Quality Measurement Proposal

liealtlicare By Mary Hayes Finch and Maurice Rellins

Abraham Lincoln once said thedogmas ofthe quiet past are inad- equate to the stormy present. The occa- sion is piled high with dijficulty, and we must rise with the occasion. The over- all challenges facing the health and human service agencies in our country are certainly piled high with difficulty. Faced with constant change, decreas- ing resources, increasing demand, and human need, we are in the midst of perhaps one of the most transitional times experienced. Health and human service agencies across the board are

operational and legal environment. Whether it is within Medicaid, public welfare, state nutritional assistance programs, or TANF, today's public health and human service organiza- tions are operating in arguably one of the most complex economic and politi- cal environments of its history. While technology advancements have offered tremendous opportunities for automa- tion and efficiency, technology alone is not enough to transform the current operations of America's HHS agen- cies. Technology is a tool for improve-

system worldwide. Why? Evidence- based results that are irrefutable.

The goal ofthe Six Sigma program is to achieve a level of quality that is as close to perfection as possible. Sigma is actually a statistical term used to gauge how far a process deviates from perfection. The Six Sigma and Lean program institutes innovative methods of affecting cost savings while striving for perfection. In the health and human service sector, it does so by improving efficiency and boosting the quality of service. Providing high-quality service

is profitable and the long-term

Getting More Done with Less: How :Zt!ZZ:::.^Ly Lean Six Sigma Enhances Performance Î L T t l ' r a î r Î

being asked—required, even, to retool operational policy and procedures in a manner predicated on transparency, technical integration, the adage of doing more with less. In light of these challenges, public health and human service agencies remain anchored by the overall philosophy that individual health, Wellness and safety are ulti- mately what will strengthen our com- munities, states and country, and the quality of life enjoyed by our citizenry.

More with less—cut out the waste. These phrases are often bantered about when resources are low and need is high. The current economic and politi- cal environments are no different. What is different is the growing expectation that public health and human ser- vice agencies operate in an efficient, fully integrated and interoperable, consumer-centered, and user friendly environment. While this philosophy is shared by most agencies, they have historically been plagued with a con- stant dilemma—-how to respond with the continued increase in need for ser- vices with declining state and federal resources in an ever-more complex

ment and efficiency. However, more fundamental than technology, is the underpinning of any system—opera- tional policies, procedures, and orga- nizational culture. What is required to reaffirm the foundation of health and human services in this country at a time when demand is high and resources continue to dwindle is a rethinking and redesign of traditional operational policies, procedures and relationships to identify opportunities for contin- ued improvement and system wide integration.

Jack Welch, former chairman and chief executive officer of General Electric, once said, "Once you under- stand the simple maxim "variation is evil," you're 60 percent ofthe way to becoming a Six Sigma expert yourself. The other 40 percent is getting the evil out." The evil he was speaking about could well be ignoring the value of eliminating waste and not implemting a performance-based system in the day- to-day operation ofa business.

Since its inception in 1986 with Motorola, Six Sigma has become the most popular business performance

" ^ ' ^ ' " ' Every year 200,000 incorrect prescriptions are made. Five

thousand incorrect surgical procedures are made each week.

Eliminating errors, redundancies and waste will help the health care industry maintain its profit margins while complying with the new law and increasing customer satisfaction. The Six Sigma Lean strategy has been suc- cessful with such corporate giants as General Electric, Toyota and Merrill Lynch. Six Sigma was instituted at G.E. in 1996. In the following two years, the company increased revenue by 11 percent, profits went up 13 percent, and operating margins grew 17 percent. Lessons learned about organization, mistakes and efficiency from automo- bile giants like G.E. don't lead to the dehumanization of medical patients. In fact the Lean method creates more doctor patient interaction. Cutting out middle-men increases the number of patients one physician can see in a day. Efficiency at hospitals can be increased by applying common sense strategies like listening to employees, cutting redundancies and becoming more user- friendly for patients.

