Improve Phase: Lean Six Sigma in Healthcare Tutorial

6.1 Module 6 Improve

Hello and welcome to the sixth module of the Lean Six Sigma in Healthcare course offered by Simplilearn.   The DMAIC process is the foundation of LSS projects. DMAIC stands for the project phases of Define, Measure, Analyze, Improve, and Control.   This module is dedicated to the fourth of these phases, improving the process by finding and implementing a solution that addresses the root causes.     Let us explore the objectives of this lesson in the next screen.

6.2 Topic 1 Techniques to Generate Solutions

While coming up with solutions is not usually difficult for most people, it can be unnerving when they are asked to do it in a structured and methodical way.  As we've seen in the previous modules, in the other phases of the DMAIC process, the project team must be very disciplined to not immediately jump to solutions to ensure that the root cause gets properly addressed. Let us begin with the first topic of this lesson, Techniques to Generate Solutions.

6.3 Topic 2 Evaluate, Select, and Prioritize

There can be many more solution ideas generated than are actually required. So how does a projeçt team select the most appropriate solution?   If there are several solutions possible, the project team may have to vote on the one they should implement. This may be a difficult task if the project manager doesn't have a way to facilitate the decision.  While there is no right or wrong way to do this, there are different approaches that can be taken.  One of the best ways is to have an open discussion while attempting to render the decision as objective as possible.  The following are some tools to help with this approach.   List down Advantages and disadvantages including constraints and limitations   For each potential solution, the team has to brainstorm and list the advantages of that particular solution.  Also, ask them to list the disadvantages such as constraints, limitations, or other issues related to the solution. Once this exercise is done, the team can have a much easier time comparing options based on more than just their own personal opinions.   Next process is the consideration of ease of implementation vs impact on y.   For each potential solution, the team should discuss and plot the points on an x, y grid where the particular solution should be situated relative to others in terms of ease of implementation and impact on the problem.  For example, solution A may be very easy to implement and has a low perceived impact on the kpov while solution B may be very difficult to implement but has a high impact on the kpov. Seeing the solutions plotted relative to each other from the perspective of these 2 dimensions may help to decide which is the most appropriate to implement.   Multivoting   Another tool is multivoting.  While this is effective, it can be somewhat subjective when used on its own and may even be discouraging for certain team members if used without a thorough understanding of each of the solutions.  Multivoting works best when combined with other tools mentioned previously. This way, team members vote from a common level of understanding of each potential solution.   Multivoting can be done in several ways.  One of the easiest ways to conduct is to assign a certain number of votes to each participant (for example, 5 or 10 votes). Participants can then allocate those votes among the solutions as they seem fit. The solutions they feel more strongly about, get the most votes.   Another way to do multivoting is to ask each participant to rank the solutions from best to least best. For example, if there are 5 solutions, the best one gets a score of 1 and the worst (or least best) gets a sore of 5. All the ranking scores from each participant are then tallied for each solution and the totals are ordered from lowest to highest. The lowest total score will be the overall favored solution by the participants.   Remember, by it’s very nature, multivoting is subjective. The purpose of this exercise is to facilitate the team decision-making process by offering an opportunity to reach consensus or common ground. Once the project team agrees on the chosen solution, it’s time to work out the implementation details. However, there are some important risks that should be discussed beforehand.   As mentioned earlier, chances are the project team will have several solutions on the table.  This reality gives rise to several risks as well.  These risks are scope creep, delays due to batching, and not adequately addressing the root cause.  Let us look at each of these risks in the next screen.

6.4 Topic 3 Develop and Implement Solutions

After all the time and effort spent getting to the root cause and coming up with a solution to fix it, it would be really discouraging and wasteful for the team and the organization as a whole to hit a roadblock while implementing that solution. This is why a little bit of planning and coordination at this stage goes a very long way. In this topic, we will cover some of the key considerations in developing an effective solution implementation plan.

