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The Performance Management Group (TPMG) announces its 3rd Quarter Lean Six Sigma Excellence in Healthcare Delivery Certification Graduates.

8/30/2018 – Phoenix, Arizona  USA

The Performance Management Group (TPMG) announces its 3rd Quarter Lean Six Sigma Excellence in Healthcare Delivery Certification Graduates.

TPMG Education Services would like to congratulate its 3rd Quarter 2018 Lean Six Sigma Certification Graduates.

This accomplishment acknowledges they have fulfilled the requirements for the program of study and, from this day forward, they are certified as Lean Six Sigma Green Belts and Black Belts.  This designation is conferred upon them as of Friday August 24, 2018.  They are now authorized to place their respective “LSSBB” or “LSSGB” designation, which acknowledges this credential, following their name.

Congratulations Lean Six Sigma Black Belt Certification Graduates:

  1. Joyce Taylor, Director – Telligen
  2. Janice L. Stanton ,  Manager of Pre-Design Services – Gresham, Smith and Partners
  3. Ann Hastings, Business Intelligence Data Analyst – St. Luke’s Health System
  4. Ismael Groves – Director of Program Operations, Consumerism – Banner Healthcare

Congratulations Lean Six Sigma Green Belt Certification Graduates:

  1. Landin Shan, Project Manager of Shanghai Market – Shanghai United Healthcare
  2. Solomon Fatima, A/R Management Supervisor – Shanghai United Healthcare
  3. May XU, Outpatient Cashier Supervisor – Shanghai United Healthcare
  4. Clement Qi, IT Manager of Shanghai Market – Shanghai United Healthcare
  5. Susan Fang, Clinical Manager – Shanghai United Healthcare
  6. Sabeen Irfan, Clinical Operations Manager – Shanghai United Healthcare
  7. Zhang Ying, Lab Associate Manager – Shanghai United Healthcare
  8. XiaoMeng Sun, Medical Staff Office Supervisor – Shanghai United Healthcare

For more information regarding lean six sigma training, certification and consulting – contact TPMG llc at 623.643.9837 or logon to http://www.helpingmakeithappen.com.

Patient Safety: Akron Children’s Hospital Uses Lean Six Sigma and Minitab in the NICU

Serious about Patient Safety: Akron Children’s Hospital Uses Lean Six Sigma and Minitab in the NICU

 Akron Children’s Hospital is serious about enhancing the patient experience, along with delivering quality healthcare in a timely, efficient manner. While the hospital formally established the Mark A. Watson Center for Operations Excellence in 2008, it has been performing quality improvement since its early beginnings 125 years ago. It’s no wonder the healthcare provider has consistently earned Best Children’s Hospitals rankings in 7 of the 10 specialties evaluated annually by U.S. News & World Report—including cancer, diabetes and endocrinology, pulmonology, neonatology, neurology and neurosurgery, and orthopedics.

The hospital encourages employees across all skill levels and departments to become involved in quality improvement, offering several levels of Lean Six Sigma training. As part of its green belt training and certification, employees learn to use Lean Six Sigma by leading and completing long-term projects with the guidance of experienced black belts.

One such green belt project, which began at the hospital’s Mahoning Valley, Ohio campus, had a goal to decrease one particular safety event—unplanned extubations in the hospital’s neonatal intensive care unit (NICU). To complete this project, the hospital improvement team relied on Lean Six Sigma tactics and the data analysis tools in Minitab Statistical Software.

The Challenge

Akron Children’s Hospital relies on Minitab Statistical Software to analyze their Lean Six Sigma project data. The hospital used Minitab to verify improvements made to the intubation process in the NICU.

An intubation is a medical procedure in which a breathing tube is placed into a patient’s trachea. This tube connects the patient to a machine called a ventilator, which helps the patient breathe. The procedure is common for both pediatric patients and adults in intensive care, but is most common for premature newborn babies residing in a hospital’s NICU. Babies born prematurely often have undeveloped lungs, which cause breathing problems and the need for the assistance of a ventilator.

