Six Sigma Class Exercises

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					                                                 Six Sigma Class Exercises
                                   Alameda County EMS – September 14 & 15, 2005

                                                            Group 1: Patient

            Voice of the Customer                               Interpretation                      Critical to Quality (CTQ)
        “Get here fast!”                                Quick response                          Response time*
                                                                                                Continual training with
        “Know what you’re doing”                        Competence
                                                                                                evaluations
                                                                                                Uniformity: well-groomed,
        Clean and Confident                             Professionalism
                                                                                                uniform clean & pressed
        Listen and Care                                 Compassion                              Understand patient needs

        “Make me better”                                Solve the problem                       Customer satisfaction
                                                                                                Taxes: Effective use of
        “Is there a charge?”                            Cost effectiveness
                                                                                                taxpayer dollars


 *Problem statement: Over the last six months, we received 25 complaints that we were slow to respond.

  Project statement: We will reduce complaints of slow response by 50% during the next quarter.



                               Fire Station                  Dispatch

          Alert devices
                                                                                   Appropriate company assigned
              Gear on rig

      Workout, sleep, shower                                                          Rotating station closures

              Equipment failure                                                          Call transferred

                     Station layout                                                         Dispatch staffing levels

        Personal protective equipment
                                                                                                Dispatcher training

                                Run card
                                                                                                                         Complaints of
                                                                                                                       Delayed Response

                                                                                                                  Size of apartment complex

                                              Burnout                                                              Traffic

                                                                                                            Inclement weather
                            Operational readiness
                                                                                                        Major road construction
                     Turnout policy training
                                                                                                     Knox boxes

                   District familiarization
                                                                                                  Time of day

                                                                                              Traffic calming devices

 VOC Group 1: Patient                            People                   Travel
Cause and Effect Diagram

                                                                                                                                              1
Receipt of call
  to PSAP




  Fire/EMS               Transferred to
                  no
     call?             Police Department




     yes




  ACCREC
  Dispatch




  Take EMD
 informaiton




  Route call




   Turnout
    time




  Response
    time




                                 VOC Group 1: Patient
                                Response time flowchart
  Arrival at
   patient




                                                          2
                                               Group 1: Causes of Delayed Responses


                                                                                                         99%                    100%
                                                                                     97%
             90                                                  93%


                                              85%
             80


             70


             60
Percentage




             50       48
                           49%


             40
                                         35

             30


             20


             10                                              8
                                                                                 4
                                                                                                     2
                                                                                                                          0.5
             0
                  "Brown outs"     Locution failure    Traffic calming   New mapping system   Equipment failure   Policies/Procedures
                                                          devices
                                                              Contributing Factors



                             All data in the class exercises were made up by the workgroups




                                                                                                                                       3
                                                            Group 2: Medical Director

              Voice of the Customer                                 Interpretation                        Critical to Quality (CTQ)
                                                            Competent CPR
         Increase cardiac arrest
                                                            Witnessed v.fib survival rate
         survival rate
                                                            up to 30%
         Improve advanced airway
                                                            95% successful
         success rates                                                                                    Data collection analysis
                                                            Excellence in assessment;                      and procurement of
         Quality shortness of breath
                                                            Appropriate treatment and                       outcome data from
         care
                                                            care                                                 hospital
                                                            Appropriate assessment
                                                            Appropriate lead interpretation
         Quality cardiac care
                                                            Appropriate treatment
                                                            Appropriate destination
                                                            Accurate and timely                     Data collection system
         Collect data*                                      Complete documentation and              System software, hardware
                                                            reporting                               and training to achieve this

*Problem statement: Over the past three months, it has been noted that 50% (PCR/bubble)
                    paperwork/documentation has been submitted.
 Project statement: Assess potential causes by process evaluation over 90 day period
                     • Design (user friendly)
                     • Behavior
                     • Measurement system

                                        Call/Dispatch        On Scene            Responders

                                                                                                             Transport


  Personnel                                                                  Personnel        ETA to ER
                                                                                                                  Personnel
          Training Competency Fatigue Behavior                                   Equipment
                                                                                                                       Equipment
                                                                                                                Resources
  Equipment                                                                           Patient
                                                                                                                 Patient condition
                                                                                     Condition
                                                                                                                      Available time
               CAD        Clocks     Phone Computer

                                                                                                                             PCR not left
                                                                                                                              at hospital

