Draft Page 1 Simplifying Process Improvement/Lean/Six Sigma Programs for Healthcare Craig A. Stevens, MBB, PMP, ACS In the words of Dr. Deming, “A bad system will beat a good person every time.” Abstract and Key Objectives of the Paper and Presentation: The biggest problem with many of the process improvement programs is that you have to have a degree in statistics or engineering to understand them - Not so with our process improvement program. We focused on three easy to grasp phases: Assessment, Problem Solving, and Implementation. In this paper, we will walk through a three-phase process that incorporates the concepts of continuous improvement, Lean, Six Sigma, a little common sense, and TQM described by the Westbrook Stevens seven attributes of excellent management found in the book Geronimo Stone written by me. See how we apply an approach to Continuous process Improvement (CPI) using the framework of a Total Quality Management (TQM) Approach applied with Lean, Six Sigma, and Strategic Project Management (SPM) tools. Learn how we simplify CPI using three easy to understand phases - Assessment Phase, Problem Solving Phase, and Implementation Phase. Learn our framework for a sustainable program using the Westbrook Stevens Mobile of the Seven Attributes of Excellent Management: 1. Build Excellent Leaders and Empower Practitioners; 2. Develop an Excellent Culture of Commitment to Process Improvement; 3. Ensure an Excellent Customer Focus; 4. Motivate People and Build Excellent Improvement Teams; 5. Build Excellent Core Competencies and Skills in Problem Solving and CPI tools (Lean, Six Sigma, SPM, etc.); 6. Apply Excellent Change Management and CPI to Systems and Processes; and 7. Use the seven steps of excellent Performance Measures in each of the three phases. See how we apply all of the above to our 600 Healthcare Practices (Doctor Offices).
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Simplifying Process Improvement/Lean/Six Sigma Programs
for Healthcare
Craig A. Stevens, MBB, PMP, ACS
In the words of Dr. Deming, “A bad system will beat a good person every time.”
Abstract and Key Objectives of the Paper and Presentation:
The biggest problem with many of the process improvement programs is that you have to have a
degree in statistics or engineering to understand them - Not so with our process improvement program.
We focused on three easy to grasp phases: Assessment, Problem Solving, and Implementation. In this
paper, we will walk through a three-phase process that incorporates the concepts of continuous
improvement, Lean, Six Sigma, a little common sense, and TQM described by the Westbrook Stevens
seven attributes of excellent management found in the book Geronimo Stone written by me.
See how we apply an approach to Continuous process Improvement (CPI) using the framework
of a Total Quality Management (TQM) Approach applied with Lean, Six Sigma, and Strategic
Project Management (SPM) tools.
Learn how we simplify CPI using three easy to understand phases - Assessment Phase, Problem
Solving Phase, and Implementation Phase.
Learn our framework for a sustainable program using the Westbrook Stevens Mobile of the
Seven Attributes of Excellent Management: 1. Build Excellent Leaders and Empower
Practitioners; 2. Develop an Excellent Culture of Commitment to Process Improvement; 3.
Ensure an Excellent Customer Focus; 4. Motivate People and Build Excellent Improvement
Teams; 5. Build Excellent Core Competencies and Skills in Problem Solving and CPI tools (Lean,
Six Sigma, SPM, etc.); 6. Apply Excellent Change Management and CPI to Systems and Processes;
and 7. Use the seven steps of excellent Performance Measures in each of the three phases.
See how we apply all of the above to our 600 Healthcare Practices (Doctor Offices).
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INTRODUCTION:
Environment and Background:
In a doctor’s office, revenue comes from the healthcare providers spending time with the
patients or from other nurse or medical technician providing clinical services such as X-rays or
ultrasounds. If we could just magically eliminate all other processes and cost, we could
maximize our profit and maybe even serve the patient better. If only the patients could
magically lineup for the doctor to see, spend no time waiting, get perfect service, and pay with
cash without any other staff or systems involved. That would minimize cost and maximize profit
and service. However, the world is not that simple. Systems and processes have to be
developed to bring patients in, ensure the quality and safety of all involved, maximize the
patient satisfaction with the experience, bill and collect for services, clean and maintain
facilities and equipment, track medical conditions and records, surf the growing waves of
regulations, manage risks, manage people, provide space, communicate, etc. Therefore, we
need systems and processes to pull everything together for the doctors to serve the patients.
These business processes make everything else possible.
In addition, Healthcare businesses like all other business have life cycles. Each life cycle has
different requirements for improvement. However, most process improvement (PI) programs
never consider this. Engineers should consider improvement opportunities not like cooks
strictly following cookbook recipes, but rather as chiefs challenging recipes and optimizing
favors. For example:
New emerging practices struggling for survival require an entrepreneurial approach to
lean and process improvement. Building systems too quickly takes attention away from
doing real work and will increase the risk of bankruptcy. Many a bankrupted company
had great systems to play with but never served the customers well.
Growing practices require a systems engineering and development approach and a
focus on slashing cost and staff will damage growth and limit revenue.