Although this medical procedure is commonly performed, it is not without risk, and can cause trauma to or introduce an infection into the patient’s airway. Unplanned removal of the breathing tube, which is also known as an unplanned extubation, is a likely occurrence that can cause harm. Unplanned extubations are the fourth most common adverse event in NICUs across the U.S.

Akron Children’s Hospital’s Department of Respiratory Care had been collecting data on the rate of unplanned extubations in the Mahoning Valley NICU for well over a year, but had not had the capacity to investigate the occurrences further. Bonnie Powell, a Registered Respiratory Therapist and manager of respiratory services at Akron Children’s Hospital, was a green belt candidate during the time unplanned extubation data were collected. As part of her Lean Six Sigma training and certification, she set out to lead a project that would decrease the rate of unplanned extubations in the Mahoning Valley NICU.

“I knew this project was the perfect fit for me because as a respiratory therapist, I’ve been part of the frontline staff primarily responsible for intubating,” Powell says. “When you’re the one actually putting the tube into the patient, it just affects you more because you know the trauma that you could be causing to them.”

How Minitab Helped

While there’s not a true benchmark rate that NICUs should strive to stay below regarding unplanned extubations, the Vermont Oxford Network—a research collaboration of nearly 1,000 global NICUs including Akron Children’s—considers 2 in 100 intubated patient days to be the upper limit of acceptable. Previous data collected on the rate of unplanned extubations at the Mahoning Valley NICU revealed a rate of 3 in 100 intubated days.

“Any unplanned extubation has the potential to cause harm to the patient and negatively impact overall patient satisfaction,” says Powell. “We wanted to improve our performance on this metric.”

Powell’s Lean Six Sigma project team included a multidisciplinary group of nurses, respiratory therapists, a neonatal nurse practitioner, and a neonatologist.

The team began by using Lean Six Sigma tools to brainstorm reasons why unplanned extubations were occurring, as well as solutions for stopping them. “The fishbone diagram and cause maps were among the most helpful tools we used,” Powell says. “We looked at the highest impact solutions, as well as how easy they would be to implement, and prioritized solutions from there.

“This step helped us to organize and roll out our seven improvements into two phases,” she says.

Along with more frequent communication between nurses and respiratory therapists before, during, and after an intubation, as well as educational information distributed in meetings and via email, one improvement implemented was the “two to turn” rule. “Anytime an intubated patient is repositioned, one caregiver is turning the patient and another is holding the tube at the patient’s mouth,” Powell explains.

The team applied the improvements for several months, as collecting enough data to meet the required 100 intubated days for pre- and post-improvement comparison proved difficult for many reasons.

“There is a continuing trend in neonatal care to use devices such as masks and nasal prongs to connect the patient to the ventilator to help with breathing. When these devices are used, there is no need for a breathing tube, which reduces the number of intubated days and lengthened our post-improvement data collection period,” Powell says. “That, coupled with greater attention to our weaning protocol, which focused on shortening the time babies need ventilator support of their breathing, contributed to why we saw a reduced amount of intubated days.

“Of course, fewer intubated days was a good thing in this case, and supported the idea that our improvements were working,” adds Powell.

To compare unplanned extubations, pre- and post-improvement, the team visualized their data using control charts in Minitab Statistical Software.

Minitab graphs clearly reveal the impact of improvement efforts. This control chart displays the reduction in unplanned extubations after Lean Six Sigma improvements were implemented.

To verify their results statistically, the team ran a 2 proportions test in Minitab to see if their unplanned extubation rates decreased after improvements were put into place.

Hypothesis testing in Minitab makes it easy to determine if there is enough evidence in a sample of data to infer that a certain condition is true for an entire population.

The analysis showed the team that after improvements were implemented, the unplanned extubation rate had indeed decreased.

The team also used Minitab to perform process capability analysis both pre- and post-improvement. This tool provided another before-and-after comparison of unplanned extubation rates, and aided the project team in assessing whether the new process was capable and in statistical control.

