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https://www.commonwealthfund.org/publications/newsletter-article/case-study-applying-quality-improvement-techniques-manufacturing?
https://www.commonwealthfund.org/publications/newsletter-article/case-study-applying-quality-improvement-techniques-manufacturing?redirect_source=/publications/newsletters/quality-matters/2008/september-october/case-study-applying-the-quality-improvement-techniques-of-manufacturing-industries
Students will write a 3-5 page paper, APA 6 th format, cite at least 3 references in APA format.
Discuss the following required items in your paper (cite sources in APA format):
1) Describe the background and problem for the organization for the quality improvement project.
This case study is applying six sigma project to using the quality improvement techniques of manufacturing industries to medical practice which is name Lansing Ophthalmology. Six Sigma project management plan applies to many business companies. Since many manufacturers like an automobile, enterprises use this method to reduce costs and increase earnings but this quality improvement team identify this method and this health care organization see the potential in health care industries also this quality improvement team had enough confidence to implement to reduce process variation and waste. Also, They expected improvements revealed in patients length of stay and to reduce waiting time at the hospital.
This organization has seven facilities and runs by a total of 14 physicians with 144 employees, and they annually see 100,000 between 7,500 patients with the procedure of eye exams, perform surgery, and dispense eyewear. The remaining patients are examined in six satellite offices within a 67-mile radius.
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2) Who are the stakeholders and how were they involved in this project?
The company had their quality improvement teams, and they are involved CMPE, has been executive director, clinical director, director of life sciences for the Automotive Action Industry Group (AIAG), executive vice president and director of international operations for OMNEX, and basically they all are work as team for applying the six sigma plan in healthcare organization to develop on training, software, and consulting company, who has advised manufacturing, advertising, and shipping companies about process improvement.
Specifically, project management methodology and various Lean tools have been utilized to streamline processes and enhance the productivity of a hospital's ophthalmology department. Particular emphasis is given today case surgeries based on patients' complaints. Thorough investigations revealed various improvement opportunities at different stages of the day case surgery process, some of which have been adopted by the hospital's top management.
3) What type of data or measures were used to monitor the problem?
They use many different types of data or measures to improve the facility's problem. Project leaders and medical staff identified the most difficulty was patient flow. The administrative directors at Lansing use the methodology to streamline the flow of patients in the primary clinic. Averagely, patients were waiting as long as 90 minutes to see a doctor; they managed to bunch outside the physicians' offices, putting additional pressure on doctors.
Using on Six Sigma methods, the experts suggested assembling patient flow data of seven business days to estimating how long it practiced patients to advance through every step of the process. Technicians managed a separate time sheet for each person, noting how long it took to register the patient, gather a history, perform refraction, and provide other services. The chart also captured how long patients waited between these care processes. The staff collected data based on 1,227 patients; first, they use the previously described time sheet, which was connected to each patient chart during the data collection.
Second, The time required for each exam was entered into an Excel spreadsheet and examined by the specialists.
Third, the consultants found significant variability in the time taken to perform various procedures.
They also use the graph and monitor potential hours save from reducing the average time spent on refraction and patient histories to measure technician time with the patient.
4) What type of tools were used to collect data or to analyze the problem?
First of all, They use the histogram. Six Sigma practitioners can use the pattern reflected in the histogram to discern a process variation, and this is a kind of data visualization. Here, a histogram is useful in evaluating the shape of the data. As we can see in figure 1 in this case study, They measure the flow of the patient and determine the waiting time for seeing the doctor. They estimate with frequency and total patient wait time and A Histogram is a bar chart showing the rate of an outcome. In Six Sigma, we can use a histogram to visualize what is going on. A Histogram can reflect the voice of the process.
According to figure 2 graph, they use flow pattern sheet, the objective of this section is to identify and understand the components of variation arising out of the measurement system and to be able to use the appropriate tool for analysis depending on the data type. According to the case study, "The staff collected data on 1,227 patients, using the previously described time sheet, which was attached to each patient chart during the data collection period. The time required for each exam was entered into an Excel spreadsheet and analyzed by the consultants. The data showed that 241 patients—or 19.6 percent of those measured—had spent more than one hour waiting during their visit. The data also showed that, while there were some 149 exam combinations required by patients, nearly 50 percent followed one of five set patterns. The 242 patients who came for history, refraction, dilation, and an exam with the doctor spent an average of 79 minutes in the office, of which 45 minutes was spent waiting (Figure 2)."
