Introduction: Lean Six Sigma in Healthcare Tutorial

1.1 Course Introduction

Hi, I’m Patrick, your Simplilearn instructor for this course on Lean Six Sigma and in this module we’ll be discussing the importance of making improvements in healthcare. First we’ll review how current events and trends are creating a strain on healthcare systems around the world. Then we’ll look at the cost of healthcare in general. Next we’ll get a clear picture of the need for change by exploring the actual cost if nothing is done to change this situation. This overview will set the stage for how lean six sigma can make a difference. From there, we’ll review a few results of projects and also explore how more and more healthcare providers are embracing lean six sigma to help them improve the quality of care, reduce medical errors, and even control costs. We’ll wrap up this module with a brief course overview and an explanation of the methodology that we’ll be using for each of the upcoming modules. Importance of Improvement in Healthcare Current Events/Trends The average age of populations around the world is rising fast. As a matter of fact, according to statistics from the United Nations department of Economic and Social Affairs, the 21st century will witness even more rapid and unprecedented aging than the previous 100 years. In 1950, one in 15 persons aged 60 or older was actually 80 or above. In 2000, this number jumped to 1 in 9. By 2050, this number is expected to be approximately 1 in 5! This is no surprise really, because the baby boomer generation is a significant population bubble. Boomers are getting older, so the bubble is shifting into retirement age and then will shift again as we’ve seen in the illustration. But the problem is, as the world population grows older, demands on healthcare will become even more significant. An aging population means an increase in the need for care and treatment of chronic and age-related health issues such as: • Heart disease • Cancer • Stroke • Chronic lower respiratory diseases • Alzheimer’s • Diabetes In addition, infectious diseases, such as influenza, and injuries also take a disproportionate toll on the health of older adults. All these health issues related to a booming population segment will invariably place a never before seen demand on the world’s healthcare systems. The reason is twofold: first, seniors are more likely to have chronic conditions, and secondly, they require more medications, doctor and hospital visits, and also have longer hospital stays. If healthcare providers are not prepared, they will rapidly become overwhelmed, and the cost, risk, and safety of patients will be compromised. Cost of Healthcare A leading indicator of this alarming trend is the ballooning cost of healthcare as a person ages. For example, in 2011, The Canadian Institute for Health Information reports that a senior between the ages of 85 to 89 costs the government 5 times more in healthcare spending per capita than an adult aged 60 to 64 years old. So what is the healthcare sector to do? Unfortunately, the answer is not in asking governments to spend more. Healthcare already represents a significant portion of most countries GDP as seen in this representative graph of the United States, UK, and Canada. In addition, healthcare is already taking a large portion of government spend. For example, here we see that in the UK, healthcare is the second largest expense right behind pensions. Doing nothing differently will invariably put a strain on government coffers as spending continues to rise. On the other hand, the more likely outcome will be expense reductions and pressure to cut costs. A recent article in Forbes magazine reports: “According to the Congressional Budget Office’s 2014 Long-Term Budget Outlook, the United States remains on an “unsustainable” trajectory, driven entirely by growth in the big federal health care entitlements: Medicare, Medicaid and Obamacare.” The article goes on to refer to a study by the American Health Policy Institute where 85% of chief human resource officers of 360 large employers agreed “increasing access to the health care system without making significant improvements in the efficiency and affordability of that system” is what troubles them the most about the new U.S. Affordable Care Act. Cost of doing nothing differently With costs and demand rising and not being addressed at the root, something will have to give. Unfortunately for the people who need care, if it is not handled responsibly, this situation will undoubtedly result in a reduction of service levels and a degradation of healthcare – at a time when patient demand is actually on the rise. And this result is a true recipe for a global healthcare crisis of epic proportions. Lean Six Sigma can help Lean Six Sigma can help address this issue because not only does it provide the tools and methodology to help organizations reduce costs, more importantly, Lean Six Sigma improves process efficiencies by systematically stripping away waste, variation, and non-value added activities. Furthermore, a lean six sigma approach is customer centric. This aspect alone makes lean six sigma ideal for improvements in a health care setting because the base of any improvement should be focused on the patient (the customer). This sentiment is made extremely clear in the 1999 Institute of Medicine’s benchmark report “To Err Is Human” where a substantial body of evidence points to medical errors as a leading cause of death and injury. This report concluded there were 98,000 preventable medical deaths a year in the United States due to medical errors. Today, that figure is estimated to be at least twice that much! Since 2001, healthcare providers have embraced Lean Six Sigma to help fix this problem. Let’s take a look at what some early adopters have been able to accomplish with Lean Six Sigma. Sample Improvements Johns Hopkins Hospital was one of the first to implement a Lean Six Sigma program. What started out as a pilot project proof of concept has now evolved into a full-blown deployment with many on staff receiving training while still working their full-time position. One notable project had to