Control Phase: Lean Six Sigma in Healthcare Tutorial

7.1 Module 7 Control

Hello and welcome to the seventh module of the Lean Six Sigma in Healthcare course offered by Simplilearn.   The DMAIC process is the foundation of LSS projects. DMAIC stands for the project phases, Define, Measure, Analyze, Improve, and Control.   This module is dedicated to the last of these phases: Control, which ensures solution implementation is controlled and sustained for a long term.   Let us explore the objectives of this lesson in the next screen.

7.2 Topic 1 Lock in Performance Gains

There are 4 main considerations to ensure performance gains are sustained long term. It can’t be too complex, it has to leave little or no room for error, it has to be well documented, and the people have to be rewarded for shifting from the old way to new way of doing things.   Let us look at each one individually.   If you expect people to adopt the new way you things, you have to make sure that the path to acceptance is as direct as possible. The first thing to consider is you must make every effort to facilitate the change in behavior by making it easy for them to change from their old behavior. Ideally, doing things the new way should be easier compared to the old way. If it is more complex, it will not be easy to change behaviors.   With simplicity comes mistake-proofing. We already covered Poka Yoke in the previous module. Take the time now to go through each step of the process to think of ways people can make mistakes and then try to put checks in place to either prevent those mistakes or at least alert of the error in order to avoid the next step of the process to start with a defect.   Make sure to document the process adequately so that stakeholders can easily learn the new ways and have a point of reference during the initial stages of uncertainty. It is always useful to document answers to common questions that may arise.   Finally, ensure to recognize and reward the early adopters who use the new process. This not only recognizes their efforts but also serves as a reminder to the organization as a whole that the new way is important and recognized as such. Recognition does not have to be elaborate or expensive. You would be surprised how a simple pat on the back can go a long way to cement a desired behavior.

7.3 Topic 2 Standardize the Process

Standardizing the process ensures everyone does it the same way and hence reduces the likelihood of potential errors. The following are some points to remember when documenting processes and procedures:   Keep it simple. As mentioned in the previous topic, do not complicate the documentation. Try to keep it easy to read and logical in flow. Flipping back and forth between pages or looking up references in other documents is cumbersome and annoying. Document the procedure in a manner that provides all the necessary information in one place. Checklists, schedules, and process maps are extremely useful and easy to read. They save time and provide a wealth of information in a compact format. Be sure to use these tools in your documentation. Ensure consistency. Be very vigilant to use the appropriate terminology and language so as not to create confusion in the interpretation of the documentation. Be very specific so as not to leave room for ambiguity or interpretation. This must also be balanced with ensuring brevity, however, as long, exhaustive documents will most likely not even be read. Document the process in such a way that formal training would not be required to understand how to execute the work as described.

7.4 Topic 3 Statistical Process Control

Statistical process control provides a means to monitor a process over time and avoid firefighting. The first thing to consider in Statistical Process Control is what to monitor.   We already spoke of KPOV and KPIV. These are the outcome or output variables of the process and the critical X,or key input variable of the process that the project team actually addressed.   It only follows that process monitoring should look at these 2 variables. From now on, we’ll refer to these as key performance indicators, or KPIs.   Next, we must determine what is the appropriate monitoring tool to be used. There are many charts that can be used and some are beyond the scope of this training. The image given on the slide refers to a simple decision tree to help select the most common control charts.   The factors influencing the decision are the nature of the data and the sample being used.   As seen on the screen, there are different charts for variable and discrete data.   Once the chart type has been determined, there are 4 steps to create and interpret them. Let us review these in the next screen.

7.5 Topic 4 Improvement Implementation

Three critical elements to successful improvement implementation are:   Ensuring stakeholder management. As we discussed in previous modules, now is the time to refer back to the stakeholder analysis and to ensure that all stakeholders are at appropriate level of support. Have their concerns been addressed? Have their questions been answered? Do additional activities have to be undertaken to get stakeholders ‘on board’?   Communication. Has the implementation plan been communicated to everyone impacted by the process? Do people know about what is happening when and to whom? Has there been an opportunity for 2-way communication? Are there any unresolved issues?   Training. Is everyone trained on the new way of doing things? Does the documentation reflect the training content and vice versa? Are the people comfortable with their new knowledge? Is closer supervision or coaching required for an initial period of adjustment?   Putting adequate thought and effort into stakeholder management, communication, and training will pave way to a successful solution implementation.   In the next screen, we’ll discuss the key activities to finalize an improvement project.

