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Focus on process slashes average cycle time by 37%
Staff overcome instinct to blame personnel levels
It may seem logical to blame your overcrowding problems on understaffing, but as the ED staff at the 302-bed North Shore University Hospital at Forest Hills in Queens, NY, found out, that may not always lead you to the root of your problems. Learning that lesson, and finding the real cause of their problems, enabled them to slash their average cycle time from 187 minutes to 118 minutes.
At the outset of a Six Sigma project to address the issue of excessive patient wait times in the ED, "Every-one involved stated that the ED was understaffed," recalls Kevin G. Tuttle, MBB, MHA, the Six Sigma Master Black Belt who oversaw the project on-site. (Six Sigma Master Black Belts are quality leaders responsible for Six Sigma strategy, training, mentoring, deployment, and results.)
"The [Six Sigma] team also thought staffing was a major issue with the project," Tuttle says.
Tuttle and North Shore partnered with Waukesha, WI-based GE Healthcare, a $14 billion unit of General Electric Co., "so that GE could train North Shore in the Six Sigma methodology," he says. GE Healthcare offers services to address productivity and better enable health care providers to diagnose, treat, and manage patients with conditions such as cancer, Alzheimer’s, and cardiovascular diseases.
Tuttle, who is with the Center for Learning and Innovation at the hospital’s parent organization, North Shore-Long Island Jewish Health System in Lake Success, NY, demonstrated to them that more nurses, physicians, and registrars were not the answer. "We started to measure the data, and what we saw was there were gaps in the process that had nothing to do with staff," he adds. "We could have had 14 more ED people, but the process was broken and not where it should be."
The Six Sigma team included the assistant director of the ED, Jim Halfpenny, DO, who, in Tuttle’s words, was "our lifeline to the clinical staff." The team, which also included two staff nurses and the ED charge nurse, broke down the process into several steps, or buckets:
All of the time clocks were synchronized with the ED computer system. "That’s basically how we measured the whole process," says Tuttle. This required purchasing three additional time clocks at a cost of less than $500, he notes.
After completing a measurement system analysis, the data were reviewed by the team. A primary issue that surfaced was how the registrar was working and the batching of charts by the registration staff. When they were busy, the registration staff gathered three or four before bringing them back. In addition, which physician was on duty seemed to be a major cause of variation in the process. Here were some solutions:
Another key lesson learned is the value of having someone like Halfpenny on the team. "Given their preconceived notions, getting physician and nurse buy-in was critical," Carter notes. "For that, you need to have the people closest to the process itself on your team."
Finally, he advises, let your team find its own solutions. "I always have some good solutions in the back of my head," Carter concedes, "But you must let the team [members] figure it out for themselves. They will not let their own idea fail."
For more on the North Shore Six Sigma project, contact: