Successfully Implementing Six Sigma in Healthcare: An Introduction to Six Sigma Principles,

Practical Exercises and Case Study Examples

Matiana Gonzalez Vela, Ed.D., M.Ed., R.D.Tracy Drake-Kirkconnell, M.B.A.

March 17 , 2009

Premier integrated healthcare delivery system serving SouthTexas since 1925

• Valley Baptist Medical Center - Harlingen– 611 Licensed Beds– Lead Level 3 Trauma Center– State of the Art Children’s Center– # 1 Rated Orthopedics Service– Heart & Vascular Institute– Teaching facility for The Regional Academic

Health Center of The University of Texas Health Science Center at San Antonio

– Certified Stroke Center

• Other Entities– Golden Palms Retirement and

Healthcare Center– Valley Baptist Health Plans– Valley Baptist Ambulatory Surgery

Center– Clinical Pastoral Education Center– Licensed Vocational Nurse School– Family Practice Residency

Program– Internal Medicine Residency

Program– Home Health & Hospice– Rehabilitation & Wellness– Behavioral Health Services

• Valley Baptist Medical Center – Brownsville– 243 Licensed Beds– Level 3 Trauma Center– State of the Art Imaging Center– Center of Diabetes Management– Certified Stroke Center

Valley Baptist Health SystemValley Baptist Health System

• Strategic Initiatives– Integration– Simplicity– Growth and Development– People– Quality and Excellence

• Values– Disciplined– Entrepreneurial– Performance Oriented– Accountable

Valley Baptist Health SystemValley Baptist Health System

How did we begin implementing Six Sigma?How did we begin implementing Six Sigma?

• CEO Commitment– Vision– Leadership– Resources (time, money, people)

• Partnership with General Electric Medical Systems– Guidance– Expert Knowledge– Training – Six Sigma, CAP, Work-Out™– Project Mentoring– Transition Assistance

• A comprehensive and flexible program for achieving, sustaining and maximizing business success that:

– Is a management methodology with three perspectives:• A Measure of Quality• A Process for Continuous Improvement• An Enabler for Cultural Change

– Is uniquely driven by a clear focus on the “Voice of the Customer”

– Is founded in a rigorous use of facts, data and statistical analysis

– Provides for diligent attention on managing, improving and reinventing business processes

What is Six Sigma?What is Six Sigma?

Define Measure Improve ControlAnalyze

What is Six Sigma?What is Six Sigma?

• Integrated part of management system

• Fact & data based decision making

• Knowledge transfer, learning process

• Value added focus on defect removal

• Utilization of technology tools

• A lasting infrastructure

• Not a cost reduction program

• Not a training program• Not a statistics program• Not a quality program• Not a quick fix

Six Sigma Advantage, Inc.

A Measure of QualityA Measure of Quality

• Six Sigma is a statistical measure that expresses how close a service process comes to its quality goal

• Six Sigma refers to a process that produces only 3.4 defects per million opportunities

Sigma DPMO Yield

2 308,537 69.1463%

3 66,807 93.3193%

4 6,210 99.3790%

5 233 99.9767%

6 3.4 99.9997%

Sigma Score vs. Percentage Yield

0

10

20

30

40

50

60

70

80

90

100

0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6

Sigma Score

Per

cen

tag

e Y

ield

Sigma Score vs. Percentage YieldSigma Score vs. Percentage Yield

DMAIC MethodologyDMAIC Methodology

Lean Six SigmaLean Six Sigma

• 5 Ss– Seiri………….…..Sort– Seiton……………Standardize– Seiketsu…………Simplify– Seiso…………….Sweep– Shitsuke…………Sustain

• Value Added vs. Non-Value Added activity

• Genuine Focus on the customer

• Data and Fact Driven Management

• Process focus, management and improvement

• Proactive management

• Boundaryless collaboration

• Drive for perfection; tolerance for failure

Six Sigma ThemesSix Sigma Themes

• Traditional Quality Programs– Driven internally– Focuses on outcomes– Fixes defects– Improves quality– Looks backwards– Concentrates on products– High on theory and people

