Combining Lean Six Sigma and Baldrige to Create a ProcessOriented Organization

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Combining Lean Six Sigma and Baldrige to Create
a Process-Oriented Organization

• Nancy Pratt, Sr. Vice President, Clinical
  Effectiveness
• Patricia Atkins, Director, Lean Six Sigma
• Sharp HealthCare
• San Diego, CA
• Contact Information 1-888-Sharp08
• baldrige_at_sharp.com

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Baldrige Core Values and Concepts

• Visionary Leadership
• Patient-Focused Excellence
• Organizational and Personal Learning
• Valuing Staff and Partners
• Agility
• Focus on the Future
• Managing for Innovation
• Management by Fact
• Social Responsibility and Community Health

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Core Competency
Strategically important capabilities that provide
an advantage in your marketplace they frequently
are challenging for competitors to imitate and
they provide a sustainable advantage.
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Work Systems Key Work Processes
Enterprise Work Systems
Enterprise Work Systems
Key Health Care Work Processes
Key Health Care Work Processes
Emergency Care
Emergency Care
Home Care
Home Care
Screening
Screening
Hospice Care
Hospice Care
Inpatient Care
Inpatient Care
Admission Registration
Admission Registration
Long
-
term Care
Long
-
term Care
Assessment/Diagnosis
Assessment/Diagnosis
Mental Health Care
Mental Health Care
Treatment
Treatment
Outpatient Care
Outpatient Care
Primary/Specialty
Primary/Specialty
Discharge/Education
Discharge/Education
Rehabilitation
Rehabilitation
Urgent Care
Urgent Care
Each work system is comprised of each key work
process.
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Performance MeasurementLinkage and Alignment
Enterprise Work Systems
Strategic Planning Deployment
Process Management
Seven Step Process
Performance Improvement System
Performance Measurement
Data Analysis, Prioritization Dashboards, Report
Cards Comparative Data Selection Annual Targets
and Goals
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Breakdown Work Systems to Key Processes that are
Actionable
Level 1 Key Processes
Screening
Admission / Registration
Assessment and Diagnosis
Treatment and Management
Discharge
Level 2 Processes
Level 3 Processes
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Sharps Project Prioritization
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SIPOC (forward) andCOPIS (backward)
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Performance Measurement

• Translating Voice of the Customer to Process
  Requirements Using Customer Needs Mapping

• Real Issue
• Efficiency
• Cost
• Timeliness
• Accuracy
• Friendliness
• Convenience
• Access
• Communication
• Other

Critical to Quality (CTQ) Requirements Specific M
easurable Accurate Realistic Timely
1st, 2nd, 3rd Level Needs
Voice of the Customer
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Key Health Care Processes
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Key Business Support Processes
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Performance Improvement Processes
Team Resource Management
Team Improvement
Knowledge Management
Individual Improvement
Change Management
Workforce and Leadership Development
Process Improvement
Process Design and Improvement

• Scorecard
• Dashboard
• Strategic Plan

Process Management Strategic Planning
Deployment Process
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DMAIC 12-Step Processto Discover the Best
Solution
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Change Acceleration Process (CAP)to Process
People Through Change
Leading Change
Creating A Shared Need
Shaping A Vision
Mobilizing Commitment
Current State
Transition State
Improved State
Making Change Last
Monitoring Progress
Changing Systems Structures
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Sharps Best PracticeSharing Model
Identify Verify Best Practice, Promising
Practice, Lesson Learned
Share Out
Collect Best Practice/Lesson and Communicate
Monitor Progress
C.A.P.
Scan
Evaluate for Applicability
Apply the Best Practices
Share In
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Lean Six Sigma Deployment Time Line
Phase I ?
Phase 3 ?
Phase 4 ?
Phase 2 ?
Demo Projects
Site visit Exec Team Coalition
Engage Entire Leadership Commitment
High Visibility Projects
Small Scale Black Belt Training
Share Results and Vision
Large Scale Black/Green Belt Training and Beyond
Develop Talking Points and Tool Kit
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Critical Success Factors Deployment of
Performance Improvement Processes

• Executive commitment, Clear strategy
• Initial priority Financial ROI
• Expert training mentoring
• Cross functional team of Black Belts
• Rigorous structure
• Accountability for results
• Communication plan
• Alignment with rewards

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Diabetes Initiative
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Benchmarking DiabetesPerformance
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Ambulatory Care
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Evidence-Based Medicine Performance
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Core Measures
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SMH Discharge Project Discharge Order Written
to Discharge Time
When PD Flag is used there is a significant
decrease in Discharge Order Written to
Discharged Time
(Includes Routine Discharges only Excludes day
before DC orders) Action Increase use of
Potential Discharge PD program to anticipate
discharge needs prior to discharge order written
p.05
3.0
2.4
Target 2 hrs
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Case Cart Ready
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Call Center
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April 2006 January 2007
Reducing Out of Network Costs

• Total Estimated Savings 4,340,498
• Revenue Enhancement (PPO Transfers) 278,263
• 4,618,761
• Program Expenses to Date 725,500
• Savings Revenue Less Expenses 3,893,261
• Return on Investment to Date 1 5.3

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SMH Physician Engagement with Cerner EMR and CPOE
Exclusions a) MDs who had lt30 orders in Feb,
2008 b) Orders put into a planned state (not
initiated)