Lean Six Sigma Enhances Healthcare Performance in Women’s Diagnostic Imaging
Dr. Ed Popovich is a leader in business transformation and organizational performance enhancement including the deployment and application of Lean Six Sigma. In healthcare, Ed led a hospital Lean Six Sigma initiative as the hospital was undergoing the development of an academic medical center in South Florida realizing that the development would also require business transformation of its care, research, and teaching processes. Under contract, Ed also began the initial stages of Lean Six Sigma deployment for the Office of the Surgeon General, Army Medical Command leading to a full scale Lean Six Sigma implementation across the organization. Now working as a consultant, Ed discusses his healthcare Lean Six Sigma experience with the American Strategic Management Institute.
Q: Dr. Popovich, what is your definition of Lean Six Sigma?
A: Lean Six Sigma is systematic means to measure, analyze and improve business systems and processes to drive breakthrough results. It is also a business strategy and within healthcare it can drastically improve patient and family satisfaction and drive safety along with better patient outcomes.
Q: With a number of process improvement tools and methodologies out there, what differentiates Lean Six Sigma from other process improvement tools?
A: Lean Six Sigma is a data driven approach to improving processes in order to increase outcome performance through elimination of process waste and reduction of process inconsistency. Many of the tools of Lean Six Sigma are known and used by other process improvement methodologies. However, Lean Six Sigma methodology provides a sequenced way of utilizing the tools while seeking to uncover the causal factors that drive process inconsistency as represented by variation in performance data around the mean, or average, level of performance. So it is not the tools that are new, it is the disciplined, sequential approach to using the tools to understand process variation and waste which is new.
Q: What are your thoughts on integrating Lean tools with Six Sigma tools?
A: When Six Sigma was first initiated in the 1980’s by Motorola, the concept and tools of the “Toyota Production System” which were sometimes called “Just in Time”production system were incorporated into Motorola’s approach for variation reduction. Over the past two decades in the USA the “Just in Time” production system tools became known as Lean tools while the variation reduction tools became known as Six Sigma. In essence, when we talk Lean Six Sigma we are putting the two methodologies together as they were originally meant to be. In view of that history, I think a comprehensive process improvement initiative requires both Lean and Six Sigma methodologies. Using either set of tools can help organizations to improve while incorporating all these tools in a larger tool box allows organizations to have more flexibility in their process improvement efforts.
In addition, one of the primary goals of Lean Six Sigma is to enable an organization to become effective and efficient. I define effective as doing the “right” thing “right” the first time. And efficient as being effective with minimal time and resources. To help us understand this we need to understand my definition of quality. Quality is meeting, exceeding and anticipating all customer’s needs and requirements and fulfilling them with no wasted effort. With that said, it is clear that to be effective an organization needs to understand what is the “right” thing from the perspective of the customer, the market, and the overall organizational mission and make sure that the whole organization understands it and is completely focused on making sure it happens. This leads to consistency, or effectiveness, of performance. With that perspective on the definition of quality and effectiveness as a foundation it is easier for an organization to understand what may be wasteful it terms of doing the “right “ thing and should seek to eliminate this waste. This leads to efficiency of performance.
Q: Dr. Popovich, you have applied Lean Six Sigma to healthcare, what is/was your most successful application of Lean Six Sigma in healthcare?
A: When I served as Vice President of Enterprise Excellence at a hospital in South Florida we began an initiative to reduce the diagnostic process time for women who visited our Women’s Center for Breast Care in order to enhance the patient experience and more quickly find patients who had cancer so it can be treated sooner. With cancer, time is of the essence. We decided to use Lean Six Sigma methodologies for this daunting task.
When we began our effort, on average the process time from screening mammography to detailed imaging studies including ultrasound, MRI, through to biopsies took an average of 8 weeks of time for those women who were found to have cancer. This is a stressful time for these patients and due to the length of the process they experienced anxiety not knowing what was going to happen to them. ,
We undertook this process with the support of our CEO who served as the Champion for this project. Two physicians were on the Steering Team including the Chief of Radiology and the physician who was the director of the Women’s Center. We met with the Steering Team in the evening to maximize attendance. Our former Executive Director of Imaging Services and former Chief Nursing Officer were trained as Lean Six Sigma Black Belts and were co-leaders of this project.
We began a phased approach to the project beginning with process stabilization, process optimization, and then ultimately process innovation. Stabilization was important as there was a morale concern with the staff, process performance was not meeting the patient demand, and some women were choosing to go to free standing diagnostic centers that were competing with the hospital. We were able to “steady the ship” as it were leading to more support from the staff and an increased ability to satisfy the demand. Part way through the stabilization process the process staff along with our Black Belt leaders discovered ways to make the process much more efficient and effective. We attacked what had previously been “sacred cows” that inhibited performance and changed how we attended to patients. We realized that we could compress the different diagnostic techniques often within the same visit if we took advantage of our digital technology, had the radiologists work more in concert with our staff in terms of the patient process, and were able to reorganize how we did our work. Within 8 months we were able to demonstrate that we could complete the whole diagnostic process to less than 1 week instead of 8 weeks and for some women we were able to reduce it to 2.5 hours!
Needless to say, not only did we do better for the patients we were seeing, through word of mouth we saw an increase in demand of 30%. Moreover, staff satisfaction increased significantly to the point that turnover not only dropped, we were having more applicants seeking to find a position at our facility. 2 years later the Women’s Center for Breast Care has expanded and added capability in facilities located in other parts of the local area.
Q: That is amazing improvement. What were your critical success factors?
A: The biggest success factor was the leadership of our Black Belts along with the support we had from senior hospital leadership. As I mentioned earlier, our CEO was the project champion and the physicians especially the radiologists themselves were closely involved throughout the whole process. This clearly demonstrated that Lean Six Sigma methodology and tools used in an environment supported by senior leadership and key stakeholders such as the physicians and staff can lead to improvements that many would have previously thought to have been impossible.
