Presentation given to Lumedx annual meeting re: hospital implementation of Lean Six Sigma

1. March 3, 2006 Lean Six Sigma Healthcare Applications Mark Kresse, MHS, PT, CHE Vice President Saint Vincent Health System

2. In the early 1990s, Saint Vincent Health Center adopted the JCAHO model of Continuous Quality Improvement, and trained every member of management in its philosophy and techniques.

3. In the early 1990s, Saint Vincent Health Center adopted the JCAHO model of Continuous Quality Improvement, and trained every member of management in its philosophy and techniques. F O C U S P D A S

4. In the early 1990s, Saint Vincent Health Center adopted the JCAHO model of Continuous Quality Improvement, and trained every member of management in its philosophy and techniques. F O C U S ind an opportunity for process improvement P D A S

5. In the early 1990s, Saint Vincent Health Center adopted the JCAHO model of Continuous Quality Improvement, and trained every member of management in its philosophy and techniques. F O C U S ind an opportunity for process improvement rganize a group that is familiar with the process P D A S

6. In the early 1990s, Saint Vincent Health Center adopted the JCAHO model of Continuous Quality Improvement, and trained every member of management in its philosophy and techniques. F O C U S ind an opportunity for process improvement rganize a group that is familiar with the process larify the process P D A S

7. In the early 1990s, Saint Vincent Health Center adopted the JCAHO model of Continuous Quality Improvement, and trained every member of management in its philosophy and techniques. F O C U S ind an opportunity for process improvement rganize a group that is familiar with the process larify the process ncover the root cause(s) of variation P D A S

9. While many of us have continued to employ the CQI philosophy and tools…

10. While many of us have continued to employ the CQI philosophy and tools… … by the mid -1990s, CQI as the Saint Vincent quality improvement infrastructure was little more than a memory.

11. While many of us have continued to employ the CQI philosophy and tools… … by the mid -1990s, CQI as the Saint Vincent quality improvement infrastructure was little more than a memory. What went wrong?

12. While many of us have continued to employ the CQI philosophy and tools… … by the mid -1990s, CQI as the Saint Vincent quality improvement infrastructure was little more than a memory. What went wrong? Why are we now intent on adopting Lean Six-Sigma at Saint Vincent?

13. … and, what have we done differently this time? Albert Einstein NY Times Insanity: doing the same thing over and over again and expecting different results.

23. SIX SIGMA: CAN IT WORK IN HEALTHCARE? MARK KRESSE November, 2005

24. What is everyone talking (and writing) about? Can there really be any question about the potential?

25. What makes Lean Six-Sigma stand out… … vs. CQI’s “FOCUS-PDSA”?

33. Is 99% Good Enough? 99.99966% Good (6 Sigma) 20K lost articles of mail per hour Unsafe drinking water for almost 15 minutes each day 5,000 incorrect surgical operations per week Two short or long landings at most major airports each day 200,000 wrong drug prescriptions each year No electricity for almost seven hours each month Seven articles lost per hour One unsafe minute every seven months 1.7 incorrect surgical operations per week One short or long landing every five years 68 wrong prescriptions per year One hour without electricity every 34 years 99% Good (3.8 Sigma)

34. A New Quality Ideology Internal & External Failure Costs Prevention & Appraisal Costs Old Belief 4  Costs Internal & External Failure Costs Prevention & Appraisal Costs New Belief Costs 4  5  6  Quality Quality Old Belief High Quality = High Cost New Belief High Quality = Low Cost  is a measure of how much variation exists in a process

35. Six-Sigma Methodology Phase 2: Measure Phase 3: Analyze Optimization Phase 4: Improve Phase 5: Control Projects worked through 5 main phases Phase 1: Define Characterization Breakthrough Strategy D M A I C

38. Before Work Time (value add) Wait and ‘ Other’ Time Work Time (value add) Wait and ‘ Other’ Time (no value) A B C E ? Making a Process Lean D 2 D 1

39. After Before Work Time (value add) Wait and ‘ Other’ Time Work Time (value add) Wait and ‘ Other’ Time (no value) A B C E ? Making a Process Lean D 2 D 1 A B C E

40. After Before Work Time (value add) Wait and ‘ Other’ Time Work Time (value add) Wait and ‘ Other’ Time (no value) + = Business Improvement A B C E ? Making a Process Lean D 2 D 1 + Same value, with less time and resources! Six Sigma Eliminate defects/variation in process Eliminate waste in & around process Lean

56. Phase I Project Status

59. Disp to Order Families of Process Variation ED Patient (admitted) LOS Time to Time Doc to Doc Time to Time Order to Assign Assign to Room Eval to Disp Hosp to PCP Hosp to Hosp Unit to Unit Time to Time Floor to Floor Time to Time Lab Radiology Time to Time Test to Test Time to Time Test to Test Unit to Unit

62. Equipment Availability

63. LSS Projects

66. It must be remembered that there is nothing more difficult to plan, more doubtful of success, nor more dangerous to manage, than the creation of a new system. For the initiator has the enmity of all who would profit by the preservation of the old institutions and merely lukewarm defenders in those who would gain by the new ones.

67. Mark Kresse Saint Vincent Heart Center 232 West 25 th Street Erie, PA 16544 814/452-7888 814/455-1675 (f) [email_address] It must be remembered that there is nothing more difficult to plan, more doubtful of success, nor more dangerous to manage, than the creation of a new system. For the initiator has the enmity of all who would profit by the preservation of the old institutions and merely lukewarm defenders in those who would gain by the new ones. Machiavelli 1532