Application of Lean Six Sigma techniques to optimize hospital laboratory Emergency Department Turnaround time across a multi-hospital system

In January 2005, Indiana University, Purdue University at Indianapolis (IUPUI) and Purdue- Calumet were invited to partner with the Alverno Clinical Labs in adapting Lean Six Sigma methodologies for use within healthcare. Our initial project focused on optimization of lab services for the emergency department at the Saint Margaret Mercy Hospitals in Hammond, IN. This project resulted in reduction of lab test report time to the emergency department from 75 minutes to less than 35 minutes. These results have been sustained from the initial implementation to present – over 14 months. Additionally, this project has been successfully implemented across two additional hospitals lab within the Alverno-Provena Clinical Labs system. This paper will describe the partnership between IUPUI faculty and Alverno Clinical Labs in application of Lean Six Sigma techniques to optimize hospital lab services for the emergency department. Additionally, this paper will discuss the strategies and methodologies used to sustain initial results following the initial implementation and the key characteristics of successful project migration to additional hospital labs

Key components of external facilitation in an acute stroke quality improvement collaborative in the Veterans Health Administration

Background Facilitation is a key component for successful implementation in several implementation frameworks; however, there is a paucity of research specifying this component. As part of a stroke quality improvement intervention in the Veterans Health Administration (VHA), facilitation plus data feedback was compared to data feedback alone in 11 VA medical facilities. The objective of this study was to elucidate upon the facilitation components of the stroke quality improvement. Methods We conducted a secondary evaluation of external facilitation using semi-structured interviews. Five facilitators and two program directors were interviewed. Qualitative analysis was performed on transcribed interviews to gain an understanding of the role and activities of external facilitators during the on-site and telephone facilitation. Quantitative frequencies were calculated from the self-reported time spent in facilitation tasks by facilitators. Results The external facilitators saw their role as empowering the clinical teams to take ownership of the process changes at the clinical sites to improve their performance quality. To fulfill this role, they reported engaging in a number of core tasks during telephone and on-site visits including: assessing the context in which the teams were currently operating, guiding the clinical teams through their planned changes and use of process improvement tools, identifying resources and making referrals, holding teams accountable for plan implementation with on-site visits, and providing support and encouragement to the teams. Time spent in facilitation activities changed across time from guiding change (early) to supporting efforts made by the clinical teams (later). Facilitation activity transitioned to more monitoring, problem solving, and intentional work to hand over the clinical improvement process to the site teams with the coach’s role being increasingly that of a more distant consultant. Overall, this study demonstrated that external facilitation is not an event but rather a process where relationships and responsibilities evolve over time. Conclusions This study shows that external facilitation involves core elements related to communication, relationship building, methods training, monitoring performance over time, and facilitating team-based problem solving. Importantly, this work demonstrates the fluid nature of external facilitation over time, as teams learn, grow, change, and experience changing contexts

ADAPTATION OF LEAN METHODOLOGIES FOR HEALTHCARE APPLICATIONS

Lean and Six Sigma quality concepts and terminology have been applied in the manufacturing arena since the late 1980’s and early 1990’s. It has only been in recent years that healthcare administrators have identified these methods as being adaptable to their organizations so that they may realize organizational improvements for continuing success and delighting customers. Unfortunately, this is not an application that is widely taught in typical Industrial Engineering curriculum and therefore there are few educated professionals coming right out of college that are able to apply these principles to healthcare. There are however, many experienced professionals knowledgeable in the basic Lean and Six Sigma principles as applied to manufacturing. This paper presents research conducted by the IUPUI School of Engineering and Technology in partnership with Sister of St. Francis Health Services (SSFHS) which was focused on the development and implementation of a Lean Six Sigma Training Program specifically for healthcare. Through the development of this training program, Purdue faculty have adapted traditional manufacturing Lean methodologies for healthcare specific applications. This paper will present multiple examples of successfully adapted Lean manufacturing training for Healthcare organizations. The authors will then present their findings and recommendations concerning Lean training specifically for Healthcare professionals. They will also present in-depth explanations of hands-on exercises used to demonstrate application of lean tools such as value stream mapping, 5S and visual controls that can be used to effectively train employees in most any healthcare organization

Lean Healthcare Applications

Interdisciplinary collaborative of Engineering, technology and Clinical Faculty from Purdue Statewide campuses. Focus on partnership with hospitals and healthcare providers to provide training/facilitation through implementation to create self-sustaining programs

Implementing Lean Six Sigma Methodologies in the Radiology Department of a Hospital Healthcare System

