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Excellence in Healthcare Delivery

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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.

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The Heart of the Matter: Hospital’s Improved Diagnostic Process Saves Lives and Money

You expect to find many lifesaving techniques in hospitals—expensive medical research, groundbreaking procedures—but when it comes to treating patients with cardiovascular disease, the approach one Taiwanese hospital used might surprise you: data analysis.

Heart disease is one of the leading causes of death in Taiwan, so it’s no wonder the country’s healthcare professionals are looking for ways to improve treatment options.

That’s why a Lean Six Sigma project team at Cathay General Hospital in the city of Taipei examined the emergent angioplasty process for treating patients suffering from acute ST-elevation myocardial infarction (STEMI), a heart attack caused by coronary heart disease. Improving aspects such as the wait time between diagnosis and treatment could help to save many lives.

Doctors and quality managers from the hospital’s Quality Management Center used Minitab Statistical Software to assess the hospital’s process and confidently re-engineer both the diagnosis and treatment processes while increasing savings in medical resources.

The Challenge

A project team at Cathay General Hospital used Minitab Statistical Software to analyze data that would improve treatment for patients suffering from heart attacks. Above, the hospital is shown in its Taipei City, Taiwan, location.

Patients with STEMI are diagnosed through electrocardiogram findings and cardiac markers, and the recommended course of treatment for these patients is angioplasty completed within 90 minutes of arrival.

Medical professionals refer to this period as the door-to-balloon (D2B) time, because angioplasty involves inserting a small balloon inside the blocked blood vessel with a catheter. When inflated at the site of the blockage, the balloon enables blood flow to resume.

To maximize the patients’ chances for survival, the team needed to evaluate each step of the process. They needed to identify which variables were responsible for a D2B time that exceeded the recommended treatment time, and, more importantly, what adjustments could be made to minimize it.

How Minitab Helped

The team analyzed D2B time—which includes an electrocardiogram, the wait time before the operation, and the time for balloon inflation—using Minitab Statistical Software.

However, you can only trust the results of an analysis if you trust the data you’re analyzing. To ensure the data were trustworthy, the project team used Minitab to conduct a Gage R&R Study of their measurement system. This method evaluates a system’s precision, including its repeatability and reproducibility to ensure that measurements are consistent and reliable.

Minitab’s Assistant menu makes it easy to choose and use the right tool, even if you’re not a statistician. The dialog box above helps users create a data collection worksheet for a Gage R&R study.

Once they verified the precision of their measurements, the team analyzed D2B data from 40 STEMI cases that occurred over a nine-month period.

First, they tested the data to see if it followed a normal distribution, which is a key assumption in many types of analysis. The data were not normally distributed, but using Minitab the team easily applied a Box-Cox transformation to normalize it. The team then used the transformed data to create an I-MR control chart to evaluate if their process was stable over time. This type of control chart plots both individual observations (I) and the moving ranges (MR) to show how the mean and variation in the observations change over time.

The I-MR control chart above displays the normalized data from the Box-Cox transformation and identifies unusual sources of variation in the data.

The project team also used Minitab to conduct a process capability analysis to determine whether their process met performance specifications and provide insight into how they might improve their process. In this case, the upper specification limit for D2B time was 90 minutes. The results of the capability analysis confirmed that the hospital’s handling of STEMI cases had significant room for process improvement.

The team examined each step in handling a STEMI patient and identified several areas in which efficiency could be significantly enhanced, including confirming the diagnosis, medicating the patient, preparing for the operation, transferring the patient to the catheterization laboratory, and inflating the balloon.

Results

After assessing the STEMI process, the team implemented improvements such as sending patients who arrive with chest pain directly to an electrocardiogram test, printing treatment sheets automatically as opposed to writing them by hand, making a STEMI medication pack available in the emergency department, contacting the catheterization staff upon diagnosis confirmation, prepackaging all STEMI operation equipment in one box, and discontinuing the use of operation time as a forum to teach staff members who are not familiar with the procedure.