7.6 Topic 5 Finalize the Project

The following activities are the key components in finalizing a project:   Put in place a schedule and process to perform periodic reviews of the process. This will ensure that there is a check to see if the gains are sustained. Common audit schedules are to perform a verification every 6 months and then every 12 months after the improvement was made. This could be integrated into the control plan.   Identify potential areas where the gains realized from the project can be leveraged elsewhere. For example, if a project removed delays or waste in a process, can those same changes be done elsewhere? This type of thinking is called leveraging to other parts of the organization, and it greatly increases the pace of improvements.   Celebrate the success with the project team and also with other participants. This type of recognition goes a long way to instill a culture of continuous improvement and is very motivating for those involved.   The final project closure act is to transfer the ownership of the process back to its rightful owner. Of course, the project leader must ensure that the process owner agrees to the improvement and has all the tools he needs to monitor the process.   In the next screen we’ll look at a checklist that can be used when closing a project.

7.7 Topic 6 Case Study

The project team at Mercy West hospital had come up with an improvement plan and presented it to the Director of Administrative services.   To summarize, the solution entailed the initial assignment of a temporary administrative clerk to be available to perform discharge coordination tasks outside of regular office hours. This was to be done in addition to some minor process adjustments such as identifying discharges requiring in-home care and advising stakeholders to submit these by 10 am weekdays.   The director agreed with the plan and now it was time to put it into action.   Prior to implementing the solution, the project team ensured to document the process, change the release forms, and created a memorandum for circulation with the modified administrative procedure text and the implementation plan. This memorandum would be used for the initial change and then the text could easily be used to permanently modify the procedures.   The team then held some training sessions for both the existing administrative staff and the new temporary clerk as well. This training covered the process, the documentation, a checklist, and FAQ document as well. This FAQ covered what to do in certain likely scenarios so there would be no ambiguity in how to complete the tasks. The new release form had a highlighted note stipulating the 10 am submission requirement for same-day home care releases.   Once the fix went live, doctors who respected the 10 am deadline were personally called and thanked for their compliance.   I-MR control charts were created to monitor the release coordination cycle time and after 2 weeks the data was compared to the cycle time data from before the change. It was confirmed that the mean had shifted.   A control chart of the overall discharge cycle time also showed a shift in the mean for the same period. This confirmed that their improvement had made a difference.   The team created a control plan with some corrective actions if the statistical process control signalled an out of control situation. The first was to verify the day’s releases submitted and the second was to check the time of releases.   The team also validated their stakeholder chart to make sure they had the proper level of support, scheduled a Q&A session a few days prior to implementation, and assigned a point of contact from the administrative staff who was a part of the solution design and who could answer any questions that may arise.   Finally, the sampling plan stipulated that a new sample of the cycle time would be taken after 4 weeks, after 6 months, and then after 12 months. John and the team included some suggestions to leverage this improvement in other areas of the hospital that also exhibited bottlenecks due to a lack of after-hours personnel. The project was handed back over to the director of administrative services and he organized a small pizza luncheon with the administrative staff and the project team to celebrate their success. Now the team was ready to move on to the next upstream bottleneck to resolve the bed capacity problem.

7.8 Quiz

You will now attempt a quiz to check your understanding of this lesson.

7.9 Summary

In this module we discussed some of the important elements of the Control phase of an improvement project. Here is a quick recap of what was covered in this module:   There are 4 main considerations to ensure sustained improvements Standardizing the process that ensures everyone does it the same way and hence reduces the likelihood of potential errors.  Statistical process control provides a means to monitor a process over time and avoid firefighting. The control plan is a procedure to continuously gather and monitor data. There are three critical elements to successful improvement project implementation To properly finalize an improvement project, the team must ensure these key activities are completed

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  • PMP, PMI, PMBOK, CAPM, PgMP, PfMP, ACP, PBA, RMP, SP, and OPM3 are registered marks of the Project Management Institute, Inc.

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