They categorized the top five traffic flow patterns and explicitly detected how long the patient spent more than one hour waiting during their visit. Also, some of the procedure spent tremendous time consuming with some other exam and I would sure the organization try as best as they can to reduce that average 45 minute waiting time for delivering better quality and waste time which could be the value.
In Figure 3, They use the graph to detect the significant variability in the time taken to perform various procedures base on patient id and average time per patient which it tells patient seen per hourly by a physician. This graph shows some of the problematic procedures would spend more time than the basic procedure. In my opinion, the physician and other clinical staff would know specific procedure expect to spend more time so they are trying to find the solution to reduce the procedure time as well as they might consider they need extra staff or more advanced medical device to improve the speed of procedure. Also, the case study explained it depends on clinicians to save time during the process so if the quality improvement team would as a training session for clinical staff to reduce procedure hours.
Lastly, They used the queuing system tools to limit the number of patients entering the doctors' waiting area. A queue management system is used to control queues. Queueing system is the system of waiting lines, or queues and servers. In queueing theory, a model is constructed so that queue lengths and waiting times can be predicted( ) This Six Sigma method uses it substantially decreased the stress that doctors felt upon seeing many quantity patients waiting outside their entrance. They used this method moderately easy: A staff member created color-coded cards for each doctor. The number allotted to each was based upon the number of patients he or she could see in one hour. The cards were placed at a desk, which patients were allowed to pass only when a map for his or her doctor was available.
5) What changes were made and how were the changes monitored?
Lansing Ophthalmology suggested taking part in a pilot project sponsored by AIAG, which tried to demonstrate the value of applying Lean Production and Six Sigma techniques to this health care industry.
The project manager had a major problem especially with gathering data from the physician and other medical staff because they all need to team up and create and the same idea of quality improvement to collaborate with the full of support. All the medical staff includes doctor agree on the significant problem, especially on current patient flow system and also they all afraid to change the existing system because the physician believed they have more freedom and manage time well due to priorities in their duties.
However, after change the system they significantly visualizing the improvement on patient flow.
6) Describe strategies to get buy-in or support for the changes.
They financially change with The consultant's services were provided to the clinic at no cost through the AIAG pilot project.
Instead of spending extra time about a year on the project, they regularly spent 10 to 20 hours per week on the improvements, and while they were practicing, they did not spend any money for this project except they pay consultants' fee about 20,000 dollars. Also, they proved the clinic to increase little bit more support staff especially by hiring two more additional physicians for the practice, Which it improved the staff ratio decrease to 3.1 to 1 from 3.3 to 1. According to his result. I believe employee satisfaction is essential because they have difficulty with patient flow, any of employee would get highly stressed and that will deliver poor quality care service to the patient. Therefore, I would support the stakeholders and focus on employee satisfaction and receive feedback on their good things, as well as complains and problems that a quality improvement team could sustain the medical team.
7) What are your own recommendations for improvement for this organization?
I believe that it is an excellent idea that they use six sigma and lean techniques in quality improvement technique in this organization. Also, I would like to recommend for improvement for this organization is Plan-Do-Check-Act (PDCA) cycle. PDCA is the most widely recognized improvement process today to ensure continuous improvement, the steps perpetually cycle and repeat. The repetitive approach helps the team find and test solutions and improve them through a waste-reducing cycle. The PDCA cycle includes a mandatory commitment to continuous improvement, and it can have a positive impact on productivity and efficiency. First, recognize an opportunity, and plan the change. Second, Do: Test the change, third, check and review the test, analyze the results and identify learnings, and Lastly, Act: Take action based on what you learned in the check step. If the change was successful, incorporate the learnings from the test into more comprehensive reforms. If not, go through the cycle again with a different plan. Therefore, I would like to add this technique for this organization to provide simple, and I agree that all the stakeholder would keep up together as the team.