The team then collected additional data and reevaluated the process. Using Minitab to analyze the new data, the team demonstrated that the average D2B time dropped from 139.2 to 57.9 minutes—a 58.4% improvement. Furthermore, capability analysis showed that this new process could meet specifications.

A more efficient process means patients receive angioplasty more quickly, which saves lives. Moreover, the average hospital stay for STEMI patients has decreased by three days since the new process was implemented, and the hospital has saved $4.4 million in medical resources. The project was recognized by the Taiwan Joint Commission of Hospital Accreditation, and was awarded the Symbol of National Quality by the Institute for Biotechnology and Medicine Industry.

Applying data analysis and Lean Six Sigma methods to the health care system doesn’t grab headlines like an experimental surgery might. But as more hospitals use data analysis to make procedures better, faster, and safer, its benefits will be seen every day in the faces of patients whose lives are saved.

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

Mapping the Healthcare Value Stream

Using Six Sigma to Reduce Pressure Ulcers at a Hospital

Since 2001, Thibodaux Regional Medical Center (TRMC) in Louisiana has applied Six Sigma and change management methods to a range of clinical and operational issues. One project that clearly aligned with the hospital’s strategic plan was an initiative to reduce nosocomial or hospital-acquired pressure ulcers, because this is one of the key performance metrics indicating quality of care.

Although the pressure ulcer rate at the medical center was much better than the industry average, the continuous quality improvement data detected an increase between the last quarter of 2003 and the second quarter of 2004.

In October 2004, a Six Sigma project to address this issue was approved by the hospital’s senior executives. A team began to clarify the problem statement. Their vision was to be the “Skin Savers” by resolving issues leading to the development of nosocomial pressure ulcers. The project team included a Black Belt, enterostomal therapy registered nurse (ETRN), medical surgical RN, ICU RN, rehab RN and RN educator.

Scoping the Project

Through the scoping process, the team determined that inpatients with a length of stay longer than 72 hours would be included, while pediatric patients would be excluded. The project Y was defined as the nosocomial rate of Stage 2, 3 and 4 pressure ulcers calculated per 1,000 patient days. Targets were established to eliminate nosocomial Stage 3 and Stage 4 pressure ulcers and reduce Stage 2 pressure ulcers from 4.0 to less than 1.6 skin breaks per 1,000 patient days by the end of the second quarter of 2005.

The team developed a threats and opportunities matrix to help validate the need for change (Table 1). They encountered some initial resistance from staff, but were able to build acceptance as the project began to unfold.

Table 1: Threats and Opportunities Matrix
Threat Opportunity
Short Term Increase length of stay Improve quality of care
Increase costs Decrease medical complications to patient
Increase medical complications to patient
Long Term Decrease patient satisfaction Improve preventative care measures
Increase morbidity rate Improve hospital status/image
Decrease physician satisfaction Increase profitability
Increase number of lawsuits Improve customer satisfaction
Decrease reimbursement
Loss of accreditation

Measurement and Analysis

During the Measure phase, the team detailed the current process, including inputs and outputs. Using cause and effect tools, process steps having the greatest impact on the customer were identified as opportunities for improvement. The team also reviewed historical data and determined that overall process capability was acceptable, but that the sub-processes had a great deal of room for improvement. Improving these sub-processes would positively affect the overall process and further improve quality of care.

Measurement system analysis on the interpretation of the Braden Scale was performed to verify that results obtained by staff RNs were consistent with the results obtained by the enterostomal therapy RN, because this is the tool used to identify patients at risk of developing a pressure ulcer. This analysis indicated that the current process of individual interpretation was unreliable and would need to be standardized and re-evaluated during the course of the project.

A cause and effect matrix was constructed to rate the outputs of the process based on customer priorities and to rate the effect of the inputs on each output (Figure 1). The matrix identified areas in the process that have the most effect on the overall outcome, and consequently the areas that need to be focused on for improvement (Table 2).

