identification Process –
Mother Baby Unit4. Inpatient Identification Process –
Ancillary Departments
VBHS
1. Forms Management
2. MDS Accuracy – Golden Palms
3. DRG Assurance of Accuracy
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