Lean Six Sigma for Hospitals: Simple Steps to Fast, Affordable, and Flawless Healthcare

369 Pages·2011·5.49 MB·English

by  Jay Arthur

Lean Six Sigma
for Hospitals
About the Author
Jay Arthur, The KnowWare Man, works with companies that want
to boost profits using Lean Six Sigma. He is the author of Lean Six
Sigma Demystified and the QI Macros Lean Six Sigma software for
Excel, which is used by more than 3,000 hospitals. Jay has worked
with Tenet Healthcare, Kindred Healthcare, Centura Healthcare,
and Christus Healthcare on projects to improve patient flow and
reduce clinical and operational errors.
Lean Six Sigma
for Hospitals
SIMPLE STEPS TO FAST,
AFFORDABLE, FLAWLESS
HEALTHCARE
JAY ARTHUR
New York Chicago San Francisco Lisbon London
Madrid Mexico City Milan New Delhi San Juan
Seoul Singapore Sydney Toronto
Copyright © 2011 by Jay Arthur. All rights reserved. Except as permitted under the United States
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ISBN: 978-0-07-175326-5
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Contents
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi
CHAP TE R 1
Simple Steps to a Faster Hospital . . . . . . . . . . .1
Goal: Accelerate the Patient’s Experience of Healthcare . . . .1
A Faster Emergency Department in Five Days . . . . . . . . . . . .3
Faster Door-to-Balloon (D2B or DTB) Time in Five Days . . . .6
A Faster Operating Room in Five Days . . . . . . . . . . . . . . . . . . .7
Faster Medical Imaging in Five Days . . . . . . . . . . . . . . . . . . . .8
A Faster Lab in Five Days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
A Faster Nursing Unit in Five Days . . . . . . . . . . . . . . . . . . . . .13
The Problem Isn’t Where You Think It Is . . . . . . . . . . . . . . . .13
Take the Domino’s Challenge . . . . . . . . . . . . . . . . . . . . . . . . . .15
How to Get a Faster Hospital in Five Days . . . . . . . . . . . . . .15
CHAP TE R 2
Lean for Accelerated Patient Flow . . . . . . . . . .19
Mind the Gap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
Value-Stream Mapping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
If They Can Do It in Botswana . . . . . . . . . . . . . . . . . . . . . . . . .21
v
vi Contents
The Fast Eat the Slow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
Core Score . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
Speed Saves Lives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
You Already Understand Lean . . . . . . . . . . . . . . . . . . . . . . . . .28
The Power Laws of Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
Economies of Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
The Toyota Production System . . . . . . . . . . . . . . . . . . . . . . . . .30
Core Ideas of Lean . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
The Lean Mindset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
The Seven Speed Bumps of Lean . . . . . . . . . . . . . . . . . . . . . . .34
The Five S’s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36
Value-Stream Mapping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37
Pull versus Push . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38
Redesign for One-Piece Flow . . . . . . . . . . . . . . . . . . . . . . . . . .38
Lean Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
Walking Is Waste . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45
Lean Principle—Load Leveling . . . . . . . . . . . . . . . . . . . . . . . .48
Lean Principle—Minimize Inventory . . . . . . . . . . . . . . . . . . .48
Theory of Constraints (TOC) . . . . . . . . . . . . . . . . . . . . . . . . . . .49
Get the Idea? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52
CHAP TE R 3
Simple Steps to a Better Hospital . . . . . . . . . .53
A Better Emergency Department (ED) in Five Days . . . . . . .54
A Better Clinical Staff in Five Days . . . . . . . . . . . . . . . . . . . . .54
A Better Operating Room (OR) in Five Days . . . . . . . . . . . . .55
A Better Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63
Better Order Accuracy in Five Days . . . . . . . . . . . . . . . . . . . .64
Better Medical Imaging in Five Days . . . . . . . . . . . . . . . . . . . .68
A Better Lab in Five Days . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68
A Better Nursing Unit in Five Days . . . . . . . . . . . . . . . . . . . . .70
Better Diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72
A Better Intensive-Care Unit (ICU) in Five Days . . . . . . . . . .72
Contents vii
Misuse of Antibiotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74
Bar Codes Bust Medication Errors . . . . . . . . . . . . . . . . . . . . . .75
The Problem Isn’t Where You Think It Is . . . . . . . . . . . . . . . .75
I Pledge Allegiance to Science and Evidence . . . . . . . . . . . . .77
Simple Steps to a Better Hospital in Five Days . . . . . . . . . . .79
CHAP TE R 4
Reducing Defects with Six Sigma . . . . . . . . . .81
Invisible Low-Hanging Fruit . . . . . . . . . . . . . . . . . . . . . . . . . . .82
Six Sigma’s Problem-Solving Process . . . . . . . . . . . . . . . . . . .83
Getting to Lean Six Sigma . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84