The team identified several critical Xs affecting the process:

  • Frequency of the Braden Scale – The Braden Scale is an assessment tool used to identify patients at risk of developing pressure ulcers. Policy dictates how frequently this assessment is performed.
  • Heel protectors in use – Heel protectors are one of the basic preventative treatment measures taken to prevent pressure ulcers.
  • Incontinence protocol followed – Protocol must be followed to prevent against constant moisture on the patient’s skin that can lead to a pressure ulcer.
  • Proper bed – Special beds to relieve pressure on various parts of the body are used for high-risk patients as a preventative measure.
  • Q2H (every two hours) turning – Rotating the patient’s body position every two hours is done to prevent development of pressure ulcers.

Figure 1: Cause-and-Effect Matrix

Table 2: Data Analysis

Process

Defects

Opportunities

% Defective

Z Score

Overall Process

64

16,311

0.39

2.66

Braden Scale Frequency

10

76

13.16

1.12

Proper Bed

24

76

31.58

0.48

Q2H Turning

49

76

64.47

-0.37

Data analysis revealed that the bed type was not a critical factor in the process, but the use of heel protectors, incontinence protocol compliance, and Q2H turning were critical to the process of preventing nosocomial pressure ulcers. The impact of the Braden Scale frequency of performance was not identified until further analysis was performed (Figure 2).

Figure 2: One-Way Analysis of Means for Sub-Process Defects

Evaluating data specific to at-risk patients, the team separated populations who developed nosocomial pressure ulcers from those who did not have skin breakdowns. The Braden Scale result at the time of inpatient admission from each population was analyzed to see the effect on development of a nosocomial pressure ulcer. One unexpected finding was that the admit Braden Scale result was higher for patients who develop nosocomial pressure ulcers than for those who do not develop them, showing that patients at risk are not being identified in a timely manner, thus delaying the initiation of necessary preventative measures.

The team then looked at defects for Braden Scale frequency of performance for each population of patients using a chi square test. They found the frequency of Braden Scale performance did have an effect on the development of nosocomial pressure ulcers. This was confirmed with binary logistic regression analysis (Table 3).

Table 3: Binary Logistic Regression Analysis
Process

Coefficient

Odds

Probability

Odds Ratio

No Defects

–0.5222

0.59

0.37

N/A

Braden Scale Defects

2.54322

7.55

0.88

12.72

Bed Defects

1.56220

2.83

0.74

4.77

Q2 Turn Defects

–2.16870

0.07

0.07

0.11

The most significant X is the Braden Scale frequency of performance. This analysis confirmed the need to increase the frequency of Braden Scale performance to identify at-risk patients.

Recommendations for Improvement

During the Improve phase, recommended changes were identified for each cause of failure on the FMEA with a risk priority number of greater than 200. Some of the recommendations include:

  • Frequency of Braden Scale performance to be increased to every five days
  • Braden Scale assessment in hospital information system (HIS) to include descriptions for each response
  • Global competency test on interpretation of Braden Scale to be repeated annually
  • Prompts to be added in HIS to initiate prevention/treatment protocols
  • ET Accountability Tracking Tool to be issued for non-compliance with prevention and treatment protocols as needed

The Braden Scale R&R was repeated after improvements were made on the interpretation of results. The data revealed an exact match between RNs and the ETRN 40 percent of the time, and RNs were within the acceptable limits (+/– 2) 80 percent of the time. Standard deviation was 1.9, placing the results within the specification limits. The data indicated that the RNs tend to interpret results slightly lower than the ETRN, which is a better side to err on because lower Braden Scale results identify patients at risk of developing pressure ulcers.

The Control Phase

Another round of data collection began during the Control phase to demonstrate the impact of the improvements that had been implemented. A formal control plan was developed to ensure that improvements would be sustained over time, and the project was turned over to the process owner with follow-up issues documented in the Project Transition Action Plan.

