Healthcare Case Study Part 2

 

Continuing on with my healthcare case study.  There was also a review of the basics of both Lean and Six sigma and how to combine these three methodologies into a single methodology. Figure 2 is a basic look at how these methods can be used together to generate improvements to any process or system being studied.  Remember, the Theory of Constraints identifies the focal point for improvement, while Lean works to reduce waste and Six Sigma reduces and controls the variation within the process.

Figure 2 Integrated TOC, Lean and Six Sigma

For whatever reason, the agency who developed this universal metric used the median rather than the mean. The current median standard for Door to Balloon (D2B) time had been set at 90 minutes, and this hospital was actually doing quite well against this standard with a median score of 66 minutes. However, because this hospital was anticipating the standard would be changing to 60 minutes in the future, they decided to be proactive by putting together a team of subject matter experts to look for ways to achieve this future target, before it was mandated to do so. In addition to this new time benefitting the patient (i.e. much less heart muscle damage), there was also a financial incentive for the hospital, in that reimbursement rates for Medicare and Medicaid patients are tied to completing the D2B time below the standard median time.

Figure 3 represents the first part of the D2B Time referred to as Door to Doc Time whereby the patient enters the emergency department and is eventually seen by a doctor for diagnosis.

Figure 3 D2Doc Time

After completing the training session, the team was instructed to “Walk the Gemba” by going to both the Emergency Department and Cardiology Department to observe what happens during this process and to have conversations with employees from both departments about problems they might encounter. This was a fact-finding mission aimed at understanding how patients are managed through this treatment process. The team collected many observations during this walk, most of which would be used to construct their Current State Process Map, which will be displayed shortly. Figure 4 is a high-level summary of part of their Gemba walk for Door to Doctor.

                                                Figure 4 High Level D2B Time

In my next post, we will continue with this Healthcare Case Study.