Increased focus is being placed on the quality of care provided by Hospitals and Healthcare Systems around the country. Caught in the middle between tightening govenment standards, stricter compliance guidelines for insurance companies, and the basic mission to serve those in need with quality and compassion, hospitals are searching for ways to improve their processes and services for the benefit of all. CT (Computed Tomography - CAT Scan) and MRI (Magnetic Resonance Imaging) services in the hospital radiology departments are revenue generating areas. The reimbursement rates for these services are very high, the scan times (especially in CT) are relatively low, and so the potential for additional revenue to the hospital comes with increasing patient capacity for these services. However, it is also a very competitive time for hospital radiology departments as many outpatient diagnostic centers are being built, drawing patients and physicians to their fast, efficient, no hassles approach to imaging. This brings additional hurdles to the already struggling hospitals. The Sisters of St. Francis Health Services (SSFHS) group enlisted the aid of faculty at IUPUI to address issues within their organization. The objectives were to imrpove key performance indicators directly tied to patient and physician satisfaction, improve and streamline CT/MR processes, increase the capacity to perform MT/MR services and regain a portion of the referral base lost ot outpatient diagnostic centers. To address these issues, Lean Six Sigma methodologies were implemented. This paper describes the initial results from project initiation

Healthcare Quality Partnerships: An Emerging Educational Frontier for Industrial Engineering Technology Programs

Wtih the understanding that the industrial engineering profession has grown out of industrial/manufacturing oganizations, it is important to note that the profession has gradually matured to the point where it is readily being accepted in service industries, such as hospitals, retail stores and banking. Today, this means that industrial engineers are among the most versatile of the engineering professions, spanning various degrees of functions within various types of organizations. Therefore, educational institutions that offer Industrial Egnieering (IE) and Industrial Engineering Technology (IET) curriculum must also offer a versatile curriculum that will allow their graduates to gain experience in various areas other than traditional manufactuinrg, thereby allowing them greater opportunity to enter into these non-traditional areas. This paper will focus on strategies that have been used at Purdue University regional campuses to develop successful on-going partnerhips between their IE and IET faculty and one of the larger service industries: healthcare and hospitals. The partnerships that have been developing over the last few years have provided various engagement opportunities for faculty and students alike. This paper will discuss topics such as funding of faculty involovement in hospital projects, the integration of students into on-going efforts, as well as adaptation of curriculum and further collaborative efforts that are being developed with medical/nursing programs within the various university campuses involved in this program

“All Bundled Out” - Application of Lean Six Sigma techniques to reduce workload impact during implementation of patient care bundles within critical care – A case study

Within healthcare, clinical practice bundles have been used to implement standardized, nursing driven protocols resulting in standardized patient care and improved patient outcomes. Examples of these types of bundles include clinical practices shown through evidence based medicine to reduce occurrences of Ventilator Associated Pneumonia – VAP bundle; those shown to reduce the occurrences of central line infections – CL bundle; and those shown to significantly improve the outcomes of patients presenting with sepsis – Sepsis Bundle. Unfortunately, as critical care units cycle through the implementation of multiple bundles without adjustment in workflow practices the result is often increased staff fatigue and a more stressful work environment – a phenomenon appropriately termed by critical care staff members as being ‘All Bundled Out’. This paper will describe the partnership between IUPUI faculty and Sisters of St. Francis Health Services (SSFHS) in application of Lean Six Sigma techniques. These techniques were adapted for use within healthcare and were applied to reduce the workflow impact and optimize implementation of nursing driven, clinical protocols used to implement intensive glucose control for ventilator patients within two critical care units. Additionally, this paper will discuss the strategies and methodologies used to sustain initial results during the 9 months following the initial protocol implementation

Improving process throughput of Cardiac catheterization using Six Sigma Training

Healthcare is changing daily with the introduction of technology. Heart catheterization is one area that has excelled in the new technology that is constantly being introduced. Facilities are being built which provide patients with diagnostics and treatments that save lives daily. Due to the continual improvement of healthcare processes, it is also important to review process and continually improve efficiency. The catheterization lab patient care process must provide quality patient care that exceeds expectations of all involved. A project was completed to train a team that would implement process improvement. The team was made up of the technicians, nurses and administrative personnel who worked daily in the lab. Using six sigma as a basis of process control, training was executed on a weekly basis with deliverable outcomes that were implemented for improvements. A team of professionals worked to optimize current practices regarding patient through put. This was completed by applying six sigma concepts to communications, scheduling, documentation, and resource utilization of the unit. As a team, resources were compared to the needs of patients’ and regulatory requirements. Interval steps of discovery occurred as the project proceeded. This paper will outline the process, difficulties and outcomes of the project in general terms which provides a basis of validating the time spent on six sigma training