The team implemented multiple improvements, including compilation of a document concerning expectations for skin assessment with input from nursing and staff. They also gave a global competency test on interpretation of the Braden Scale, which will be repeated annually. The Braden Scale frequency was increased to five days, and they corrected the HIS calculation to trigger clinical alerts for repeat of the Braden Scale. Prompts were added for initiating the Braden Scale, and monthly chart audits were developed for documentation of Q2H turning. A turning schedule was posted in patient rooms to identify need and document results of Q2H turning of patient. Additional solutions included the following:

  • ETRN to attend RN orientation to discuss skin issues
  • Revise treatment protocol to be more detailed
  • Wound care products to be reorganized on units
  • Unit educators to address skin issues during annual competency testing
  • CNA and RN to report at shift change to identify patients with skin issues
  • Task list to be created for CNAs
  • ET accountability tracking tool to be issued for non-compliance with prevention and treatment protocols as needed

Results and Recognition

Since this was a quality-focused project, the benefits are measured in cost avoidance and an overall improved quality of care. A 60 percent reduction in the overall nosocomial pressure ulcer rate resulted in an annual cost avoidance of approximately $300,000.

To make sure their initiatives are producing a positive impact on the patient care environment, the hospital continuously measures patient and employee satisfaction through Press Ganey. Inpatient satisfaction is consistently ranked in the 99th percentile and employee satisfaction in the 97th percentile. TRMC also has received recognition in the industry for their achievements, including the Louisiana Performance Excellence Award for Quality Leadership (Baldrige criteria), Studer Firestarter Award and Press Ganey Excellence Award.

“This project is a perfect example of the need to verify underlying causes using valid data, rather than trusting your instincts alone,” said Sheri Eschete, Black Belt and leader of the pressure ulcer project at TRMC. “Six Sigma provided us with the tools to get to the real problem so that we could make the right improvements. There had been a perception that not turning the patients often enough was the issue, but the data revealed that it was really the frequency of the Braden Scale. Leveraging the data helped us to convince others and implement appropriate changes.”

The nosocomial pressure ulcer rate is monitored monthly as one of the patient-focused outcome indicators of quality care. The results are maintained on the performance improvement dashboard (Figures 3 and 4).

Figure 3: Stage 3 and 4 Nosocomial Ulcers

Figure 4: Stage 2 Nosocomial Ulcers

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 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.

The Value of Lean Six Sigma in Healthcare Delivery

Lean Six Sigma Excellence in healthcare delivery means helping improve patient outcomes while driving down the cost of patient care!

Doing so empowers healthcare providers to become more productive.  Now, more than ever, the healthcare industry needs to embrace the economic value proposition of improving productivity.  For the past 20 years, the industry has experienced negative productivity growth.  The economic consequences of this type of industry performance are stunning.  U.S. health care costs currently exceed 17% of GDP and continue to rise. A PricewaterhouseCoopers report projects that health care costs will increase 7.5 percent in 2013. That is more than three times the rate of inflation and the forecasted rate of US economic growth. That same report also notes that health insurance premiums are expected to rise 5.5 percent, in large part because employers are shifting costs to their employees.  Medicare’s Office of the Actuary forecasts that health care spending will jump to more than 7 percent in 2014.  At the same time, healthcare providers will face unprecedented cuts in reimbursement rates from Medicare and other third party payors.  The bottom line is that until true health care cost reform becomes a reality, these pressures will continue to cause problems for providers, for people’s health care and for the nation’s economy.  Healthcare organizations should use these pressures as motivation to embark upon a relentless pursuit of ever-increasing productivity.

What is the Value Proposition of Lean Six Sigma to the Healthcare Industry?

Lean six sigma is a quality improvement methodology that encourages perfection in the delivery of healthcare services.  From an operational perspective, lean six sigma’s value proposition is to improve productivity.

Value Proposition Operational 1.0

Improving quality creates a “chain reaction”.  When a provider organization improves quality, their costs go down.  Their costs go down to the tune of 20 – 40% of total operating expenses.  The decrease occurs because the costs of wasted effort reworking problems, correcting medical errors, reassuring dissatisfied patients, and reconciling invoices are eliminated.  As these costs go down, productivity naturally improves.  Productivity improves because of the increased use of human capital, technology and working capital in producing favorable patient outcomes.  Better patient outcomes and the termination of the hidden factory leads to greater profit margins and enhanced economic value.  The additional economic value funds growth and innovation, which lead to improved healthcare quality and high value jobs.