Key Tools for Defect Reduction . . . . . . . . . . . . . . . . . . . . . . . .84
Problem-Solving Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85
The 4-50 Rule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104
Six Sigma Tar Pits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104
Become a Lean Six Sigma Detective . . . . . . . . . . . . . . . . . . . .108
Mistakes, Defects, and Errors . . . . . . . . . . . . . . . . . . . . . . . . .111
Measurement Simplicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . .113
Accidents Don’t Just Happen . . . . . . . . . . . . . . . . . . . . . . . . .115
Analysis Is Easy . . . If You Know
What to Look For . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115
CHAP TE R 5
Simple Steps to a Cheaper
(More Profitable) Hospital . . . . . . . . . . . . . . . . .117
Faster + Better = Cheaper and More Profitable! . . . . . . . . . .117
Reducing Denied Claims in Five Days . . . . . . . . . . . . . . . . .120
Reducing Rejected Claims in Five Days . . . . . . . . . . . . . . . .122
Reducing Appealed Claims in Five Days . . . . . . . . . . . . . . .127
How to Get a Cheaper (More Profitable)
Hospital in Five Days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .131
Insights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .132
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .133
viii Contents
CHAP TE R 6
Six Sigma for Hospitals . . . . . . . . . . . . . . . . . .135
Double Your Profits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .135
Manufacturing and Service . . . . . . . . . . . . . . . . . . . . . . . . . . .137
Tricks of the Trade . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .138
The Faster, Better, Cheaper Toolkit . . . . . . . . . . . . . . . . . . . . .140
Every Business Has Two Sources of Cash Flow . . . . . . . . . .141
Every Business Process Has Three Big Leaks . . . . . . . . . . . .142
Every Business Has Two Improvement Focuses . . . . . . . . .143
The Universal Improvement Method . . . . . . . . . . . . . . . . . .148
Lean Six Sigma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .152
CHAP TE R 7
Excel Power Tools for Lean Six Sigma . . . . .155
The QI Macros for Excel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .156
The QI Macros Are Easy to Use . . . . . . . . . . . . . . . . . . . . . . .156
QI Macros Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .157
Power Tools for Lean Six Sigma . . . . . . . . . . . . . . . . . . . . . . .168
Analyzing Customer Service Data Hidden in
Trouble-Reporting Systems . . . . . . . . . . . . . . . . . . . . . . . . . . .169
Setting Up Your Data in Excel . . . . . . . . . . . . . . . . . . . . . . . . .172
Data Collection and Measurement for Six Sigma . . . . . . . .175
Mistake-Proof Data Collection . . . . . . . . . . . . . . . . . . . . . . . .178
Troubleshooting Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . .185
Technical Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .186
Chartjunk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .186
Get the Idea? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .188
CHAP TE R 8
Is There an Improvement Project
in My Data? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .189
Data Mining with Excel and the QI Macros
PivotTable Wizard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .189
Contents ix
Word Count . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .195
PivotTable Wizard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .196
Get the Idea? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .202
CHAP TE R 9
Sustaining Improvement . . . . . . . . . . . . . . . . .205
Process Flowchart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .206
Control Charts for Sustaining the Improvement . . . . . . . . .208
Control Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .219
CHAP TE R 10
Laser-Focused Process Innovation . . . . . . . .221
Focusing the Improvement Effort . . . . . . . . . . . . . . . . . . . . .221
Critical-to-Quality Indicators (CTQs) . . . . . . . . . . . . . . . . . .228
SIPOC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .228
Balanced Scorecard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .230
Quality Management Systems . . . . . . . . . . . . . . . . . . . . . . . .232
CHAP TE R 11
Statistical Tools for Lean Six Sigma . . . . . . . .235
Hypothesis Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .235
Hypothesis Testing for Variation . . . . . . . . . . . . . . . . . . . . . .236
Hypothesis Testing for Means . . . . . . . . . . . . . . . . . . . . . . . . .239
Analysis of Variance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .249
Are Your Data Normal? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .251
Tests of Proportion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .256
Chi-Square Tests in Excel . . . . . . . . . . . . . . . . . . . . . . . . . . . .257
Determining Sample Sizes . . . . . . . . . . . . . . . . . . . . . . . . . . . .261
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .267
CHAP TE R 12
Implementing Lean Six Sigma in Hospitals . .269
Excuses, Excuses, Excuses . . . . . . . . . . . . . . . . . . . . . . . . . . .270