Transforming Hospital Finances with Six Sigma

The Mount Carmel Health System

By Mark Matthews MD

A “Scrubbed” True Illustration

One of the earliest healthcare adopters of Six Sigma was the Mount Carmel Health System in Columbus, Ohio.

The organization was barely breaking even in the summer of 2021 when competition from surrounding providers made things worse. Employee layoffs added fuel to an already all-time low employee morale.

The CEO

The Chief Executive Officer was determined to stem the bleeding, break the cycle of poor financial performance and return the hospital system to profitability.  He sought the potential benefits of Six Sigma and began a full deployment of its methodology. The plan was a bold move, as the organization ensured that no one would be terminated as a result of a Six Sigma project having eliminated his or her previous duties. These employees would be offered an alternative position in a different department. Moreover, top personnel were asked to leave their current positions to be trained and work full time as Six Sigma expert practitioners who would oversee project deployment while their positions were back filled.

Assessment

The Six Sigma deployment was the right decision. More than 50 projects were initiated with significant success. An example of an early Mount Carmel success story is the dramatic improvement in their Medicare Part C product reimbursements, previously written off as uncollectible accounts. These accounts were often denied by HCFA due to coding of those patients as “working aged.”

Since the treatment process status often changed in these patients, HCFA often rejected claims or lessened reimbursement amounts, effectively making coding a difficult and elusive problem. The employment of the Six Sigma process fixed the problem, resulting in a real gain of $857,000 to the organization. The spillover of this methodology to other coding parameters also has dramatically boosted revenue collection.

A Glimpse of Lean Medical Management Tools and Techniques

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

Our Other Print Books and Related Information Sources:

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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

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Physician Advisors: www.CertifiedMedicalPlanner.org

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A Glimpse into Lean Medical Management Tools and Techniques

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A Very Brief Review

By Dr. Mark Matthews with Dr. David Marcinko MBA

As most medical and healthcare executives and consultants are aware, there are a few tools and techniques that are unique to the world of Lean process improvement and management.

These  include: Kaizen Events, The 5-S Technique, Standard Work, Visual Controls and Human Factors Engineering.

We will review the first two techniques in this ME-P. Of course, the last three are reviewed in much greater detail in our new book complete with checklists, figures, tables, drawings, graphs and other illustrations.

Kaizen Events

Kaizen is one of the most powerful tools in the Lean methodology. These events involve intense work sessions aimed at making concrete decisions in a short time period without the need for much data collection. Kaizen events are fairly narrow in scope, ideally concentrating on making one or two decisions at the most.

For example, there may be competing improvement ideas that require more exploration. Using a Kaizen event can provide the necessary structure to make the decision needed to move forward with implementation. The steps in a typical Kaizen Event often include:

  • Determine and define the objectives
  • Determine the current state of the process
  • Determine the requirements of the process
  • Create a plan for implementation
  • Implement the improvements
  • Check the effectiveness of the improvements
  • Document and standardize the improved process
  • Continue the cycle

The 5-S Technique

This technique was developed to allow employees to visually control their work area around visual management techniques. The principles involved in visual management include:

  • Improving workspace efficiency and productivity
  • Helping people share workstations by providing standard layouts
  • Reducing the time required to look for needed supplies or tools
  • Improving the work environment

Each “S” in 5S stands for a step in the process:

  • Sort – classify every item in the designated area as either needed or not needed
  • Set (Straighten) – put “everything in its place”
  • Shine (Sweep) – clean all work environments for order and organization
  • Standardize  – document what goes where, who will clean and who will inspect and on what schedule
  • Sustain-design a system for monitoring process, providing feedback, and rewarding good outcomes

Assessment

Prior to conducting a 5S event, a significant amount of planning is vital. It is important to scope the target area as something that is manageable, draw a physical map of the area under consideration [hospital, ED, OR, clinic, office, etc], and assemble a list of current items in that area. This is usually accomplished by taking photographs (both before and after) of the area.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

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Case Model Illustration of a Six Sigma Healthcare Pioneer

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The Mount Carmel Health System

By Mark Matthews MD

A “Scrubbed” True Illustration

One of the earliest healthcare adopters of Six Sigma was the Mount Carmel Health System in Columbus, Ohio.

The organization was barely breaking even in the summer of 2000 when competition from surrounding providers made things worse. Employee layoffs added fuel to an already all-time low employee morale.

The CEO

Chief Executive Officer Joe Calvaruso was determined to stem the bleeding, break the cycle of poor financial performance and return the hospital system to profitability.  He sought the potential benefits of Six Sigma and began a full deployment of its methodology. The plan was a bold move, as the organization ensured that no one would be terminated as a result of a Six Sigma project having eliminated his or her previous duties. These employees would be offered an alternative position in a different department. Moreover, top personnel were asked to leave their current positions to be trained and work full time as Six Sigma expert practitioners who would oversee project deployment while their positions were backfilled.

