1 Achieving Physician Buy-in for Performance Improvement: Leveraging 6 Sigma Management System Leveraging 6 Sigma Management System at at OSF Saint Francis Medical Center OSF Saint Francis Medical Center Tim C. Miller, M.D. Tim C. Miller, M.D. Vice President, CMO & Director of Academic Affairs Vice President, CMO & Director of Academic Affairs & Tom Thomas Tom Thomas 6 Sigma Black Belt 6 Sigma Black Belt WCBF’s 7 WCBF’s 7 th th Annual Lean, Six Sigma and Process Improvement in Healthcare Annual Lean, Six Sigma and Process Improvement in Healthcare Summit Summit
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Leveraging 6 Sigma Management System at OSE Saint Francis Medical Center
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Achieving Physician Buy-in for Performance Improvement:
OSF Saint Francis Medical CenterOSF Saint Francis Medical Center
Tim C. Miller, M.D.Tim C. Miller, M.D.Vice President, CMO & Director of Academic AffairsVice President, CMO & Director of Academic Affairs
&&
Tom ThomasTom Thomas6 Sigma Black Belt6 Sigma Black Belt
WCBF’s 7WCBF’s 7thth Annual Lean, Six Sigma and Process Improvement in Healthcare Summit Annual Lean, Six Sigma and Process Improvement in Healthcare Summit
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Achieving Physicians Buy-in for Achieving Physicians Buy-in for Performance ImprovementPerformance Improvement
OBJECTIVESOBJECTIVES
A.A. Traditional PI and the Physician CultureTraditional PI and the Physician Culture
B.B. New Order of PI for PhysiciansNew Order of PI for Physicians
OSF Saint Francis Medical CenterOSF Saint Francis Medical Center
Peoria, Illinois
Traditional Traditional Performance Improvement Performance Improvement
andandThe Physician CultureThe Physician Culture
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Traditional Physician CultureTraditional Physician Culture
Traditional Physician Training:
• Is Independent, Autonomous, Scientific
• Is Focused on the Individual Versus System Thinking
• Maximizes Individual Competence Rather than Team-based Learning
• Is Concerned with Individual Patient Safety and Outcomes
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Traditional HealthcareTraditional HealthcarePerformance ImprovementPerformance Improvement
• Attempts to benchmark facilities with similar service lines...
Our hospital is different. • Impossible to achieve exceptionally high levels of
quality... Patients are non-compliant, co-morbidities… My patients are different.
• Poor data, validity suspect...We can’t trust the data.
• Complexity of human diseases compared to assembly-line “widgets”…
We will never be able to attain 6-Sigma levels.• Driven by bottom line or external market
conditions... It’s all about the money.
Creating a New OrderCreating a New Orderof Performance Improvement of Performance Improvement
with Physicianswith Physicians
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• Since the first IOM Report, there has been a public outcry for immediate and comprehensive improvement in healthcare quality and safety.
• CMS, Joint Commission, and other regulatory agencies and payers have responded by raising the performance bar to new levels with significant consequences for performance failure.
• These conditions are challenging the old order of relationships.
BurningBurningPlatformPlatform
Critical Shift in HealthcareCritical Shift in Healthcare
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Learning from ManufacturingLearning from Manufacturing
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ADMISSIONS - 34,160 TotalADMISSIONS - 34,160 Total
– CFH 35% increase in from 52% to 70%– Main Campus 26% increase
• General Radiology Throughput – 37% improvement cycle time IP arrive to complete
• OP Radiology – 50% reduction in delays and cancellations
• Interventional Radiology (IR) Patient Throughput – 3.7 additional CT cases per day– 6.3 additional IR cases per week– Decreased direct cost of procedure 26.2% and 25.7%
• Coordinate New Projects with Clinical/Academic Strategies
• TAL (Teaching, Administration and Leadership) video
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Engaging PhysiciansEngaging Physicians
I heard that you are a certified 6 Sigma Black Belt Zombie. Is that true?
He didn’t seem dangerous, Dr. Smith.
I’m an assertive and innovative professional, experienced in lean, six sigma and process improvement in healthcare.
I just sat through a 3-hour project review meeting.
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• Project Example: Quality Quest and Evidence-Based Standards
• Quality Quest is a strategic partnership between OSF HealthCare System and Caterpillar Inc.
• Goal: Improving the quality and efficiency of healthcare delivery and improve health in the tri-state area.
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To establish the consistent application of evidence-based care standards for Central Illinois tri-county area health providers.
Project GoalProject Goal::
• Identify, evaluate, and recommend evidence-based guidelines/protocol sets
• Recommend endorsement and adoption process to gain acceptance and use
• Identify implementation and maintenance support requirements• Identify operational processes and relationships
Deliverables:Deliverables:
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• 17 community physicians representing all 4 major hospitals at all levels and types of service
• 2 executive level nurses
• 1 change agent expert
• 1 6 Sigma Black Belt
Who did we bring to the table?Who did we bring to the table?
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• Healthcare is local
• Respect
• Process & Environment
• Opportunity to be a part of the change
• Talents & Expertise
• SBAR
How did we get them there?How did we get them there?
““WWe are going to ask you to do some tough thingse are going to ask you to do some tough things…”…”
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Articulate the Burning PlatformArticulate the Burning Platform
What will m
ake you
uncomfortable
enough that you will
want to be a part o
f
the change?
In the future, everybody will have 15 minutes of quality health care.
State Ranking on Quality Dimension
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• Constantly articulate the vision
• Establish aggressive agendas & timelines
• Extensive sub-team work
• Scientific approach
• Take-aways (WIFM)
How did we keep them there?How did we keep them there?
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Clear goalsExposed and validated concernsLeveraged a physician championDetailed project plan with all meetings
scheduled before kick-offSpecific tasks linked to specialtyChange management principlesCommunication
What we did right…What we did right…
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What did we do wrong?What did we do wrong?
ØTeam too large to function as a group
ØAvoid tedious tasks (i.e. creating surveys)
ØBenefit of meeting 1-on-1 with team
members
ØTimelines (i.e. Resident Hand Off Project)
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4 Major hospitals
represented by 17 physicians
and 2 of the communities largest payers
CAME TO AN AGREEMENT
on 1 set of Evidence Based Standards guidelines
for the Tri-County area
IN JUST 90 DAYS
Project Outcome…Project Outcome…
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Involving Physicians Involving Physicians “Rules of the Road”“Rules of the Road”
• Establish and Maintain Credibility Aggressive Agenda No Agenda, No Meeting Send Materials for Pre-meeting Prep Provide Key Articles from Scientific
Journals Provide Bibliography or References for
Further Reading• Respect MD Time and Be Flexible with
Participation Methods
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Engaging PhysiciansEngaging Physicians“If physicians participate on teams, communicate their needs and help design improvement strategies, it is more likely that their concepts will become an integral part of the improvement plans.
Physicians should not act as innocent bystanders in process improvement but must actively participate and support teams in performing the hard work that goes along with it.”
6 Sigma Works6 Sigma Works Operations Must Go First Operations Must Go First Data Credibility is EssentialData Credibility is Essential We Must Include the MDsWe Must Include the MDs
- Find and Develop MD Champions- Find and Develop MD Champions
- Meet Them Where They Are- Meet Them Where They Are