Wednesday, March 5, 2008

Six Sigma in Healthcare

In the last couple of posts I’ve mentioned a lot about six sigma. For those of you who are not familiar with it here’s a summary (from a non-expert point of view – sorry if I offend the six sigma black belts out there) and how it will decrease you're clinics waits.

Six Sigma terminology and methods were developed in 1986 at Motorola but came out of many quality engineering projects from the 1920’s on. The premise is that in any manufacturing process there will be a certain amount of variation. Say, for instance a part needs to be made to 100mm. In reality there will be a range of exact measurements all around 100 but the engineers may tolerate anything between 98.5-101.5mm. Any measurements that fall outside of that range are beyond the acceptable limits. The sigma value refers to the number of defects that fall outside of that range. Three sigma is 66,000 defects per million (where most of industry is) whereas six sigma is to have less than 3.4 defects per million (where are few are). There is a cost to acheiving six sigma, but it's usually offset by not having to repeat works, have items returned in warranty, etc...

To understand how sigma applies to healthcare it's easier to consider another service industry. The classic example is a hotel. When you call to book a hotel there is a series of steps you go through. If one of those steps is a "defect" (such as their website is down, leave you on hold for 15 minutes, haven't staffed enough to open rooms) you will not book the hotel room. This is considered a "defect" in service terms. How does sigma apply to healthcare? I consider a defect in health care an error that causes a patients course of treatment to be altered. For example:

-failing to a call a patient back about test results or treatment
-failing to file/find paperwork
-keeping someone waiting too long
-failing to do something that prevents complications
-failing to do something that improves outcome

The best example I've found (as it impacts on wait times) is not calling patients back about tests, results or treatments. For instance, a patient books an appointment for a procedure then cancels at the last minute. Often the chart ends up on a "call back rack" . When I look at the “call back" racks they typically have an excess of charts dating back months and years. No one is being irresponsible, but the system is created around patients arranging their own follow-up. Also, most of us are short of time and the immedite need is to deal with the patient in front of us. The problem is that after a period of time the entire process has to be repeated, or worse, the administrative staff has to go through extraordinary efforts to rearrange appointments. All of which chews up time and takes it away time from other patients.

In our computer system we have automated the way patients like this are followed up tomake it fool-proof. For instance, if someone calls and cancels the day of surgery or fails to show-up they are automatically put on a call back list.

I’d ask you to look at how you’re office organizes appointments, follow-ups, procedures and investigations. Do you have a call back rack? If so, how large and dated is it? Do you have an automated means for follow-up? If not take a look at the last 100 charts and see how many have been lost to poor organization. There are all kinds of area that can be made to six sigma in our offices but it is not easy. It will decrease on wait times, however, because time saved with one patient can be spent with another.

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