Using Six Sigma Approach For Reducing Transfer Times From Emergency Rooms

Hospital emergency room wait times are the talk of the United States right now. Long wait times can contribute to the problems that decrease the quality of our health care system. Emergency room wait times depend on how busy the day is going, how long it takes for each patient to be seen, and how much staff is on duty. Wait times are also based on your injury as well. If you are there for a broken toe versus a head injury, you are going to be seen after the patient with the head injury despite the fact that you were there first. A case study researched and and written by Kevin Tuttle explains a challenge with a mission to decrease the wait times in the emergency room department.

The issue of longer wait time can results in a major implication to the hospital overall workflow, community reach, quality, patient perception, profitability, efficiency, and can lead to failure in meeting regulatory guidelines and standards affecting the organization operations.

The driving factors for a success or failure of implementing Six Sigma is largely dependent on the inputs set forth at the conception and duration of the integration. This whitepaper will compare and contrast these critical inputs for a successful deployment. In order to accomplish this five various companies: GE Electric, W.R. Grace, Royal Chemicals, Diversified Paper and Lemforder. Some of these organizations had very successful results while others failed to reach their full potential. What is clear is the similarities of those that succeed and those that failed.

The additional revenues that were collected due to increase in ICU capacity by 20 beds enhanced the total ED revenues by 10%.4 The efficiency of care delivery is decreased when patients are diverted to other hospitals, they have to wait for long period to receive care or if they are placed on the floors where they do not belong. This is seen often due to delay in discharging patients.3 These delays and inefficiencies are the primary cause of decreased satisfaction among patients, their families, hospital employees, and physicians. They also result in avoidable increases in patient length-of-stay, reduced quality of care, and lost or diminished hospital revenue.3

Due to ineffective management systems, inefficiency is increasing, which often leads to congested emergency rooms, customer complaints, and lost revenue. Over the past seven years, Six Sigma concepts are increasingly being implemented in the healthcare industry. Despite the challenges of adopting these concepts, the healthcare industry uses them to improve services rendered quality, increase efficiency and reduce fatal human errors. Primarily because Six Sigma is based on a comprehensive approach on improving the human and transactional aspects of the process (human performance and task completion). In the case of JPS, the factors that determine quality and efficiency are the flow of information and interaction with the patients. Using the Six Sigma DMAIC process improvement approach, JPS Emergency Department should be able to streamline information flow and achieve strategic business results (p.

al, N. M. (2010). Reducing waiting time at an emergency department using design for Six Sigma and discree event simulation. Int. J. Six Sigma and Competitive advantage, 6, 91-104.

The presence of Emergency Department (ED) crowding, and long boarding times, hinders its ability to provide the quality and efficient care (Weiss, Rogers, Maas, Ernst, & Nick, 2014). According to Mullins and Pines (2014), an average patient in the United States spends more than 4 hours in the ED before being admitted to an inpatient unit. ED crowding and increased boarding time have negatively impacted bed availability, increased staff workload, decreased productivity, and lessened patient satisfaction. Many healthcare organizations, including the Veterans Health Administration (VHA), have established an electronic bed board system (BMS) and InterQual Level of Care Criteria (IQLCC), which aim to enhance patient flow within organizations (United States, 2013).

Hospitals are experiencing patient congested emergency departments. At Baptist Memorial Hospital, the increase in patient volume and limited capacity contributes to long length of stays and patients leaving without being seen. As a result of overcrowded emergency rooms, patient length of stay becomes more important. Throughput times in the emergency department (ED) play a substantial role in patient and staff satisfaction. Length of stay in the ED is directly related to patient volume, patient acuity, lab turnaround times, and time to treatment, which is all connected to patient satisfaction. Long wait time

Soleimanpour et. al (2011) explained that patient satisfaction is an essential component in the Emergency Department (ED) because it is the entrance for patients to receive their initial treatments. The most important and single possible cause for ED patients’ flow problem is the availability of inpatients beds (Peck et. al, 2012). The American College of Emergency Physicians (ACEP) (2011) explained that the primary cause of ED overcrowding is boarding; which was defined as holding patients in the ED after the admission had been completed due to unavailability of inpatient beds. Lutheran Medical Center faced this problem and in his paper will discuss analysis of the problem, determination of possible quality lapses, identification of performance measures, designing and evaluation of the interventions and reporting of the results.

Six Sigma (SS) has emerged above other QI models with its innovative use of extensive data analysis and problem-solving methods to provide consistent healthcare services. SS identifies and analyzes the root cause

This model is made up of teams that comprise a variety of specialties within the hospital that range from anesthesiologists to nurses and social workers. These teams all had a team leader, which were required to take part in a LEAN Six Sigma training process. UC Irvine considered LEAN Six Sigma to be a vital aspect to implementing a perioperative surgical home model since LEAN was created with Toyota, which has since transformed the car industry. UC Irvine considered a PSH model to be very similar to a car manufacturing process so implementation of LEAN within their PSH model was considered crucial for a more efficient and high-quality method

With its success in manufacturing and other service industries, and because of new payment models and a shift in focus to better outcomes, there is no doubt the healthcare community will embrace Six Sigma techniques as a way to stay competitive in an ever-shifting landscape. And, because the main basis of health care reform is to eliminate underperformers in an effort to redesign the healthcare delivery system toward value-based medicine, eliminating waste in every internal process becomes even more critical.

The Lean Six Sigma looks for ways on how to eliminate defects. In healthcare, a defect can be the difference between life and death. The Lean Six Sigma is used to improve patient safety by eliminating life-threatening errors. Lean Six Sigma uses a five-step approach to process improvement called the Define-Measure-Analyze-Improve-Control (DMAIC). The DMAIC is an approach that is a data-driven quality strategy used to improve processes (ASQ, n.d.). The first phase, the define phase, is where the leaders would define the problem and begin to understand the needs of the customers. This is an important phase of the Lean Six Sigma because this is where the team would outline of their efforts for themselves and the leaders of the organization (goLEANSIXSIGMA.com,

A quantitative study conducted by Lifvergren, Gremyr, Hellstrom, Chakhunashvili, and Bergman (2010) analyzed the experiences and from a hospital group during a three-year period after the introduction of Six Sigma. It reports on 22 large Six Sigma improvement projects, their results and influence on other improvement activities. The study shows that 75% of the completed projects reached their goals within 18 months. The average net cost savings per completed project/year was $55,300. Overall, the results showed that Six Sigma is a useful concept when trying to improve healthcare processes. They recommend that Six Sigma should be an addition to the improvement practices used in healthcare development initiatives. It was also observed that the Six Sigma program can create much organizational pull regarding quality management and improvement efforts if teamwork is applied.

The concept of Six Sigma was developed in the early 1980’s at Motorola Corporation (Harry and Schroeder, 2000). Six Sigma can be defined as a statistical measure of the performance of a process or product (Kumi et. al., 2006). It is used as a quality control mechanism, which seeks to reduce defects or variations in a process to 3.4 per million opportunities thereby optimizing output and increasing customer satisfaction (Sambhe, 2012). Sigma is representing the standard deviation, a unit of measurement that designates the distribution or spread about the mean of a process (Six Sigma Academy, 2002). In addition, the Six Sigma uniquely driven by close understanding of customer needs, disciplined use of fact, data, and statistical analysis, and diligent attention to managing improving, and reinventing business processes (Pande, P., et. al. 2000). The Six Sigma methodology uses statistical tools to identify the factors that matter most for improving the quality of processes and generating bottom-line results. The Six Sigma DMAIC (Define, Measure,