Six Sigma at Academic Medical Hospital

Six Sigma at Academic Medical Hospital

The Academic Medical Hospital (AMH) was an educator and a hospital that was a major contributor to the community with the help of the resident physicians at AMH and the administration at AMH was looking to improve the quality provided at AMH, it was advocated by Dr. Gerry Elbridge – Chief of Staff at AMH. Through many projects that were being undertaken by AMH through the use of Six Sigma and the statistical methods that are associated with it to improve the quality of medical care at AMH – the different projects that were taken up were Emergency Department (ED) wait times, Discharge cycle time, Physician coding among many others at AMH. ED wait time is taken as the focus of the Six Sigma study in this case analysis. There were obstacles for the Six Sigma team while they were trying to get into main stream for the ED wait times, which I will discuss further in the case analysis.

The core of Six Sigma that was introduced at Motorola consists of the phases Define, Measure, Analyze, Improve, and Control (DMAIC). The organizations that follow the Six Sigma methodology make use of empirical statistics from the different processes that are involved as the core processes for the operations of the organization. The use of the methodologies makes it imperative for the organization to have a back-up system from the major stakeholders and in the business processes, so that there is inclusion of the practices that are modified in order to fit into the standards of Six Sigma. The current environment at AMH, was in need of change for the past 10 years – Dr. Elbridge was leading the change at AMH and wanted to improve the ED wait times so that the patients and the physicians could get the most out of the Six Sigma methodologies.

The Six Sigma – was implemented at AMH by training groups of people as advocates of Six Sigma – Black belts (Project Leader) and Green Belt (Part-time project leaders) who were responsible for advocating the methodology among their peers and the major stakeholders that were involved in the project funding and getting the results incorporated in the processes.

The obstacles that were in front of the Six Sigma team at AMH are as follows, the change processes were not welcome by the medical practitioners and also the resident physicians - this was seen in the efforts that were made by Dr. Elbridge to cut down the wait times of the ED. The other major obstacle was that the funding that was to be given out for the project was in the hands of the project Sponsor – Dr. Terry Hamilton, a close friend of Dr. Elbridge was given this responsibility and he was reluctant to go ahead with the funding opportunity as he didn’t want this to be another effort that would be shelved by Dr. Elbridge. The other concern was that the stakeholders involved with the project need to be informed of the benefits and the changes that it would be bringing about in the organization, their acceptance for the project was a prime obstacle which had to be got to be a success for the ED management at AMH.

The implementation of the Pilot study using the Six Sigma was statistically giving out the right improvement curves – to be explained to Dr. Hamilton and Dr. Elbridge, the Sponsor and the Champion – it begins with the introduction of a sample study on a group of 30 patients for the ED wait times. The wait times consisted of 2 major areas that needed to be focused on – the Lobby wait time and the MD wait time (Xs in the study) the meant wait times for the lobby was 31.2 minutes and MD wait time was 16.1 minutes, this was not statistically significant as it was a small group of people and then another study was conducted on a group of 129 people which had the following results – wait times for MD and Lobby respectively were 11.2 and 34.5 minutes. The defect rates for study 1 and study 2 for the Lobby wait times were – 56.7% and 51.2% respectively, and the MD wait time’s defect rates were at 55% and 42% respectively. After the implementation of the pilot study, which was conducted on a sample of 172 people it gives us a clear picture of the improvement in the wait times which were reduced drastically – MD wait time was at 8.9 minutes and lobby wait time was at 12.6 minutes – these showed a significant amount of reduction in the time and which meant that there were lesser patients in the queue and also that the MDs didn’t have to waste their times in the IS related code changes and the status changes – which had to be done in the system, the physicians focused on the core patient care facilities and left the systemic work to a clerk that was hired to do that job. The implementation of Six Sigma methodologies to improving the ED wait times proved to be a great enhancer with the improved process improvements like bedside registrations when there was a free bed and also means of focusing on the patients requiring medical aid and shifting the waiting patients out of the beds.

The foundations team was effective under the leadership of Nancy Jenkins, who was the owner of the Six Sigma pilot project – the foundations team though had a few hiccups in accepting the six sigma process because it wasn’t easy to convince them to do the time-studies and other important statistical studies that were needed for the Six Sigma success. The DMAIC processes through the implementation of the Six Sigma panned out from defining the problems and the critical to quality (CTQ) factors that need to be identified to begin, next came the measure phase where the processes that influenced the CTQ could be measured and also the customers voice had to be taken into account, moving ahead to the analyze phase it was identify the root cause of the defects and the key inputs that effected the outputs, then comes the improve phase to create an optimal solution for the problems found and also to identify the acceptable ranges of the key variables that were measured and analyzed. Finally, control phase dealt with the maintenance of the modified processes to stay under the limits of accepted times and also create any dashboards for metrics that can relate to the reporting of accountability for the Six Sigma project.  The success factors included the identification of the benefits to the customer as well as the internal staff – which were reduce  wait times, improve satisfaction , enhance outcomes for the patients and increase the ED capacity for operational efficiency. The patients were surveyed and an acceptable wait time was in between 10-20 minutes for the level-II patients. The next success factor was that the critical Xs or the critical problems were correlated to the root causes which were identified as to be census related, staffing related, code related and others – which had the following success factors included; direct-to-bed flow and bedside registration, patient relocation to semi-private space when appropriate after being taken care of and they are waiting for the results of reports, flow facilitator to coordinate the flow of the patients, modified zoning of the physicians and the nurses, clinical protocols and the communication board that was visible to the staff another was the employment of a clerk to streamline order entry and to get results. The critical success factor here was that the lobby wait times had come within the polled time for the customers after the pilot was conducted i.e. 12.6 minutes, and MD wait time was 8.9 minutes, the defect ratios for the wait times >37 minutes had reduced from 51.2% to 22.8% for the lobby wait time, and for the MD wait time it reduced from 42% to 34.9%. The stake holders also supported the department-wide, multi-patient population implementation.