“I have never taken a statistics course and have no background in this type of work,” Powell notes, “but Minitab, coupled with the instruction I received from the Center for Operations Excellence, made it easy for me to analyze and understand my data.”

Trauda Gilbert, deployment leader for the Center for Operations Excellence at Akron Children’s, echoes Powell. “To be able to use Minitab to visually demonstrate the before and after effect with a control chart, which you can then share with your team and champion is really valuable. Minitab also makes it easy for front-line staff to document that they have made a statistically significant difference. To be able to do that without having to interact with a biostatistician or one of the other very rarely found statistical resources in our organization, is very beneficial,” she notes.

“Healthcare quality is a little different than manufacturing because we can’t just run a DOE and tweak a process line,” says Gilbert. “Even though we’re different, Minitab still helps us out.”

Results

The data revealed a dramatic reduction in intubated days after the improvements were made, as well as a considerable reduction in the rate of unplanned extubations at the Mahoning Valley campus. The reductions brought their rates in line with the Vermont Oxford Network’s suggestion of 2 unplanned extubations in 100 intubated patient days.

“This project showed us that simple improvements can create real change,” says Powell. “The cultural change this project instilled in our team was exciting—the recognition that even they could make a difference is huge.”

Cost savings resulting from the reduction in supplies and staff time needed to care for unplanned extubations can be calculated, but the overall financial impacts are hard to quantify. “The larger costs of unplanned extubations—such as a longer NICU length of stay, ventilator-associated pneumonia, and other setbacks that the patient can experience from the event—can be difficult to tease out,” Powell says.

“Neonatal patients are some of our key customers here,” she continues. “Due to the fact that they were born early, they come back to our institution for care frequently, especially initially. Making sure they have a safe experience early is critical, because the results of good care at this stage can have exponential benefits for patients in the future.”

In addition to improving the patient experience, the project helped Powell obtain her Lean Six Sigma belt certification. “I did get my green belt as a result, and we’ve also rolled out selected improvements to the NICU at our Akron campus,” she says. “We’re in the process of collecting data there as well, so this project didn’t just stop in Mahoning Valley.”

Powell’s project is just one example of an estimated 300 documented projects that have been completed throughout the Akron Children’s organization. The total financial savings of the hospital’s operations excellence program is estimated to be more than $25 million since its official beginnings in 2008.

Learn more about lean six sigma in healthcare :  Six Sigma Master Class – Improving Healthcare Processes

Lean Six Sigma in Healthcare: Improving Patient Satisfaction

Riverview Hospital Association
For providers like Riverview Hospital Association, serving Wisconsin Rapids, Wis. and surrounding areas, recent changes in the U.S. healthcare system have placed more emphasis on improving the quality of care and increasing patient satisfaction. “In this era of healthcare reform, it is even more essential for providers to have a systematic method to improve the way care is delivered,” says Christopher Spranger, director of Lean Six Sigma and Quality Improvement at Riverview Hospital Association. “We have had a Lean Six Sigma program in place for four years, and we are continuously working on ways to make our hospital safer and more efficient.

The Challenge

Under what is known as Hospital Inpatient Value-Based Purchasing (VBP), a portion of the Medicare payments hospitals receive are tied directly to patient satisfaction metrics and the quality of care, rather than entirely on the volume of Medicare patients treated. A new rule from the Centers for Medicare and Medicaid Services (CMS) grants Medicare incentive payments to hospitals that are meeting high quality of care standards, or have shown sufficient improvements. Hospitals that do not meet these standards are subject to a reduction in Medicare payments. “Nearly all hospitals treat a sufficiently large percentage of Medicare patients,” says Spranger, “so this rule presents a significant challenge with substantial financial implications for us—and for many other hospitals.”

Incentive payments are determined by how well hospitals score on two point-based domains. One domain takes into account the clinical process of care, where the hospital is judged on its performance in meeting twelve predefined clinical measures. The second domain is based upon the overall patient experience and measured through a survey called the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). HCAHPS scores depend on the percentage of positive responses received for each question within each specific ”dimension,“ or category. Dimensions include communication with doctors and nurses, clarity of discharge information, overall hospital rating and more.