2 4 Policv&Practice June 2010

liealtlicdrev Lean Six Sigma is a practice that

considers the outlay of resources for any goal Lean creates more value with less work. Like it or not, health care is a business and hospitals and doctors are seeking ways to increase their prof-̂ its. Systemic change in the health care industry will bring higher quality and cost savings for patients and hospitals alike.

Lean's successes in the health care industry have been well documented. In 2005. Virginia Mason Medical Center in Seattle had remarkable results with Six Sigma. For example, in the chemotherapy unit, the center cut preparation time by two-thirds, enabling doctors to treat an additional 50 patients weekly. Furthermore, the hospital was able to free 13,000 square feet of space, cut tbe cost of inventory by $360,000, and save $6 million in capital investments.

The Alabama Primary Health Care Association adopted Lean practices and the result has been better moti- vated and empowered employees, flex- ible and cross-trained staff, and again, shorter patient wait times.

Lean Six Sigma teaches hospitals innovative methods to optimize efforts, use less space, cut down on capital investment, decrease material use, save time, and most important, reduce errors.

Continuous efforts to improve effi- ciency and care are necessary. Lean Six Sigma is not only based on incremental improvements, but also offers a guide on how to make long-term changes. Managers should view changes from a patients prospective rather than one of simple functionality.

Lean was designed for customer satisfaction. Anything that doesn't achieve that goal should be eliminated. Outdated or superfluous equipment takes up space that could be used for something useful and should be removed. Sigma gives a step-by-step

guide of how to eliminate inefficiencies and improve care.

The five disciplines of Six Sigma; sort, set in order, shine, standardize and sustain have revolutionized care at hospitals that have embraced them.

• Sorting is the process of removing items that are superfluous to opera- tions, leaving only what is absolutely needed. Extra gear equals wasted space and a cluttered and confusing workplace.

• Setting the items in order is the pro- cess of organizing tools so that they are easy to find and use. Use of visual aids like color coding and outlining on work areas improves productivity and cuts down on errors.

• Step three or shine refers to continu- ous cleaning and upkeep of the physi- cal workspace. Six Sigma illustrates how the use of charts and mainte- nance schedules improves working conditions and perpetuates quality.

• Standardization is the method devel- oped to ensure that the first three dis- ciplines are maintained.

• Sustain refers to the perpetual pro- cess of top down evaluation to ensure and maintain a high level of quality. A simple example of how efficiency

helps both the patients and the corpo- rate bottom line is wait times. Reducing wait times increases the number of patients you can see. Another example is increasing the amount of in house services offered. This can decrease administrative and transportation costs.

New strategies can be scary to employees but one of tbe many great aspects of Lean is that their opinions are not only requested but are crucial to making improvements. Just as the old saying goes "no man is an island," no department or area of a hospital operates entirely independently. Six Sigma seeks to make stronger connec- tions and improve lines of communica- tion. Interaction between the staff and

management implementing the Sigma strategy is crucial. Communication is vital to improve performance and ease any fears that employees may have con- cerning their jobs under the business model.

It is important to look beyond who can provide a service at the lowest rate and instead look strategically at what can be provided efficiently in the long term. Mangers should act more like small business owners rather than man- agement and not be afraid to delegate responsibility.

Lean Six Sigma provides a continu- ously improving culture based on the importance of internal value where your team is passionate about provid- ing service. The Lean way makes more room for doctors to develop long-term relationships with patients. Better busi- ness skills can lead to better medicine.

As we embrace the current environ- ment and expectations, public health and human service agencies have the opportunity to do so in a way that changes and enhances the lives of the individuals we serve. While we are clearly in the business of providing critical health and human services, we are in professions positioned to influ- ence the lives of millions of Americans. In the midst of the fast-paced demands and challenges of our transformation, we can continue to be anchored by the human connection of our respective agencies—the opportunities we have every day beyond our operational areas of expertise—the opportunity to touch lives in a very real, meaningful way. Ifl

Mary Hayes Finch is the chief execu- tive officer at the Alabama Primary Health Care Association. Maurice Rollins is quality improvement manager at APHCA.

June 2010 Policy&Practice 2 5

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