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What did the team do?
The project was
What happened next?
Change is Good
New CEO
New Medical School Dean
The Decade Plan
New ED Leadership
New Associate Dean
Clinical Affairs
Change is Good
Increased Patient Acuity
Increased Boarding
Increased Wait Time
Patient Satisfaction Plummeted
Increased Saturation Frequency
Current State of ED Local Affairs
 Things had to get worse before they got better, especially to
influence physician behavior change
A renewed commitment to reducing wait times and developing new
local leaders capable of managing change
 Physician and department performance expectations have been
linked. Incentives based on patient satisfaction and program metrics,
and physician performance metrics dashboards – This is big!
 Spin off initiatives that positively impact ED wait times by addressing
patient admissions have been implemented: Short Stay Unit, Discharge
by Noon Program, Difficult Discharge Initiative
 New process improvement projects in the pipeline to “lean out” the
ED admission process and address ED patient boarding
Lessons Learned
 Program level executive support is critical
 Selectivity of Black Belts / Project Managers (skills, experience, credibility)
 Project selection is key. The initiative must be important to local
stakeholders and executive administrators as Project Sponsors
 Sponsor role is critical: Do not proceed with a reluctant sponsor
 Data is power: Removes subjectivity, opinions and feelings from
decisions—use of PDCA thinking—scientific method!
 Six Sigma program establishment is a multi-year endeavor, especially
when adapting industry methodologies to healthcare
 Demonstrated repeated success is a key to culture change
Lessons Learned
 Improvement initiative efforts may be confounded by
the diversity of competing priorities and incentives of a
large academic medical center
 Making the link to the passions of doctors and nurses
(patient care) was the breakthrough
 Temporarily suspending project implementation may be
the right thing to do
 Even moderately successful projects have value
 You don’t have to be a Six Sigma Organization to be
successful with the methods, tools and “acceptance
management”
Six Sigma: The AMH Evolution
2003-2005
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Financials
Business Processes
2006 
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2001-2003
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Patient Safety & Satisfaction
“Best Place to Care”
Market Share
Reduce Process Variation
Patient Safety
Patient Outcomes
Morbidity & Mortality
Current State of Global Affairs
The 7 Year Road to Culture Change
What hasn’t changed?
 Volume & intensity (e.g. Acuity)
 Market & economy (e.g. Payor requirements)
 Technology emphasis( e.g. RFID)
 People (From leadership to mid mgt. to staff and physicians, including
new ED Chair)
 Even the facilities
The Decade Plan and Organizational Quality Dashboard
 Provide clear and specific strategic objectives with accountability
expectations
 Selection and Alignment of improvement initiatives
 User involvement in development of 2008 - 2010 Medical Center
Quality Plan and Metrics/Dashboard
New organizational “Quality” structure
What Drives Improvement Projects?
 Organizational Quality Dashboard based on the Medical Center’s Goals
 I Care: Pt. Satisfaction
 I Heal: Quality Outcomes (e.g. mortality)
 I Build: Operating Margin and Financial Stewardship
 Payors / Medicare
 Withholding of payment r/t Hospital Acquired Conditions not present on
admission (e.g. Nosocomial Infections)
 Joint Commission (Accreditation Organizations) & CMS
(Center’s for Medicare & Medicaid Services)
 Joint Commission & CMS Standards – Survey Process
 Patient Safety Objectives
 Core Measures: Best Practices (Publicly Reported)
 Voluntary Participation in Benchmark &
Best Practice Programs
 Consumerism and the Internet Effect
 Quality Rounds: “Get out of your chair”
What have AMH been doing lately?
 ED Boarding – Patient flow imitative / bed availability: System thinking opportunity
 ED Admission – Process improvement from time of bed assignment to transfer
 Patient Identification – Goal: Right Patient / Right Treatment / Right Time
(Reduce “wrong patient” errors)
 Medication Errors – Administration, Prescribing, Preparation and Dispensing
 Replacement Meds – Reduce the number of medication order fulfillment
“do-overs”
 Hospital Acquired Urinary Tract Infection Reduction (Nosocomial Infection)
 Blood Utilization – Due to new restrictions on blood donors / decrease in
donors / increased need / increasing product cost
 Glycemic Control – Current research correlates increased complications
with less than optimally control blood sugar levels
 The Lean Lab Project – Reduce waste from product and operator flows,
Improve Efficiency, Space Allocation, Kan Ban Inventory System, etc.
 Emergency Response Program – Pre-Code system to reduce cardiac and
respiratory arrest on acute patient care units
 RFID Project – Radio Frequency Locator System for Equipment, Specimens,
Blood Products, Medications, Patients, Staff
 Expansion/Renovation Communication WorkOut – Between Operational
Departments (Facilities) and Clinical Departments (Patient Care Areas)