Case Report of Six Sigma at Academic Medical Hospital Essay

Six Sigma is a business heed strategy designed to meet customer needs and physical process capability. Six Sigma seeks to improve the quality of process outputs by identifying and removing the causes of defects and minimizing variability in manufacturing and business processes. It uses a systematic go out-oriented fashion through define, measure, analyze, improve, and control (DMAIC) cycle, including statistical tools, and creates a special infrastructure of people within the organization (like Black Belts, Green Belts, etc.) who ar experts in these methods. Each Six Sigma project carried out within an organization follows a defined sequence of steps and has quantified financial tar perk ups (cost reduction, profit increase, etc). Overview stand out name Six Sigma at Academic medical Hospital (AMH) enigma long-sufferings with probablely life-threating injuries and illnesses argon defermenting for over an hour for treatment in arrest Department at AMH Although long wait tim es seemed to be readily excuses by many physicians due to complexity of managing pinch way of life and processes and clinical staff, it is still unacceptable for the patients.Targets help Emergency Department (ED) at Academic Medical Hospital (AMH) to reduce the wait time Method instituting Six Sigma at AMH and establishing a Six Sigma Foundations Teams, which start out an application practicum on an assigned AMH project with, cooperate trainers acting as coaches. Six Sigma Foundation team up Champion Dr. Elbridge (establishes business organises and creates an environment within the organization to promote the Six Sigma methodological analysis and tools) supporter Dr. terry Hamilton (key communicator and approves final preachation) Owner Nancy Jenkins (implementation and accountable for sustaining long-term gains) Black Belts Jane McCrea (project leaders who be experts in Six Sigma methodology and statistical tool applications) Green Belts Dr. James Wilson (trained by six Si gma methodology from hospital) The Foundations Team (a group of local anaesthetic experts who participate in the project) &4 people (Nancy Jenkins, tolerant Care Manager Georgia Williams, ED fitting Manager Bill Barber, senior Clinician and Steve Small, Senior Clinician and Quality Improvement Coordinator) Seven Process Steps and Activities for patients at the Emergency Department Triage The Nurse complete a preliminary assessment of the patients spring and ranks his criticality accordinglyRegister The Nurse obtain demographic and insurance info Lobby The Patient wait for the nurse call your name Tx Room& Nurse The patient do testing and get the results MD The patient wait for doctors. Questions Q1.Describe how Six Sigma Methodology (DMAIC) is implemented in the ED face clipping Project. As stated, Six Sigma is based on a 5 chassis, step-by-step process that was used in the ED face m Project. In the Define phase the team identified expected benefits of the project includin g expedited medical care delivery, ameliorate patient satisfaction, reduced patient complaints, increased patient capacity and improved operational efficiency. Moving on to the Measure phase, the team determined the baseline measures and the target performance of the buff light process as well as defined the input/output variables. They collected 2 groups of information sets as well as administered a patient satisfaction survey, which produced the maximum wait times for patients.During the count phase the team then analyzed the baseline study and found that two processes mainly maked the wait time the waiting room time and the time spent waiting on the MD. As the ED continue Time Foundations team moved on to the Improve phase it was decided that they would improve Patient flow, Care Team Communication and Streamlined Order Entry and Results Retrieval Process. By changing execution by which the Priority Level II patients were moved, it resulted in less or no waiting room tim e and allowed patients to proceed to the examination room. Modifying ED zone assignments within the patient- care team and using cutting communication boards would reduce patient complaints and improve satisfaction. This change will also help with new fundamental clerks that will help entering patients and decrease the amount of time that physicians and nurses are occupied. Lastly, in the Control phase the team ensures that the new standard operation procedures for moving patients through the ED are maintained.They compared the performance of the Emergency Department before and after in order to none their progress and set guidelines to preserve their advancement. Q2.Access the master results from the process changes. What should the team say to the Project Sponsor, Dr. Hamilton, and to the Project Champion, Dr. Elbridge about the results? According to the results, the pilot Lobby check Time mean value came in under the acceptable target of 15 clears, and the MD Wait Time meas ure was improving(pilot mean was 8.9 minutes against a study 1 baseline of 16.1 minutes and a study 2 baseline of 11.2 minutes). Although pilot MD Wait Time didnt reach the target set at 8.0 minutes, it was apparently improved. Pilot Lobby Times were better than established 15 minute target, the defect rate dropped, and the 95% confidence interval test on the study 1 average and study 2 median vs. pilot median validated statistical significance of the improvement in wait times. Results of MD Wait Times were statistically significant in one of two conceptions Median tests (study 1 vs. pilot). Positive trending was demonstrated