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Well-established practices can take a full PI approach and should focus on a strategy of
optimization along with creating and spinning off new ideas for expanding markets.
However, these new ideas are intra-preneurial in nature. Therefore, be careful of over
doing error minimization (six sigma, zero defects). That could also limit creativity and
increase stress and the risk abandoning good ideas too early.
Declining practices requires an opportunistic approach for mergers and divestitures or
for looking for other opportunities. Cost savings, lean, and minimization become survival
tactics.
The Healthcare Problem to Solve:
What do you really want your doctor to send time on? Likely, the answer is “medical
acumen as applied to your medical needs.” Therefore, others usually focus on the business of
practice management, which allows the doctor and other medical personnel to focus on high
quality medical services. Nevertheless, the medical staff makes up the senior stakeholders and
the revenue engines. The senior medical staff is the only revenue generator and has the most
to gain or lose and will likely have a high degree of interest in the operations of the business.
The dichotomy becomes this - to maximize the revenue the doctors must maximize
concentration on medicine and are usually too busy to participate in the routine business part
of medicine. However, to minimize efficiencies, lower cost, and provide the systems and
process to see patients, someone has to optimize the operational business part of medicine.
Therefore, a practice management staff has to do that.
Over staff and you may have smoother operations but you also have lower profits and
possibly an unsustainable business model. Too little staff and your revenue may drop as
patients find more service oriented practices, which may also lead to an unsustainable business
model.
The medical office world is very competitive and the practice management staff is often
highly stressed. Therefore, we owe it to our customers, teammates, and staff to continuously
improve our systems and processes to better serve our customers and simplify our work. The
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question then becomes - How can we do that in a simple way so that the medical and office
staff can focus on their primary jobs?
Creating a Systematic and Repeatable Way to Improve: The two words, “Systematic and
Repeatable” are the key to excellence in operations. Furthermore ensuring that operations are
systematic and repeatable is one of the key goals of every audit. Whatever we create has to be
systematic – meaning smart people use their expertise to develop the optimal programs and
systems that they applied to their operations. Repeatable means, whoever uses the systems
can apply the same rules and have similar success. This is especially true in large organizations.
In our case, we want to apply simple systematic and repeatable improvement tools in a busy
medical service environment so that our many practices can all have similar positive results.
Size of the Problem: We have many (about 600) similar but different islands of independent
revenue and cost centers of different sizes (1 doc to 200), with over 10 different medical
specialties, in different markets across the U.S, with different levels of resources. Different
managers and senior staff with different interest run each of the practices. Although everyone
is a knowledge worker, very few understand statistics or higher-level mathematics and no one
has the desire or time to spend on complicated techniques.
Our centralized Continuous Process Improvement team is small and may only be able to
reach 1/30th of the practices in a single year. Therefore, we have to develop systematic and
repeatable systems that practice managers and their staff can use, supported by our small CPI
Program (CPIp) team, and augmented with third party vendors as needed. The rest of this paper
talks about the program we developed.
A SYSTEMS APPROACH TO CONTINUOUS IMPROVEMENT:
We decided to take a unique approach to Continuous Improvement using a specific Total Quality
Management (TQM) Approach, Three Phases of Problem Solving, Three Types of Support, and Five
Levels of Lean Six Sigma Training.
A Total Quality Management Approach:
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Throughout my career as a consultant, I spent a couple dozen
years taking graduate level courses leading to PhD’s but with a
different purpose, to learn as much as I could about business and
operations. During this time, my first dissertation attempt focused
on defining a model for TQM that everyone could understand and
implement successfully. As the popularity of TQM died, the model that we developed became the seven
attributes of the Mobile of Excellent Management and the subject of the first Geronimo Stone book:
1. Growing Excellent Leaders,
2. Building an Excellent Working Culture,
3. Focusing on Excellent Customer Service,
4. Building Excellent Teams of Empowered People,
5. Mastering Skills, Problem Solving, and Core Competencies,
6. Mastering Change and Continuously Improving Methods, Systems, and Processes, and
7. Driving Toward Excellence by Measuring Performance.
As a mobile requires perfect balance, so too, does Excellent Management within an organization or
project. Master this and you can improve any operation. On a mobile, remove any one piece and the
system is out of balance. Likewise, remove any one of these seven attributes within an organization and
the management of the organization or project is out of balance. Also, as on a mobile, in an organization
or project, no one attribute will work alone. For example, one cannot just continuously improve. That
requires addressing leadership commitment, removing organizational culture barriers, focusing on the
value added for the customers, motivating the teams doing the work, teaching the tools to the people
doing the work, and measuring performance (before, during, and after) to understand the results.
Each of the seven attributes represents major concepts in management theory and process
improvement and chronological order is important. You therefore need to address the seven attributes in
order (1-7, as listed above). We use the seven attributes of excellent management as the foundation for
approaching continuous improvement.
Three Easy To Understand Phases for Process Improvement: