The Power of Six Sigma in Hospitals & Healthcare Management

1. POWER OF SIX SIGMA IN HOSPITALS & HEALTHCARE MANAGEMENT DR. PRADEEP BHARDWAJMedical Director & CEO Six Sigma Star Healthcare, DelhiSix Sigma Accreditation Boardwww.drpradeepbhardwaj.in << 7 National Awards I 2 LIMCA Book Record Holder >> Visiting Faculty : IIM-Ahemdabad, IIM-L, ISB-Hyderabad, AIIMS, National Board of Exam, GIHM Delhi Listed under India’s TOP-10 Doctors (Hospital Management) Rajiv Gandhi Award – 2010 (First in Healthcare Management) Youth ICON Award – University of Delhi Rashtriya Ratan Award in Healthcare - 2009 Youngest Medical Superintendent in India -2005 (Limca Book) Padma Award- 2012 (Nominated by CM Delhi) Indian Achiever Award – UAE Govt. Shram Shri Award – 2012 Best Enterprise Award – Oxford, UK

2. Briefly About “Six Sigma Healthcare” Delhi • Rated No – 1 (Healthcare Management Company) by HBS. • Six Sigma Managing 278 + hospitals and successfully delivered over 1200 healthcare projects. (Hospital Planning/ O & M / Med. Education/ Quality) • Managing operation of more than 2600 bed across the India, having staff strength of 7500. • Managing 30 Post Graduate Hospitals/ Institute. • GIHM Offering 45 Doctorate/ PG/ Master Degree / Diploma in Healthcare • Offering one stop solution for all healthcare management (MM, July 2010) • Geographic footprint in 42 Cities of India. • 2 Monthly Magazines – Medgate Today & Six Sigma Health Express • High Altitude Medical Services at Any Time- Any Where – Any Height @ AmarnathYatra - JK, KailashMansarover- China, Nepal Earthquake, UK Flood

3. Outsource it to Consultants Current Scenario of QUALITY in Healthcare QUALITY : BUSINESS OF OUTSOURCING If u can’t do it yourself….

4. Six Sigma - Global Acceptability • “Six Sigmaaims for world-class performance” • Encourage and stimulate greater Accountability and Transparency • NO Constraint if you Implement Six Sigma

5. CPD (Continue Professional Development) • How you are DIFFERENT ? • What value addition you can do ? • What is yours STRATEGY ? • If “SYMBIOSIS Post Graduate” does not showcase the ‘Next Big Things..then WHO will ? • Rules of the GAMES are going to CHANGE..Be ENSURE, You change them. • If you Don’t GROW, the Competition will grow

6. INTRODUCTION • Patients are the foundation of our medical practice. • A Patient can survive without a Doctor but A Doctor cannot survive without a Patient. • Poor customer-service is a Worldwide problem. • Great customer-service is the Backbone to all successful businesses

7. Your first question is likely…. What is Six Sigma? • Your second question is likely… Why Six Sigma?

8. Presentation Outline

9. Presentation Outline …. • An Introduction ….What is Six Sigma ? • International Accreditation..Country wise • JCI vs NABH vs Six Sigma • What Six Sigma can do ? • Most Popular Outcomes from Six Sigma • How Six Sigma is Different ? • Steps in Six Sigma. • When to use it. • Implementation Road Map. • Education & Training in Six Sigma. • Success Factor for Six Sigma. • Six Sigma Learning Institutes. • Six Sigma online learning centre.

10. Six Sigma in Healthcare Six Sigma can change the face of modern hospital & healthcare delivery system. Corporatization and Competition in healthcare sector is forcing the organization to look for the new ways and mean for improving their process so that the quality of the products and services improve, dissatisfaction reduces and patient satisfaction increases. Hospitals involve highly qualified professionals dealing with the question of Life & Death. Hospital Administration is more complex than Administration of any other Business Institute / Organization . “GREAT CAREER Opportunities in Six Sigma Projects @ International Levels”

11. Healthcare become more complex, the opportunities for error abound. As Healthcare become more complex, the opportunities for error abound. Most of the corporate hospitals functions at a three sigma to foursigma quality level and patient safety is usually described by medical mistakes. There is a need to breakdown the traditional boundaries that separate Physicians, Hospital Administration, Pharmacist, Technician, Nurses by shifting away from a culture of blame and working together to systematically design safer, more effective and efficient systems

12. What is Six Sigma? • Statistically-based process improvement methodology which aims to reduce defects to a rate of 3.4 per million opportunities. • This reduction is achieved by identifying & eliminating variation in process. • Through defining “defects” the Six Sigma process focuses on customer requirements, and thus is very customer orientated. • Fundamental methodology of Six Sigma is based on “DMAIC” an acronym: Define, Measure, Analyze, Improve, & Control. • Six Sigma is not a quality management system, or quality certification system like ISO-9001. • THE FOCUS ON DEFECTS IS SHIFTED FROM CHECKING PRODUCTS FOR DEFECTS TO IMPROVING THE PROCESS SO THAT DEFECTS DO NOT OCCUR.

13. Six Sigma Belt’s • Master Black Belt:Highest level of technical & organizational proficiency. These individuals provide technical leadership to the program, as well as provide most of the training. Because of this communications & teaching skills are as important as technical competence. • Black Belt: A technically minded individual with a strong background in college level mathematics & statistics. The Black Belt provides much of the quantitative analysis involved in the daily six sigma project. • Green Belt: Six Sigma project leader, capable of facilitating six sigma teams & projects from conception to completion. Training for green belts in much less than Black, with emphasis on project management, and quality control. These individuals are not employed full time on six sigma projects.

14. International Accreditation.. • India: National Accreditation Board for Hospitals & Healthcare Providers (NABH) • USA:Joint Commission International • United Kingdom: QHA Trent Accreditation • Australia: Australian Council on Healthcare Standards International (ACHSI) • New Zealand: Quality Health New Zealand (QHNZ), QHNZ quality standards are based on those used in Australia and Canada. QHNZ is accredited by the international umbrella organization, the International Society for Quality in Healthcare (ISQua). • Canada -Accreditation Canada • France -HAS (Haute Autorité de Santé) • ISQuais the umbrella organization responsible for accrediting the Joint Commission International (JCI) accreditation scheme in the USA and Accreditation Canada, as well as accreditation organizations in the United Kingdom and Australia. • UKAF ( United Kingdom Accreditation Forum) is responsible for accrediting accreditation schemes in the United Kingdom

15. JCI by FACTS • JCI Founded – 1951 • 821 Accreditation Done (Total) • 27 Accreditation in INDIA • 15 Languages – JCI 5th Std. • 90 Country having JCI Accreditation

16. NABH vs JCI • NABH Accredited Hospital : 337 • JCI Accredited Hospital in India : 027

17. ON THE ONE HAND….. Success is based on your PEOPLE • ON THE OTHER HAND….. Success is based on your PROCESSES

18. The Six Sigma Accreditation Journey: GENERAL SUGGESTIONS • Senior management must be committed: without top management support six sigma projects are doomed to failure. • Training the right people: People selected for a six sigma initiative should be motivated by compensation, rewards, recognition & promotion. • Selecting the right project: Initial six sigma projects should be focused on key problem areas with impact to critical aspects of business success. • Set a realistic timeframe for preparation, such as 3-6 months • Allocation of resources: may include facility enhancement, Six Sigma training, recruitment of Qualified Manpower, and redesign of systems

19. LEADERSHIP SKILLS FOR SIX SIGMA • Getting and Giving Information • Understanding Team Needs and Characteristics • Understanding Team Resources (SWOT) • Controlling the Team • Counseling • Setting the Example • Representing the Team • Problem-Solving • Evaluation • Sharing Leadership • Manager of Learning

21. SIX SIGMA ACCREDITATION - NEW • Powerful Quality Tool – Low Cost Investment • Higher Patient & Staff Satisfaction • World class Recognition • Benchmark of Quality Healthcare Service • Eliminate the ‘I don’t know’ • DMAIC - Methodology • Reduce overtime, Employee Turnover & Error • Improve Health Services & Accuracy • Make sound data driven decisions • Six Sigma Impact Bottom Line Improvement • Opportunity to serve organization with power & status • Matter of Great Pride for the Staff, patient & Management • A better ambiance for innovation & creativity is observed. • Error free process • NO chance of medication mistakes.