in the comparison of study 2 to the pilot which showed that the MD Wait Time became shorter and the detect rate decreased. The outcome looked promising.However, the Hawthorne effect came into play, particularly in the study 2 data collection activities. Due to un honest automated data-gathering procedures in the EDs information systems and the need to use int ra-departmental manual data surveyors, the presence of bias was recognized. The team needed to decide whether to remodel some aspects of their work in the Improve phase. The data was not convincing enough, and the result of improvement in MD Wait Time was not very apparent. Q3.What are the obstacles to AMH adopting Six Sigma? The equation Q*A=E is the seat of successful Six Sigma improvement implementation. It infers that the quality of process solutions multiplied by the Acceptance level of stakeholders is tinge to the effectiveness of those results. In this case, the primary obstacle is the acceptance level of the hospital. NO matter which solutions result from the analysis, the potential for success will be limited without the acceptance of the people touched and gnarly. Getting people to encompass six Sigma reforms in ED was going to be an uphill battle.There are 3 reasons 1) Physicians are not hospital employees, but independent contractors of a sort from the Medical schoo l. It is almost a disincentive to participate since their incentives lie with research, education, and patient care specialty. 2) Dr. Hamilton who is the sponsor of the project was hesitant to get involved in anything that he was unfamiliar with or which would add to his already full plate. Also, Nancy Jenkins, who is the project owner, implementing significant process and mien change were not among her strengths. 3) Last, it was noted that the Hawthorne effect came into play. The Hawthorne effect refers to a phenomenon in which participants alter their behavior as a result of being part of an experiment or study. It is hard for the team to get reliable automated date-gathering procedures. Q4.Consider whether or not the team should recommend a change in the Project Sponsor even at this late phase of the project. The project sponsor is supposed to be the requestor of the project and is commit to its solutions. He/She should also be responsible to identify project goals, objectives and scope remove barriers and aligns resources serve as a key communicator of project progress and status and approves final recommendations.However, in this case, Dr. Terry Hamilton, the project Sponsor, had a lot of work in his own domain to focus on (busy vice-chair of the Medical Schools Emergency Medicine Department, active in several other(a) department initiatives and responsibilities) and he was also an involved father and husband. As a result, he was so reluctant and kind of indifferent to this project. We would like to recommend the project team to change the Sponsor. Whos elective? Dr. George Calhoun, the Emergency Medicine Department Chair, had remained at beef ups length throughout the teams work. As the chair, Dr. Calhoun was in a position of influence over faculty and long-term changes that could result from the ED Wait Time Project. And we also learned that Dr. Calhouns interests and incentives were linked to achieving national emergency medicine program recogniti on and publications. So Dr. Calhoun is the appropriate candidate for the Project Sponsor. Q5.Based on what you know of the projects results, limitations, and key stakeholders, what would you recommend as the next step for McCrea in her role as the Black Belts of the ED Wait Time Project?According to the results and the analysis, there are many improvements we can do. There are four aspects of improvements Eliminating interference factors They should reduce the Hawthorne effect recording the Wait Time without being observed by the staff. They should think of new methods to record the MD Wait Time much accurately because there were some bias and errors in the measurement. Perhaps we can use motion picture camera to observe staffs actions to make sure they comply with the rules of Six Sigma and to record the MD Wait Time. 2.Increasing the Acceptance level The equation, Q x A = E, is the cornerstone of successful Six Sigma improvement implementation. No matter which solutions result f rom the analysis, the potential for success will be limited without the Acceptance of the people affected and involved.I think increasing the Acceptance level is the most important mission for the next step. The tools and techniques are referred to as The Change Acceleration Process, or CAP. Several CAP techniques were used throughout the ED Wait Time project, including Process Mapping, Elevator Speech, Extensive and Creative Communication Plans and The Stakeholder/Resistance Analysis. 3.Quality Improvement Considering that the Pilot MD Wait Time apparently didnt decrease, I suggest the team should look for some other methods for improvement.The current methods seemed not very effective. Changing some key members As the article mentioned, the project Sponsor, Dr. Hamilton, was not very active. He was very busy and was not interested in Six Sigma project. The project Owner, Nancy Jenkins, was not good at implementing significant process and behavior change. Its less likely that the i mplementations will be sustained after the Six Sigma experts leave. Perhaps the two members mentioned above should be replaced by more competent people. As mentioned above, Dr. Calhoun may be the right person for the Sponsor. I also think that Dr. Elbridge should be more positive in this project.