The Six Sigma DifferenceThe Six Sigma Difference

• Six Sigma– Driven by the

customer– Focuses on processes– Prevents defects– Improves bottom line– Looks forward– Concentrates on

CTQs– High on methodology

and data– Forces disciplined

decision making

• Dependant• Output• Effect• Symptom• Monitor

• Independent• Input & Process• Causes• Problems• Control

Y X1 … Xn

Six Sigma Focus Six Sigma Focus Y = ƒ(x)Y = ƒ(x)

The Effectiveness (E) of the result is equal to the Quality (Q) of the solution times the Acceptance (A) of the idea

times the Accountability (A) to solution execution

Six Sigma Methodology

Change Acceleration

Process

Effective Results

Work-OutTM

Q x AQ x A22 = E = E

Six Sigma EffectivenessSix Sigma Effectiveness

Art

Spirituality

Science

Fundamentals/Foundation

Six Sigma and the Art of Medicine

PATI

ENT

CAR

E PA

TIEN

T CA

RE

6σAccuracy and Speed

Medication Management

Turnaround times

Wait Times

Research Based Disease Management

Ventilator Associated Pneumonia

Core Measures

AMI

CHF

Pneumonia

CABG

VBHS Confidential & Proprietary Information

Performance Measurements

Not just about formulas….Cultural AcceptanceChange ManagementA² = Acceptance &

AccountabilityDefines Success or Failure

Foundations of SuccessFoundations of Success

VBHS Confidential & Proprietary Information

RespectPeople

RecognizeEffort

RewardPerformance

System Executive Council

Entity Leadership

Department

Managers

Individual

Annual Goals

Monthly R

eportsQ

uarte

rly E

valu

atio

ns

System Executive Council

Board of Directors

AccountabilityAccountability

Roles at VBHSRoles at VBHS

• Master Black Belt – 6 Sigma mentor and educator• Black Belt – 6 Sigma trained specialist who works on 6

Sigma improvement initiatives on a full time basis• Green Belt – 6 Sigma trained specialist who uses the Six

Sigma methodology to solve problems as a function of their normal work

• Yellow Belt – Physicians and Executives trained in basic 6 Sigma methods who assist with problem solving, initiative sponsorship and solution implementation

• Sponsor – Executive with responsibility to identify 6 Sigma initiatives, assign resources and remove barriers

• Change Agent - Expert in the application of CAP and Work-Out™ tools

Six Sigma Practitioners at Six Sigma Practitioners at VBHSVBHS

• Master Black Belts (5)– 5 Certified– Black Belts (9)– 3 Harlingen– 2 Brownsville– 2 Corporate– 2 Seeking Certification

• Green Belts (93)– 73 Certified – 20 Seeking Certification

• Yellow Belts (43)– 17 Executives– 26 Physicians

• 16 Six Sigma Physicians’ Council members

CEO Expectation:All Executives will be trained to Yellow Belt levelAll Directors and Managers to Green Belt certification

• Master Change Agents (2)• Change Agents (263)

– 196 Harlingen– 67 Brownsville

VBHS TimelineVBHS Timeline

• May 2002– Engagement with GEMS– Wave 1: 6 initiatives– Green Belts trained

• March 2003– Wave 2: 6 initiatives– 3 Full Time Black Belts appointed

• April 2003– 3 Full Time Master Black Belts

appointed and trained• June 2003

– Wave 3: 8 initiatives– Green Belts trained– 2 Master Change Agents trained

• March 2004– Wave 4: 15 initiatives – Green Belts trained

• July 2005– Wave 5/1: 13 initiatives – Green Belts trained

• September 2005– Wave 6/2/1: 14 initiatives– Green Belts trained

• May 2006– Wave 7/3/2: 14 initiatives– Green Belts trained

• November 2006– Wave 8/4/3: 16 initiatives– Green Belts trained

• May 2008 – Wave 9/5: 8 initiatives– Green Belts trained

• May 2009 – Wave 10/6; 12 initiatives

95 Completed Training and 95 Completed Training and Translation InitiativesTranslation Initiatives

Examples of Clinical and Examples of Clinical and

Operational InitiativesOperational Initiatives

Case Study 1Case Study 1

Case Study 2 Case Study 2

Questions?Questions?