do with reducing wasted blood units purchased from the American Red Cross. The project team determined the main sources of waste and discovered that the largest cause was related to an unreliable indicator on the insulated containers used to keep the blood temperature within usable limits. Replacing the indicator resulted in a 4 percent reduction in waste, but more importantly, increased blood availability for patients. The Mayo clinic also uses lean six sigma. In one particular project, the team was able to significantly reduce cycle time of a critical process related to their transplant program. The Mayo clinic has the largest transplant program in the United States, so any improvements to this process have an enormous impact on patient outcomes. The team eliminated many non-value steps in the time from initial patient contact with the transplant center to an appointment being set up and reduced the cycle time from 45 to 3 days. At New York Presbyterian Hospital, six sigma is used to enhance teamwork and increase efficiency. In one project, the team sought out to improve first case start times. After brainstorming potential factors responsible for delays, the team gathered data and determined the highest contributing factor. Had they not used the data, improvement efforts would have been mistakenly focused in the wrong place. North Shore University hospital decided to focus their improvement efforts on the first point of entry for most patients, the Emergency Department. After gathering cycle time data and walking through the processes, the project team applied lean principle of one-piece flow. The result was a 37 % improvement in wait times. At the beginning of the project, everyone thought the ED was understaffed. After the project staff members were not only seeing more patients, but they seemed to enjoy their work more as well. These are just a handful of results healthcare organizations have been able to achieve using Lean Six Sigma, which begs the question, “why aren’t all hospitals using it?” Growth of LSS in healthcare Compared to other industries, the healthcare sector has been relatively slow to accept Lean Six Sigma. Some researchers feel that this is due in part to disparities between processes that are driven by humans as opposed to automated or engineered processes. Additionally, and paradoxically, healthcare delivery methods often run counter to the idea of customer centricity. In many instances, the idea of being patient centric is unfortunately very far from the reality of the bureaucratized processes involved. While a growing number of early adopters in healthcare have embraced the DMAIC approach, and it has shown to be very effective with significant improvements and transformations in the organizational culture, Lean Six Sigma is not yet widespread today. Since its introduction in healthcare, we have witnessed a significant increase in interest in Lean and in Six Sigma (especially in 2006) and then in 2009 the introduction of a merge both approaches grew in popularity as well. The graph below from Google illustrates how interest has remained relatively unchanged over the past 5 years, however… Does this mean that Lean Six Sigma does not work in healthcare? Absolutely not! The results of projects speak for themselves. However, healthcare practitioners realize that successful implementation requires the acquisition of a particular skillset (and an appreciation of the nature of the healthcare environment as well) so an investment in time and education is required. This course will help you acquire some of that skillset. The course modules are broken up to reflect the typical Lean Six Sigma project methodology. We’ll start with the preparatory stage in module 2. There you will learn how to recognize a problem (or improvement opportunity), get the buy-in to fix it, how to scope the improvement project and we’ll also cover some fundamentals of effective project management. We’ll wrap up module 2 with a sample case study to put it all into perspective. Module 3 is all about defining the problem. We will explain how to gain a clear understanding of what the problem actually is and it’s impact, and we’ll also see how to communicate it effectively to others. We’ll explore stakeholders, choosing a project team and flushing out the causes of the problem. Then we’ll see all of it come together as we review the case study. In module 4, we carry on from there and begin the measure stage. This consists of gaining a clear understanding of the process, narrowing down the causes, and gathering data. Once again, the case study will illustrate these steps in a healthcare project scenario. The next phase is to analyze the data. Module 5 will explain how it’s important to validate the data gathered and also how to determine the vital few causes that will lead to the greatest improvement. Once again, the case study will show how these apply to a sample project. In the next module, the focus is on finding potential solutions and implementing the best one. In module 6 we’ll also cover how to manage stakeholders and how to structure an effective improvement implementation. The case study ties this all together. Module 7 is about making sure the improvement sticks for the long term. Here we’ll discuss the importance of good documentation, how to communicate the change and also how to measure the results. The case study portion of this module will serve to illustrate these key points. While the final module of the course is not part of the DMAIC methodology, it will serve as a recap of the entire process by providing a complete summary of the case study project throughout all of the steps. So this concludes the First module of Lean Six Sigma in Healthcare. In this module we covered the importance quality improvement in healthcare, how Lean Six Sigma can help to make those improvements and also how utilization of Lean Six Sigma has increased over the years. We also covered the breakdown of the course and explained how the case study ties it all together. In the next module, we’ll cover the steps required before you actually begin a DMAIC project.

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