Assessment

The Six Sigma deployment was the right decision. More than 50 projects were initiated with significant success. An example of an early Mount Carmel success story is the dramatic improvement in their Medicare + Choice product reimbursements, previously written off as uncollectible accounts. These accounts were often denied by HCFA due to coding of those patients as “working aged.”

Since the treatment process status often changed in these patients, HCFA often rejected claims or lessened reimbursement amounts, effectively making coding a difficult and elusive problem. The employment of the Six Sigma process fixed the problem, resulting in a real gain of $857,000 to the organization. The spillover of this methodology to other coding parameters also has dramatically boosted revenue collection.

A Glimpse of Lean Medical Management Tools and Techniques

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

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The Eight Types of Waste in Healthcare Processes Today

 The Industry Must Identify and Avoid These Traps

By Mark Matthews MD

www.Creative-Healthcare.com

Operative Definitions:

Noun:
Processes: A series of actions or steps taken to achieve an end.

 

Verb:
  1. Perform a series of mechanical or chemical operations on (something) in order to change or preserve it: “the stages in processing the wool”.
  2. Walk or march in procession: “they processed down the aisle”.

 

Waste in healthcare processes can be classified into 8 different subtypes:

  • Overproduction: This term refers to the performance of redundant work. Examples include duplicate charting, multiple forms with the same information, copies of reports being sent automatically, and multiple caregivers asking the patient for the same information.
  • Motion: This term refers to the extra steps taken by employees in order to complete a task (part or all of a process). People working in healthcare facilities or offices often spend a large part of their day moving around the environment searching for people or information, gathering supplies, moving items, dropping off records, etc.
  • Waiting: This is epidemic in most healthcare settings and is often referred to as “queuing.” Waiting for items like medical records or radiographs, or a patient waiting for providers is simply inactive time with no value content at all.
  • Transport: The unnecessary movement of patients, supplies or materials that are necessary for, involved in or produced by a process. Examples include delivery of medication from a distant central pharmacy, procurement of an unexpected surgical pack to the operating room, staff needing to travel a great distance to retrieve supplies, or transporting patients large distances from the emergency room to obtain diagnostic tests. This movement adds time to a process and contains no value.
  • Over-processing: Excess processes that do not add value from the patient’s perspective. The most prevalent example of this in healthcare is the processing of regulatory paperwork or the inclusion of extra steps merely to satisfy a regulatory condition. Also included are activities like order clarification due to poor handwriting or erroneous abbreviations, missing medications from a pharmacy area leading to a delay in treatment, and redundant charting or paperwork.
  • Inventory waste: Seen when too much product is acquired ahead of actual demand. This leads to a risk that items may become outdated or expired, leading to waste and excess cost. This is most often seen in healthcare in association with poor inventory management. Inspection of the average hospital storeroom will yield many items that will not be needed for months to years ahead. In addition, catering to the individual needs of all surgeons in the operating room leads to the accumulation of multiple trays and costly instruments that are used infrequently.
  • Rework: This term refers to work that contains errors or defects that require correction. In healthcare, this is seen in coding and billing errors requiring reprocessing, medication errors requiring additional reconciliation, patient mishaps requiring reporting and perhaps additional treatment, and surgical errors requiring re-operation.
  • Not using people to their full potential capabilities: This is often referred to as the “8th form of waste” because it was described after the original 7 forms of waste related to manufacturing were defined. It refers to a mismatch of a particular task to the skill set of the person assigned to perform that task. It is common to see significant variation in the ways different people will perform the same task. This often arises when there is an unclear expectation set forth by management or a lack of standard processes. Matching tasks to skill sets can lead to improved quality of work, employee satisfaction, and employee loyalty.

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We are now preparing the next edition of our book:
“Healthcare Organizations” [Management Strategies, Tools, Techniques and Case Studies].

In-Process from: (c) Productivity Press 2012
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About the Author

Dr. Mark Mathews has 20 years of active clinical practice in the field of Anesthesiology. Located in Scottsdale, Arizona, he has served on the management board of his large multi-specialty anesthesiology group in the Phoenix area as well as various committees within the Scottsdale Healthcare System. Currently, he is developing simulation models mimicking various medical inpatient and outpatient processes with an emphasis on improving Patient Safety through the application of Lean and Six Sigma analysis. After receiving his Bachelor of Science and Medical Degrees from the University of Arizona, Dr. Mathews completed his residency training in Anesthesiology at the University of Minnesota. Subsequently, he received specialized fellowship training in Neuroanesthesiology from the Barrow Neurological Institute in Phoenix, Arizona. Currently, he is a Diplomat of the American Board of Anesthesiology and maintains numerous memberships in professional medical societies. 

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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