22. SIX SIGMA COURSES

24. TRAININGS & CERTIFICATIONS If you want to make yourself more valuable and attractive to employers then get training and certification Option I – Certification as Six Sigma Green Belt Option II – Certification as Six Sigma Black Belt 25

25. National Record: Six Sigma Accreditation of SIR GANGARAM HOSPITAL, New Delhi Link - http://ijcpbookofmedicalrecords.com/Gangaram_Hospital.aspx About IJCP- IJCP BOOK OF MEDICAL RECORDS The IJCP Group was founded in 1990 by Padmashri and Dr B C Roy National Awardee Dr KK Aggarwal and was the pioneer of medical journalism in India. ‘The Indian Journal of Clinical Practice’ which was launched by Dr S D Sharma, former Vice President of India. Today, IJCP reaching over 200,000 doctors per month and working with over 60 pharmaceutical companies in a year. IJCP Book of Medical Recordsis the only accreditation body in India to document and publish exclusivity authenticated health and medical records. The records cover the firsts or the maximum in the medical and health field. The records are in the form of claims as authenticated by the sender as on the day of approval. The records can be used as part of a personal bio data or institution's achievements. IJCP -Recent Records- Gangaram Hospital, Delhi (750 Bedded) is awarded top quality accreditation – SIX SIGMA Heart Care Foundation of India: The Only NGO to have three national commemorative postal stamps Largest Health camp attendance in a day organized by an NGO Only DMA President to have received both Padmashri and Dr B C Roy National award Dr K KAggarwal, First Indian to have chapters in first text book of Color Doppler Echocardiography Clot Dissolving Therapy in India Dr K KAggarwal first Indian to have chapters in first text book in contrast echo 1st Pacemaker Bank in India 1st Public Conference of Heart Care Foundation of India 1st National Echo Cardiography Institute in India In Press Interviewing Dr NareshTrehan1st Color Doppler Echo Free Checkup Camp in India 

26. MOST POPULAR OUTCOMES FROM SIX SIGMA • International Hallmark of Quality Excellence • Higher satisfaction (Patient/ Staff) • FEW COMPLAINTS. • IMPROVED PROCESSES • INCREASED ACCURACY. • REDUCED WAIT TIME & VARIATION. • SAFER & MORE EFFICIENT EMERGENCY SERVICES. • FEWER MEDICAL ERRORS & DEFECT. • Increase service orientation. • Eliminate the ' I don't know' factor. • Certification by External Agency • Matter of Great Pride

27. MOST POPULAR OUTCOMES FROM SIX SIGMA..Cont.. • Generates sustained success • Sets performance goal for everyone • Enhances value for customers • Accelerates rate of improvement • Promotes learning across boundaries • Executes strategic change • Systemizes the processes • Adds great value in Medical Tourism • InternationalRecognition

28. Six Sigma Hospitals • Max Healthcare • Long Island Jewish, New York • Stanford Medical Center, CA • Northwestern Memorial, IL • M.D. Anderson, Texas • Virtua Health System, NZ • Charleston Area Medical Center, WV • Boston Medical Center, MA • Yale New Haven Medical Center, CT • Verdugo Hills Hospital, CA • Johns Hopkins Hospital, MD • Good Samaritan Hospital, Ohio • Sir Gangaram Hospital, Delhi, India • Fortis Hospital

29. SIX SIGMA COMPANIES Companies in almost all sectors have a Six Sigma success story

31. Six Sigma Project Methodology Project Phases Control Define Measure Analyze Improve • Improvement strategy • Develop ideas to remove root causes • Design and carry out experiments, • Optimize the process. • Final solutions • Collect data on size of the selected problem, • identify key customer requirements, • Determine key product and process characteristic. • Analyze data, establish and confirm the “ vital few “ determinants of the performance. • Validate hypothesis • Establish standards to maintain process; • Design the controls, implement and monitor. • Evaluate financial impact of the project • Identify, evaluate and select projects for improvement • Set goals • Form teams.