Simply put, the drive for better quality of  health outcomes and the drive for increased productivity are not mutually exclusive.  In fact, poor quality is not only poor for healthcare outcomes but also creates a drag on productivity.  As the chart below indicates, as quality improves healthcare cost per capita declines.  This correlation provides ample hope for the drive for improved productivity in the US. Healthcare system.

Cost vs Quality

Lean six sigma is a quality improvement methodology that also improves patient and stakeholder satisfaction.

Value Propositon Patient Satisfaction

From a patient and stakeholder perspective, implementing lean six sigma also creates a “chain reaction.”  When a provider organization implements lean six sigma, they continuously adapt their services to exceed patient needs, attitudes and perceptions.  They accomplish this by translating the voice of the patient into operational requirements.   Over time, they capture the market with greater patient satisfaction and a larger loyal customer base.  Consequently, they are able to make greater contributions to profits or surpluses.  The additional economic value funds growth and innovation, which lead to improved healthcare quality and more high value jobs.

What kind of results have healthcare providers experienced with lean six sigma?

  1. Mount Carmel Hospital Medicare+ Choice Plan reimbursement project reduced coding of working-aged Medicare recipients and resulted in $857k gain in net income.
  2. Commonwealth Health Corporation’s radiology project decreased the time between dictation and signature, reduced patient visit times, and improved staff scheduling.  The project saved $800,000, increased through put by 25% and freed up an additional 14 positions to fill open job requisitions.
  3. Wellmark Inc., (BC&BS Medical Plans)  physician addition to managed care networks project reduced the amount of time for adding a physician to the BC&BS medical plans.  The new process produced $3M per year in savings.
  4. Charlston Area Medical Center’s supply chain management project for surgical supplies reduced inventory levels and improved supplier relationships.  The project garnered an immediate savings of $163,410 and saved an additional $841,540 over the projects lifecycle.

Lean Methods at Miami Children’s Hospital

Why is TPMG’s Lean Six Sigma Excellence in Healthcare Delivery™ a superior program?

The focus of the program is on applying the concepts of performance management and continuous improvement to create and sustain a more productive, efficient and cost effective healthcare delivery organization.   Professionals learn to:

  • Execute the standard process improvement methodology which reduces healthcare delivery costs by 20% – 30%.
  • Use continuous improvement methods to improve patient outcomes and sustain patient satisfaction.
  • Apply lean methodology and proven six sigma practices, in healthcare facilities, that improve operational efficiency and service excellence.
  • Lead hospital executives and performance improvement staff in identifying lean opportunities across the enterprise.
  • Oversee development and execution of lean project plans to support process improvement initiatives.
  • Use Lean 5S, Value Stream Mapping, and other lean process activities in support of performance improvement initiatives.

The value is affordable for any budget.

For one affordable price a practice, hospital or system can take advantage of:

  1. Excellence in Healthcare Delivery Training
    • Executive Champions – up to 25 candidates
    • Lean Healthcare Basic Training for Managers and Individual Contributors – up to 25 candidates
    • Lean Healthcare Black Belt Certification Training – up to 25 candidates
    • Lean Healthcare Green Belt Certification Training – up to 25 candidates
  2. 120 hours of Lean Six Sigma Healthcare Master Black Belt coaching and mentoring.
  3. Free licenses to TPMG’s Lean Six Sigma Excellence in Healthcare Delivery™ training materials.

Experience and expertise counts.

  1. Benefit from a curriculum and best practices built by practitioners from the nation’s finest healthcare systems.
  2. Realize the benefits of greater productivity and cost improvements.  Improvement projects deliver an average of $256,000.00 in hard dollar cost savings per project.  TPMG certified lean six sigma black belts can deliver 4 to 6 projects per year.
  3. Receive mentoring and best practices from certified Lean Six Sigma Master Black Belts with more than 20,000 hours of experience from a cross section of industries like:  healthcare, insurance, shared services, financial services, logistics, call centers, and telecommunications.

To learn more about High Quality, Affordable Lean Six Sigma Training for Healthcare contact TPMG directly by CLICKING HERE!

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