                     System status



                                                   System Status                                                      Courier
              Turnaround time


          Patient condition                                                                                             QA
              (critical)                       Personnel
                                               (behavior)
      Equipment Failure
      (e.g. CT Scanner)                                                                                     Billing


         Personnel                          Equipment
          (Triage)


    Available time


                                                                                                   VOC Group 2: Medical Director
                          Hospital                      Station/Quarters           Routing
                                                                                                   Problem: PCR not left at hospital
                                                                                                      Cause and Effect Diagram

                                                                                                                                            4
                                             CALL




                        First
                                                                      Transport
                      Resonders




                                            On scene




                 R                             Pt.                                   B
                                                        Complete?
            D    E                          condition                                E
            E    S                           (time)                                  H
            S    O                                                                   A
            I    U                                                                   V
            G    R                                                                   I
            N    C                                                                   O
                 E                                                                   R
                                            Transport
                 S




                                               Pt.
                                            condition    Complete?
                                             (time)




                                                           Turnaround/complete?
                                            Hospital
                                                              (system status)




                                             Station      Available time/complete?




                                            Routing




                                  Billing                  Q.A.




   VOC Group 2: Medical Director
Flowchart: Leaving PCRs at Hospital

                                                                                         5
                                                   Group 2: PCRs Not Left at Hospital


             100                                                                                               99%            100%
                                                                                                   96%
                                                                                      92%
              90
                                                                       87%

              80
                                                         75%
              70


              60
Percentage




                                        56%

              50


              40

                      30 34%
              30

                                   20
              20                                    17

                                                                  10
              10
                                                                                  5
                                                                                               3           3
                                                                                                                          1
              0
                   Transport     Hospital     First Responder   Enroute        Station      Dispatch     Routing     On Scene Time
                    Agency
                                                                 Contributing Factors
                                                                                                                                     A
                               All data in the class exercises were made up by the workgroups




                                                                                                                                     6
                                                                             Group 3: Hospital

    Voice of the Customer                                                Interpretation                    Critical to Quality (CTQ)
 Billing information*                                       Reimburse me $                             Bring insurance cards
                                                            No missing pertinent info                  Time to complete PCR
 Complete PCR                                               (Hx, meds, allergies,                      Fax access
                                                            treatments)                                User friendly PCR
                                                            Pertinent details
 Good patient report                                                                                   Standardized report outline
                                                            Short and concise: MIVT
                                                            Smooth transition & interface
                                                                                                       Equipment standardization
 Equipment compatibility                                    No time lost changing tubing,
                                                                                                       process
                                                            pacer pads
                                                            Timely, pertinent info. so we              Early notification with
 Ringdown concise and timely                                can gather appropriate                     standardized report format
                                                            resources                                  (necessary info).

*Problem statement: Loss of 30% of billable revenue over past four months, resulting in $___ loss.

 Project statement: Increase billable revenue by 20% (to 90%) over the next six months, resulting
                    in an increase in revenue of $______.

                                            Transfer of care                                                                  VOC Group: Hospital
                                                                                    SNF Patient
                                             For transport                                                                   Problem: Lost revenue
                                                                                                                            Cause and Effect Diagram

                       If no go
                    (to hospital)                                                                               Nurse left room


                            Didn’t pass on                                                                            Chart AWOL
                             information
                                                                                                                            Staff language barrier




                                                                                                                                           Lost Revenue

                        Billing process



                                 “It’s in the mail”
                    Patient                                       Language                                                        No information
                    acuity                                         Barrier
                 Staffing
                 patterns
                                                                                                                   Forgot
              Patient                                    Altered                                                   To ask
               load                                      level of
                                                      consciousness
       Face sheet
       incomplete
                                                                                                                                                          No cards

   Non-compliant
     personnel                                        No family
                                                                                                                 Not           Not     No wallet
    Copier                                                                                                     available     brought    biopsy




             Location Broken


                         Hospital                                       Patient              Prehospital




                                                                                                                                                                     7
    Output (y)                                 Process (f)             Inputs (x’s)




                                                                       Do you have
                                                                       insurance?




                                                                           Locate
                                                                         insurance
                                                                        documents
                                                                       (bring wallet)




                                                 Cards brought
                                                                        Prehospital
                                                                           “field”
                                                  Copies made
Complete billing info                                                   personnel

                                           Document oral/verbal info
= $ reimbursement
                                            Clerk makes face sheet        Facilities
                                                                        clerical staff
                                                                        (Available?
                                                                           Busy?)