32. Define Measure Analyze Control Identify and Implement Quick Improvements with Kaizen Kaizen, 5S, NVA Analysis, Generic Pull Systems, Four Step Rapid Setup Method Six SigmaDMAIC Improvement Process Road Map Improve Activities • Identify Problem • Validate Problem Statement • Gather Voice of the Customer & Business • Develop CCR’s & CBR’s • Validate Goal Statement • Validate Business Case • Validate Project Scope • Select and Launch Team • Develop Project Schedule • Complete Define Gate • Appropriately Map Process • Identify Key Input, Process and Output Metrics • Develop Operational Definitions • Develop Data Collection Plan • Validate Measurement System • Collect Baseline Data • Determine Process Performance/Capability • Complete Measure Gate • Identify Potential Root Causes • Reduce List of Potential Root Causes • Confirm Root Cause to Output Relationship • Estimate Impact of Root Causes on Key Outputs • Prioritize Root Causes • Complete Analyze Gate • Develop Potential Solutions • Develop Evaluation Criteria • Select Best Solutions • Develop ‘To-Be’ Process Map(s) • Develop Pilot Plan • Pilot Solution • Develop Full Scale Implementation Plan • Complete Improve Gate • Implement Mistake Proofing • Develop SOP’s, Training Plan and Process Controls • Implement Solution and Ongoing Process Measurements • Identify Project Replication Opportunities • Complete Control Gate • Transition Project to Process Owner Tools • Process Mapping • Process Cycle Efficiency • Little’s Law • Operational Definitions • Data Collection Plan • Statistical Sampling • Measurement System Analysis • TPM • Generic Pull • Setup Reduction • Control Charts • Histograms • Constraint Identification • Process Capability • Value Analysis • Process Constraint ID • Takt Time Analysis • Cause and Effect Analysis • FMEA • Hypothesis Tests • Correlation Analysis • Simple and Multiple Regression • ANOVA • Components of Variation • Conquering Product and Process Complexity • Queuing Theory • Project Charter • Project Selection Tools • PIP Management Process • Value Stream Map • Various Financial Analysis • Effective Meeting Skills • Stakeholder Analysis • Communication Plan • SIPOC Map • High-Level Process Map • Project Management Tools • VOC and Kano Analysis • RACI and Quad Charts • Control Charts & SPC • Standard Operating Procedures (SOP’s) • Training Plan • Communication Plan • Implementation Plan • Process Control Plans • Visual Process Control Tools • Project Replication • Project Commissioning • Team Feedback Session • Brainstorming • Replenishment Pull/Kanban • Stocking Strategy • Process Flow Improvement • Process Balancing • Analytical Batch Sizing • Total Productive Maintenance • Design of Experiments (DOE) • Solution Selection Matrix • ‘To-Be’ Process Mapping • Poka-Yoke

33. Real World Examples

34. Six Principles for Quality Improvement Principle :1

35. Think and Plan Principle :2

36. Principle :3

37. Bring in Technology Principle : 4

38. Principle 5 Remain focused and not get distracted

39. REFERENCES • http://www.isixsigma.com • http://www.sixsigmaonline.org/index.html • http://www.businessballs.com/sixsigma.htm • http://www.ge.com/en/company/companyinfo/quality/whatis.htm • http://www.slideshare.net/Sixsigmacentral/10-six-sigmappt • http://mypptsearch.allpopular.info/search-ppt/six+sigma+ppt/

40. JAI HIND…Thank you Good Luck…,The Journey ahead is going to be CHALLENGING, EXCITING & REWARDING.

41. Feel Free to Share your Query • DR. PRADEEP BHARDWAJ, Mob- 98 188 68 727 • E.Mail – pradeepkb28@gmail.com • WEB – www.drpradeepbhardwaj.in www.sixsigmahealth.org