When Spranger and the Lean Six Sigma team at Riverview discovered that the hospital’s overall HCAHPS survey scores were lower than desired for the discharge information dimension, they set out to improve scores with Lean Six Sigma techniques and data analysis.

How Data Analysis Helped

The Lean Six Sigma team’s goal was to increase the percentage of “yes” responses for the following yes/no HCAHPS survey question: “During this hospital stay, did doctors, nurses, or other hospital staff talk to you about whether you would have the help you needed when you left the hospital?” To start, the team assessed their baseline performance by plotting outcomes from the previous 24 months with a Minitab control chart. The chart revealed a stable process and a current average positive monthly response rate of 85 percent. The goal was to improve positive monthly responses and exceed the preset benchmark of 91 percent.

Minitab Control Chart

To determine underlying factors that could be causing low scores, Spranger and the team chose to analyze data the hospital already had on-hand about the patient, which was collected as part of the HCAHPS survey. They had access to the responder’s age, gender, length of stay, primary language, education level, hospital unit visited and more. With Minitab charts, histograms and plots, they were able to explore the variables and responses graphically.

The team analyzed the variables further, and used the Minitab Assistant to guide their statistical analysis. They followed interactive decision trees to determine which analysis to use, and selected Analysis of Variance (ANOVA) to compare sample means and to look for significant differences within variables that could be impacting the HCAHPS survey question.

Minitab Assistant

The Riverview team began this project with a preset assumption that differences in the education level or the primary language of the respondent might offer insight into the low scores, but their analyses of these variables revealed no statistical significance. However, analysis of other variables uncovered statistically significant differences within respondent age groups and the hospital unit visited.

Surpassing the Benchmark

The Riverview Lean Six Sigma team was able to narrow the project scope and use the insights they gathered to improve patient satisfaction for groups identified as scoring the lowest. “Historically, health organizations try to increase patient satisfaction through staff training and other large-scale solutions,” says Spranger. “Now, with a data-driven approach, we are able to better target improvements.” The improvements for this project targeted low-scoring patient groups from specific age ranges, as well as patients who stayed in specific hospital units.

The team also used the improvement effort to solve key problems identified in the current process for handling patient discharges, which included timing of education, ensuring the involvement of a family caregiver, and clarifying outcomes with the patient. They redesigned the discharge education process into three phases to address previous issues with timing, collaborated with primary care physician clinics to ensure consistency, created a process to ensure that a primary family caregiver was identified to engage in care management after discharge, and clarified terminology in discharge documentation that was considered vague.

After implementing these improvement strategies, the team compared the current proportion of “yes” responses to responses before the project began. They achieved an impressive gain in the proportion of “yes” responses and met their goal to surpass the 91 percent benchmark for average positive monthly responses.

Learn more about lean six sigma in healthcare :  Six Sigma Master Class – Improving Healthcare Processes

Congratulations Michael Cossiart on Becoming a Certified Lean Six Sigma Black Belt!

7/7/2017 For Immediate Release – Phoenix, Arizona * United States

TPMG would like to congratulate Michael Cossiart for successfully completing the Lean Six Sigma Excellence in Healthcare Delivery Black Belt Certification program and earning his lean six sigma black belt!  He successfully completed the rigorous 16 unit – 65 lesson online blended lean six sigma black belt workshop by passing the certification examination with distinction.  The goal of Michael’s lean six sigma black belt certification project was to improve the throughput and productive capacity of his hospital’s radiology department.   His black belt project successfully eliminated 80 hours of non-productive wait time per month, decreased overtime by 44% ($245k annual savings) and increased the capacity to serve 22 more patients per month.  Congratulations Michael!

Michael Cossiart serves as a Program Manager in Performance Improvement at PeaceHealth.  He has more than 14 years professional experience in healthcare and served as an industrial engineer for 3 years at the Boeing Corporation.

Michael earned his Masters in Business Administration  from Western Washington University and holds a Bachelors Degree in Industrial Engineering from the Oregon Institute of Technology.

The Performance Management Group’s Lean Six Sigma Excellence in Healthcare Delivery Black Belt Certification Program is specifically designed for professionals who work for healthcare clinics, hospitals and systems. TPMG has been certifying green belts and black belts for more than 15 years. The company provides lean six sigma certification on-site, online, and on-campus (at the University of Phoenix) nationwide. For more information regarding lean six sigma training, certification and consulting – contact TPMG llc at 623.643.9837 or logon to www.helpingmakeithappen.com.

Congratulations Aleksandra Stolic on Becoming a Certified Lean Six Sigma Green Belt!

7/27/2017 For Immediate Release – Phoenix, Arizona * United States

TPMG would like to congratulate Aleksandra Stolic for successfully completing the Lean Six Sigma Excellence in Healthcare Delivery Green Belt Certification program and earning her lean six sigma green belt!  Aleksandra successfully completed a rigorous 10 unit – 45 lesson online lean six sigma green belt workshop by passing the certification examination with distinction.  This accomplishment acknowledges she has fulfilled the requirements for the green belt program of study and, from this day forward, is certified as a Lean Six Sigma Green Belt.  By completing this distinctive course, she is qualified and authorized to implement lean applications and performance management systems.  Congratulations Aleksandra!

Aleksandra is currently a well qualified Project Manager of Independent Medical Education and Medical External Affairs at Takeda Pharmaceuticals.  She has more than 18 years experience in the healthcare industry 14 of which with the American Academy of Pediatrics.  She holds a Master of Public Health from Northern Illinois University and a Bachelors of Arts in English from University of Belgrade.  In addition to her Lean Six Sigma Green Belt Certification,  Alexandra is a Certified Scrum Master and is a member in good standing with Alliance for Continuing Education in the Health Professions.

The Performance Management Group’s Lean Six Sigma Excellence in Healthcare Delivery Green Belt Certification Program is specifically designed for professionals who work for healthcare clinics, hospitals and systems. TPMG has been certifying green belts and black belts for more than 15 years. The company provides lean six sigma certification on-site, online, and on-campus (at the University of Phoenix) nationwide. For more information regarding lean six sigma training, certification and consulting – contact TPMG llc at 623.643.9837 or logon to www.helpingmakeithappen.com.

Congratulations Heather Kincaid on Becoming a Certified Lean Six Sigma Black Belt

3/23/2016 For Immediate Release – Phoenix, Arizona * United States

TPMG would like to congratulate Heather Kincaid for successfully completing the Lean Six Sigma Excellence in Healthcare Delivery Black Belt Certification program and earning her lean six sigma black belt!  She successfully completed a rigorous 16 unit – 65 lesson online blended lean six sigma black belt workshop by passing the certification examination with distinction.  Her lean six sigma certification project’s objective was to optimized the ambulatory work flow in the orthopedic clinic(s) she supports.  Heather expertly used the DMAIC improvement model along with lean management and the six sigma analytic tool set to bring about favorable sustained changes.   Her improvement plans addressed the root causes and produced results that showed a marked improvement in the clinic as well as realized savings from the staffing model.  Her project produced savings of $157, 184 (annualized) that will continue to pay dividends every year going forward. Congratulations Heather!

Heather Kincaid is a Process Engineer for the Wexner Medical Center Management Engineering and Process Improvement team and has been a respected member of the team since 2012.  She holds a Masters of Science in Industrial Engineering from The Ohio State University and a Bachelors of Arts Degree in Mathematics from Denison University.

The Performance Management Group’s Lean Six Sigma Excellence in Healthcare Delivery Black Belt Certification Program is specifically designed for professionals who work for healthcare clinics, hospitals and systems. TPMG has been certifying green belts and black belts for more than 15 years. The company provides lean six sigma certification on-site, online, and on-campus (at the University of Phoenix) nationwide. For more information regarding lean six sigma training, certification and consulting – contact TPMG llc at 623.643.9837 or logon to www.helpingmakeithappen.com.

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