                                                                          Patient
                                                                         Interview
      Y = f(x) + f(x) + f(x)...                                         LOC, Age,
                                                                          Kaiser?




                                                                        Bystander,
                                                                           family
                                                                       provides info
                                                                        (Language
                                                                          barrier)

              VOC Group 3: Hospital
  Factors impacting ability to get billing information
       “The output is a function of the inputs”




                                                                                         8
                                                   Group 3: Providing Insurance Information


             100                                                                                                                100%
                                                                                                                   98%
                                                                                                     93%
             90
                                                                                          87%

             80                                                            79%


             70
                                                            67%

             60
Percentage




                                             52%
             50


             40

                        30
             30              31%

                                        20
             20
                                                       15
                                                                      12
             10                                                                       7          6             5
                                                                                                                            2
              0
                   Cards available Family Historian Communcation   EMS asks      Copy machine   Staff      Face sheet    SNF chart
                                                                                                            complete
                                                                    Contributing Factors


                                     All data in the class exercises were made up by the workgroups
                                                                                                                                       9
                                    Group 4: Local Government

    Voice of the Customer              Interpretation           Critical to Quality (CTQ)
                                                              4-6 minute response time
 Take too long!                Quick response
                                                              95% of the time
 Cost too much!                Fiscally responsible           Operate within budget*
                                                              Appropriate behavior and
 You don’t care!               Professional conduct
                                                              appearance
 Dou you know what you’re                                     Trained (initial and ongoing)
                               Competent care
 doing?                                                       Certis & qualifications

*Problem Statement: As local government, our tax base is reduced by 10%.

 Project Goal: Reduce operating costs by 10%




                                                                                              10
Group 4: Local Government

Brainstorming solutions (Reducing staffing costs)
“Mind Map” graphic based on the team’s outline




                                                                       Group 4: Expense Reduction


               100                                                                                                                                                                        100%
                                                                                                                                                                         95%
                90                                                                                                                                  90%
                                                                                                                                    85%
                80                                                                                              80%
                                                                                      75%
                70                                               70%


                60                               60%
  Percentage




                50

                            40
                40               40%


                30

                                            20
                20

                                                            10
                10
                                                                                  5                         5                   5              5                     5                5

                 0
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                                                                                       Contributing Factors


                                            All data in the class exercises were made up by the workgroups
                                                                                                                                                                                                 11
                                         Group 5: Employees

    Voice of the Customer                Interpretation              Critical to Quality (CTQ)
                                                                   Evaluate training
 I want quality training        We want reality-based training!
                                                                   methodologies
 We need equipment that’s       Equipment that is lightweight,     Field test prior to purchase or
 right for field providers      appropriate, current and works     deployment
                                PCR & forms are time intensive     Easy to complete and avoid
 I have the paperwork!
                                and repetitive                     repetition
 I don’t know what you want*    They want clear expectations       Clear documentation policy

*Problem statement: Quarterly survey reports show that 80% of employees feel expectations of
                    performance are unclear.

 Project statement: During the next survey period we will reduce this measure from 80% to less than
                    or equal to 20%




                                                                                                      12
     Expectation
       (Policy)




   Send to company
      officers for
      comment




      Comments
                       yes      Revise
     (Revisions)?




          no




       Finalize               Review with
     (Put in book)            individuals




                              Resource
     Send out final
                              Person for
    copy to officers
                              questions




                               Place in
                               standard     Resurvey
                               location




 VOC Group 5: Employees
Flowchart: Development and
  communication of policies




                                                       13
                                                        Group 5: Poorly Understood Policies


                        14                                                                                          100%     100%


                                                                                                                             90%
                                    12
                        12
                                                                                               83%
                                                                                                                             80%

                                                             10
                        10
                                                                                                                             70%
Number of Occurrences




                                                                  61%                      8                                 60%
                        8




                                                                                                                                    Percent
                                                                                                                             50%
                                                                                                                6
                        6
                                                                                                                             40%

                                         33%
                                                                                                                             30%
                        4


                                                                                                                             20%

                        2
                                                                                                                             10%


                        0                                                                                                    0%
                             Volume of Policies      Complexity of Policy          Location of Policy   Poor Dissemination
                                                                   Contributing Factors


                                         All data in the class exercises were made up by the workgroups




                                                                                                                                    14