Striving for Perfection
You may be asking, "What is Six Sigma?" Simply put, it is a method used to improve quality. This method is unique, because it uses such a highly disciplined approach. More importantly, it has a lofty goal: to improve processes to make them as near perfect as possible. It involves questioning the way everything is done. It means that "good" is not good enough and "better" may not be the best.
Six Sigma at Deaconess
Beginning in July 2003, Deaconess Health System began ongoing training of leadership and staff to use rigorous Six Sigma methods including DMAIC, Lean Change, Acceleration Process, and Work-Out ™.
Six Sigma Method
DMAIC - Rigorous, data driven problem solving approach; DMAIC is used to improve existing processes and stands for the following steps:
- Define - the problem or the issue that can be improved
- Measure - current practices and/or results
- Analyze - all data for key relationships
- Improve - by implementing changes to the process
- Control - the improved process using measurement
Lean - Improvement strategy that focuses on identifying and eliminating waste and non-value added work in processes.
Change Acceleration Process ("CAP") - Process for effectively implementing and sustaining change. Process uses tools to build acceptance and overcome resistance.
Work-Out ™ - Well planned and facilitated working session used to develop solutions by the frontline staff that can be rapidly implemented.
Deaconess has been recognized for the results of two Six Sigma projects so far. A project in surgery to reduce cancellations and a project to reduce the door-to-inflation time for heart attack patients have received national and regional awards and recognition. Both initiatives have been published and presented at national, state and regional conferences. The door-to-inflation team was presented the Anthem Best Practice award for Indiana in 2006. Of course our patients are the true winners who reap the rewards daily.
Six Sigma projects improve patient care.
EPIC Systematic Care Process
Through a series of Work-Outs™ the Six Sigma team developed standard workflow and documentation for nursing staff using Epic, the Deaconess electronic medical record. The project was selected once Epic was implemented and staff realized inconsistencies existed in the documentation of care from nurse to nurse and nursing unit to nursing unit. Wide variation was found in workflow and work performance.
The objective of the team was to produce quality clinical outcomes through the integration of Epic and workflow and documentation. The team provided recommendations for best practices in key activities and documented workflows for to support recommendations. Charged with providing ongoing professional development, staff education plans and competency assessment process and tools were created. The team members consisted of:
- Nursing User Champions
- CNO participation in report-outs
- CIS team members
- Black Belts
- Ancillary members from Pharmacy, Emergency Department, Respiratory, Cath Lab, and Post-Anesthesia Care Unit
Over a six-day period, the care/workflow process was simulated with the use of Epic. Consistent workflows and documentation were identified; and staff competency assessments were completed. Tools developed by the team to support quality clinical outcomes include entry level proficiency checklists, and RN assessment workflow for ICU and Medical/Surgical Units.
Feedback indicated that nursing proficiency checklists were beneficial to RN competencies and > 75% of RNs and PCAs completed proficiency checklists as of February 2010.
Patient Access Kaizen Event
Deaconess Hospital held its first Kaizen event in Patient Access. A Kaizen event could be defined as "a sudden overpowering effort to take something apart and put it back together in a better way." What is taken apart is usually a process, system, product, or service. A Kaizen event is typically a week-long event and focuses on removing some of the eight defined wastes: defects., overproduction, motion, resources, waiting, transportation, over processing, and under utilization. Employees participate in the process by suggesting improvements that work for them.
The first area to participate was Patient Access located at the Main Campus of Deaconess Hospital. The goal was to improve efficiencies in the registration of patients. The process involved the review of various workspaces including: registration bays, greeter area, wheelchair locations and the areas where orders are received. The workspace environment varied from space to space.
During the week-long event, the frontline staff identified various improvements. Improvement suggestions were narrowed to ideas that contributed most to the every-day work process. Improvements include:
- Standardized workspace bays
- New keyboards and mouse pads
- Re-stocking process for workspace bays
- Improvement plan for equipment such as copiers, printers and fax machines
- Process to efficiently manage incoming orders
- Standardization of communication tools
- Standardized location of supplies and forms
- Process for flow of receive faxes
The Kaizen event was successful for employees and for visitors. Each workspace bay is standardized and other tools that assist in the successful and efficient completion of job duties are readily available. Lessons learned at this Kaizen event were also applied to Patient Access at Deaconess Gateway Hospital.