Implementation of six sigma approach at Wishmewell hospital to reduce on patient waiting time.
The cumulative amount of time that a patient waits to be served upon walking into a healthcare facility constitutes to the patient waiting time (Kim, Song & Lee, 2009). Five hours waiting time in an emergency set up can be discouraging and also frustrating for a patient who is at a chronic and critical state. ED visits are stipulated to be as a result of financial constraints that bars one from obtaining quick and invaluable care via direct visit to either state or personal doctor. For this purpose, the hospital board entrusted me as the lead incumbent manager in an initiative spearheaded at overhauling the menace of five hour waiting time at Wishmewell ED. My main role is to develop goals and devise a guideline that outlines the six sigma process and accurately premonate on possible milestones that might hinder success in reducing the waiting time at the ED by ensuring that quality improvement is amalgamated with the mark-down waiting time to aid in achieving the following objectives.
To; Prevent patient’s condition from worsening by stabilizing critical cases, improve care quality as there are heightened opportunities for error when ED capacity is exceeded, attend to as many patients as soon as possible shortly after arriving at the ED, decrease cycle times for treat-and-release, walk-in ED patients, reduce the losses incurred by the hospital when patients leave unattended, and finally increase community trust for the hospital care provision.
Six Sigma DMAIC Process; DMAIC is a five step project methodology (Define, Measure, Analyze, Improve and Control) which is used for projects aimed at improving an existing organization’s process. For an improvement quality plan to succeed at Wishmewell hospital the five steps have to be emulated and put into play. Notably, six sigma approach is popular in quality improvement of the output by either minimizing or removing any aberrations that stands on the way of the laid out plan, that is, reducing the ED waiting time which in the long run provides customer satisfaction and can also lead to rising profits. For this purpose, the statistical model employs DMAIC steps which are very crucial in fulfilling customer expectation in a quality improvement program that benefits both parties as stated earlier.
Definition; The major problem affecting Wishmewell hospital is the long hours spent at the Emergency Department. The average cycle time for an ED treat-and-release, walk-in patient at Wishmewell hospital is more than five hours. This is an issue for concern as there are possible dangers of the patients’ condition worsening while at the ED.
Measure; this phase is for determining the current performance and quantifying the problems. Some of six sigma tools that will be applicable are: customer’s voice which is pivotal in understanding feedback from current and future patients’ expectations as an indication of contented service delivery. Also, a data collection plan-for example by questionnaires can be put in place to help obtain views from the customer. Process flow chart-recording activities performed as part of a process alongside benchmarking to act as Measurement System Analysis (Tolga, Sezen & Antony, 2007)
Analysis; the stage provides in-depth analysis of the primary cause of the problem and also the course in the entire system. In order to identify the major happenstances of the Wishmewell’s ED crowdedness; the long hours spent by patients, some six sigma tools have to be used. Among them is, Fishbone (ishikawa) diagram alias cause and effect matrix. It’s a methodology tool designed to aid an organization’s team identify potential cause of a particular issue (Frings & Grant, 2005). The operations are simplified by mechanism such as machines, materials, people or environmental conditions Secondly is the 5 why analysis which is applied in order to move past the symptoms towards determining the actual cause of a problem. The question “why” is asked five times, aiding to assimilation of a true cause. The third applicable tool is Regression analysis, auspiciously useful in determining that an input process is directly co-related to an output process. For example if there isn’t enough facility to treat patient(s), the implication will be the long wait time. Last but not least is Pareto chart tool which is used to analyze the frequency of the problem or cause.
Improve; to be able to decrease the wait time at Wishmewell’s ED set up, it’s primal to put down a strategic plan that will aid in improving the process currently being used. The plan involves methodologies that have been proven to be effective in other organization and thus the tools work by eliminating defects and root cause of the problem. Examples of these are: Design of experiments (DOE) which solves problems from complex processes or systems where there are many factors influencing the outcome and also where it is impossible to isolate one factor or variable from the others. A second tool is Error proofing which is implementation of mechanisms that prevent a process from generating defects. The concept behind it is that not even the smallest aberration is acceptable and since prevention is better than cure, the plan ensures that all factors fall in play in preventing any defects from happening at all costs and in the end assuring the patients safety and confidence in the program. To apply this principle, all possible errors must first be identified and automated process of warnings and shutdown can be added in the system. Another important tool that can improve the process is Kaizen event which introduces rapid change by using the ideas and motivation of the staff members of Wishmewell hospital. Brainstorming is also a tool whose sole purpose is to generate new and creative ideas that ensures that a problem is solved and in addition the tool acts as a motivation that provides autonomy and, mastery ensuring that only the best ideas are in cooperated in the new quality improvement plan to ensure reduced waiting time at the ED.
Control; this phase involves creation of a standard process that features the new ways of working and monitor future process performance. To continually monitor the results, a couple of six sigma tools have to be effected. Such is, Control plan which is the centralized document needed to keep track of an improved process at its current level. Statistical Process Control that monitors process behavior by improving quality services through reduction of process variation. Lastly is Standardized work, which helps achieve optimum efficacy, efficiency and consistency when all work is leveled at all operations (Kim, Song & Lee, 2009).
