Case Report of Six Sigma at Academic Medical Hospital

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Introduction:
  Six Sigma is a business management strategy designed to meet customer needs and 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 project-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 are experts in these methods. Each Six Sigma project carried out within an organization follows a defined sequence of steps and has quantified financial targets (cost reduction, profit increase, etc). Overview:

  Project name: Six Sigma at Academic Medical Hospital (AMH)   
  Problem: Patients with potentially life-threating injuries and illnesses are waiting for over an hour for treatment in Emergency Department at AMH! Although long wait times seemed to be readily excuses by many physicians due to complexity of managing emergency room 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 undertake an application practicum on an assigned AMH project with, cooperate trainers acting as coaches.   

  Six Sigma Foundation TEAM:
  Champion: Dr. Elbridge (establishes business targets and creates an environment within the organization to promote the Six Sigma methodology and tools)   Sponsor: Dr. Terry Hamilton (key communicator and approves final recommendation)   Owner: Nancy Jenkins (implementation and accountable for sustaining long-term gains)   Black Belts: Jane McCrea (project leaders who are experts in Six Sigma methodology and statistical tool applications)   Green Belts: Dr. James Wilson (trained by six Sigma methodology from hospital)   The Foundations Team: (a group of local experts who participate in the project) &4 people (Nancy Jenkins, Patient Care Manager; Georgia Williams, ED registration 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 patient’s condition and ranks his criticality accordingly;   Register: The Nurse obtain demographic and insurance information;   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 Wait Time Project."     As stated, Six Sigma is based on a 5 phase, step-by-step process that was used in the "ED Wait Time Project." In the Define phase the team identified expected benefits of the project including expedited medical care delivery, improved 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 original process as well as defined the input/output variables. They collected 2 groups of data sets as well as administered a patient satisfaction survey, which produced the maximum wait times for patients. During the Analyze phase the team then analyzed the baseline study and found that two processes mainly influenced the wait time; the waiting room time and the time spent waiting on the MD.     As the ED Wait 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 procedure by which the Priority Level II patients...
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