6.5 Topic 4 Case Study

If you recall from our case study project at Mercy West hospital, John and his team narrowed down the critical cause of delays to a bottleneck in the discharge process related to releases involving arrangements for continued care and/or logistics. The team also discovered that if they can avoid discharge orders being given after 10am and on Tuesdays or Wednesdays, they could reduce the overall cycle times.   Now it was time for the team to come up with potential solutions.   While several solutions were offered in the past by participants and employees and also during the measure phase of the project, the team remained very disciplined and recorded them on a Parking Lot as they continued to stay focused on their tasks. This parking lot served them well during the solution brainstorm as they were immediately able to see whether or not any of the parking lot items actually helped to address the now evident root cause.   One item in particular, seemed to be on target. It was from the administrative clerk who said that her workload was not steady, she always seemed to be bombarded with discharge orders midweek and also had a pile to get through when she came to work most mornings. She suggested that the discharges should somehow by scheduled evenly throughout the week.   This suggestion alone sparked a number of solution ideas during the brainstorm. In all, the team came up with 15 different ideas or combinations of ideas to help reduce discharge cycle times.   After reviewing each one and then using the multi-voting technique to rank them, the team reached a consensus that the solution they would implement was to try to align the discharge administrative process with the doctors’ patterns of initiating the discharge midweek.   Presently, most doctors were trying to get their patients discharged in time to be home for the weekend, so they would initiate most of their discharge orders on Tuesdays or Wednesdays thinking there would be ample time for the patient to be home by the weekend. This created a wave of discharge orders and which was a burden to the administrative staff who only worked during regular office hours.   Harmonizing the administrative staff availability with this good (and customer centric) intention meant ensuring that the administrative support work schedule would be modified slightly to be present at strategic times throughout the entire day as opposed to just during regular office hours and consequently eliminate the discharge orders from piling up overnight without being treated.   The team decided that a temporary employee in a clerk role could easily perform these preliminary and repetitive coordination tasks during off hours if they are given adequate training.   The solution also required some logistics arrangements and post discharge care to be coordinated after hours. After a little discussion, the team realized that this would be rather difficult when it came to arranging for in-home care in particular. In order to address this limitation, they decided to create a risk abatement measure in the process by including a special note on the discharge form advising the treating doctor that if there is a possibility of in-home care MAY be required, the discharge order should be submitted before 10 am weekdays if it is to be treated and coordinated the same day.   Now that the solution framework was established, the team validated their idea against the original project charter in order to confirm there was no scope creep and also to make sure that their solution was actually addressing the problem they set out to resolve. In addition, the idea of using temp clerks as opposed to changing the work schedule of the administrative clerk was a kind of way to pilot the solution without having to go through the long process of justifying and then hiring additional permanent staff and delaying the solution implementation. The implementation plan was developed and included a detailed summary of what the solution was and how it would be introduced. A timeline and action plan was developed and it included activities such as modifying the discharge order form and process documentation, information sessions, and also the creation of a detailed task sheet and training for the temporary administrative clerk.   Upon the review of stakeholder analysis, the team identified the key stakeholders and devised the strategies to on board them with the proposed solution.   It is now time to get the approval to implement the solution.

6.6 Quiz

You will now attempt a quiz to check your understanding of this lesson.

6.7 Summary

In this module we discussed some of the important elements of the Improve phase of an improvement project. Here is a quick recap of what was covered in this module: First we explored how the project team can generate solutions to address the identified root cause of the problem.  We understood that a brainstorm is an effective method for the team to generate solutions.   From there, we discussed the two effective ways to address common problems —Mistake-proofing or Poka Yoke and Kanban. We also discussed that to select the best solution, the project team should have an open discussion. We also covered some of the more important risks that can arise during developing and choosing solutions of the Improve phase.    We also discussed that the implementation plan should cover these 3 main categories—Context, Risk, and Change management and communication. We concluded the module with a case study in a hospital that served to illustrate how these elements fit in together in a practical setting.

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  • PMP, PMI, PMBOK, CAPM, PgMP, PfMP, ACP, PBA, RMP, SP, and OPM3 are registered marks of the Project Management Institute, Inc.

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