Stakeholders; Members in the program play a detrimental role in ensuring that the factors to be used in reducing the patient waiting time in the ED at the Wishmewell hospital fits each other as key and lock. These stakeholders are commended to aid in improvement of the hospitals social performance by emulating the principles of teamwork and commitment to the vision and mission of the quality improvement at the ED. The implementation team constitutes; the board directors, government official and a physician in the panel to represent both the leadership and the employee aspects of organizational set up. Social functioning is highly valued because societal interests is the central mission of the health care provider.
Directors; Stakeholders trusts that hospital board is deemed to not only champion for the fundamental mission which is to reduce the waiting time at the ED but also apt for efficient asset and management services on their behalf (Bai, 2013). Stakeholders are exemplified by; taxpayers, philanthropists, physicians, staffs, and the local community (Sloan, 2000). Stakeholders invest and do not expect a share in profits. The board directors are responsible for day to day functioning of the medical facility to produce an enabling environment for quality service delivery. This is accomplished by; impacting transformational governance and passing relevant information based on decisions made, that is, from stakeholders in management and reverse. In addition, the directors are accorded with powers to summon, employ, shuffles and fire an employee. In these dimensions, the lazing staffs are compelled to up their game to ensure that the jam in the ED is minimized hence eventually reducing the waiting time. Large board size has proven to be effective in monitoring happenings because no director-role overlaps as diversity in mastery and talent is appreciated allowing efficient supervision and governance. Which eventually transforms to improved service delivery at the Wishmewell ED area.
All board directors and the executives are volunteer oriented, charged with philanthropic zeal to achieve social performance. Both have no affinity to incentives as motivators but rather exploit moral and ethics to ensure that the improvement plan is implemented accordingly resulting in a success rate that is salient over the years (Drucker & Drucker, 2004).
Government officials on the panel; their participation in deeming the mission accomplishment is a significant factor that emulates spirit of fiduciary representation of the societal majority (Bai, 2013). They possess natural qualities that mingles with philanthropy and charity. As advocates of the local community they are likely to spearhead motions that are directed to initiate and aimed at amplifying social performance. In addition to this, at the end these officials build a name for their future political prospects hence tends to spearhead for achievement of the programs objectives which builds people’s confidence in the government official. On a plus, the government official might redirect attention into fundraising by use of his political influence hence generating funds for efficient running of the facility (Drucker & Drucker, 2004).
Physicians in the board; The collective value and mission of the board is to dispatch services aimed at fulfilling societal interests, that is, quality care in the shortest time possible. Board Physician is the most nonpolitical and medically informed member of the board owed to his/her service orientation through professional practice accompanied by ethical evaluation. This is by default a responsibility that mitigates the physician for a social performance (Drucker & Drucker, 2004) (Bai, 2013).
To prove that board size, that is, directors, government officials and physicians fulfill their fiduciary responsibility by honoring efficiency to community benefits through positive social performance; these factors were put into test. Binary and continuous variables tested in association with statements in the California law portrays that, larger board size yields positive social performance. It’s also clear that responsibilities of each board member is objected at enhancing stakeholder’s interests which is laying out of a new program aimed at improving the service quality and time consciousness in the hospital’s ED (Bai, 2013).
The foundation of this program is on the six sigma approach. The tools play an essential role in ensuring the program is practical and workable but just as well there are certain crucial factors that might hinder this program from being a success.
Top managerial involvement. Senior management team members have quite a responsibility in the deployment of the program (Feng & Manuel, 2008). Their involvement in areas such as choosing projects and teams, resolving conflicts, approving ideas from team members and assessing project milestone is important if the program is to become a success. Should any of the top managers fail to do their duty the program is bound to fail.
Scope of the program is a second factor that is crucial to the implementation. If it is too large, resources required will be many, time taken will be long and this eventually takes a negative toll on the program as the team members’ loose interest and lowers the chances of survival of the program (Feng & Manuel, 2008).
The third factor is choice of the six sigma tools. Each step has its own salient tools that are required and success depends on the awareness instilled on team members on the applications of those tools. If at any point the approaches guidelines are violated, then the improvement plan is doomed because the six sigma is a detrimental statistical model that has proven to give a 99.99% success rate in its implementation (Kim, Song & Lee, 2009).
Human wellbeing is a sensitive and critical issue that cannot be juggled, doused or tossed around with hence demands tremendous attention from not only the healthcare facility management but also from all the stakeholders. When all these is comprehended, Wishmewell is compelled and bound to set a program that will reduce the five hour waiting time in the ED to ensure that the treatment process is delightful and satisfactory hence the use of six sigma attack that solely ensures quality improvement sees the light of the day. In addition, human wellbeing is the ultimate goal of word economies in ensuring the achievement of their respective growth and development, therefore, it’s a resource that must be safeguarded at all costs.
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