agile lean six sigma for healthcare · lean six sigma for healthcare jay arthur learning outcomes...
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10/30/2018
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AgileLean Six SigmaFor Healthcare
Jay Arthur
Learning Outcomes
• Learning outcome 1
• Learning outcome 2
• Learning outcome 3
• Learn the difference between Lean Six Sigma and Agile LSS.
• Discover tools and techniques to get your organization on
board quickly.
• Learn to identify problem areas and root causes.
• Discover the 12 principles of Agile Lean Six Sigma.
• Learn to "hack" Lean Six Sigma to make it agile.
20th
Century Quality Improvement
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Data
+
7 Key
Tools
Uncomplicated
Problems
Simple Problems
Complicated Problems
ToolsComplex
None
Problems
Focus
Improve
Sustain
Honor
MethodsDMAIC, DOE
Trial & Error
© MMXVI KnowWare
Hacking Lean Six Sigma
The spirit of hacking can be adapted and
applied to general business management,
not just technical innovation.Scott Brinker – Hacking Marketing
9© MMIX KnowWare www.qimacros.com
Hacking Lean
WHERE DO I START?
SHRINK THE ARROWS
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Value Stream Mapping
10 © MMIX KnowWare www.qimacros.com
Spaghetti Diagramming
11 © MMIX KnowWare www.qimacros.com
Nursing Unit Spaghetti Diagram
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Hacking Six Sigma
Action
Countermeasures
MatrixControl Chart with
Process Change
Make Sure Your Story Uses the Magnificent Seven Tools
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IS THAT GOOD OR BAD?
I DON’T KNOW
IS THAT GOOD OR BAD?
I DON’T KNOW
STABLE AND CAPABLE!
Most Data Is Overcooked
(C) MMXVI Knowware www.turningdataintodollars.com 18
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Go on a Raw Diet!
Why Raw Data?
(C) MMXVI Knowware www.turningdataintodollars.com 20
Because Summarized Data Has Little Nutritional Value
If You Have Data Like This…
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If You Have Data Like This…
Data Mining Wizardry
Raw Data
Insights
For Action
Pivot Tables
Select the
Right Charts
Counted &
Categorized
Data
Focus on Performance
Start with a control chart of defects, mistakes, errors or costs:Charges Coded as Denials
$2,552,122UCL
CL $1,071,509
LCL $(409,103)
$(1,000,000)
$(500,000)
$-
$500,000
$1,000,000
$1,500,000
$2,000,000
$2,500,000
$3,000,000
10/02 11/02 12/02 01/03 02/03 03/03 04/03 05/03 06/03 07/03 08/03 09/03
2002-2003
Ch
arg
es
Denials (E)
UCL
+2 Sigma
+1 Sigma
Average
-1 Sigma
-2 Sigma
LCL
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Go Deeper –
Apply the 4-50 Rule
4% of the Process Results in over 50% of the Errors
Use Paretos to Find What to Fix
Denial-No Appeal Charges
$150$109,813$336,270
$750,766$1,295,032
$2,516,508
$7,849,569
100%99%97%
91%
81%
61%
$-
$1,607,264
$3,214,527
$4,821,791
$6,429,054
$8,036,318
$9,643,582
$11,250,845
$12,858,109
Timely Filing Medical
Necessity
No Auth Partial Auth Invalid Auth ET ES
Memo Code
Am
ou
nt
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
n=12858108.93
Denials for Timely Filing by Insurer
1114471114151824242745
81
501
100%100%100%99%99%98%96%94%
93%90%
87%84%
81%
75%
64%
0
97.25
194.5
291.75
389
486.25
583.5
680.75
778
Ins 1 Ins 2 Ins 3 Ins 4 Ins 5 Ins 6 Ins 7 Ins 8 Ins 9 Ins 10 Ins 11 Ins 12 Ins 13 Ins 14 Ins 15 Ins 16
Payer
Nu
mb
er o
f D
enia
ls
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
n=778
64% of Denied Due to
Timely Filing Claims Due
to one Insurer
Use Paretos to Find What to Fix
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Identify Root Causes
Use the fishbone diagram to perform root cause analysis:
Medical Necessity
Payor Psych
ER
One Payor accounted for 64% Reauthorization
No Auth
In Patient
Timely
Filing
64% of
Denials
Problem
Statement
Countermeasures
(Mistake Proofing)
• Countermeasure
– Work with insurance company to resolve
excessive denials
– Reduce delays that contribute to timely filling
denials
Verify Results
Reduced denials by 35% starting the
following Monday ($380,000/month)
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Kick-Butt Improvement Posters
85% of C-suite executives say their company struggles with problem
diagnosis, not problem solving, and that this comes with a significant cost.
January-February 2017 HBR
Six Sigma is too complex and time-consuming to fit into a regular workday.
We need tools that don’t require the entire organization to undergo weeks-long training programs.
Thomas Wedell-Wedellsborg
January-February 2017 HBR
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What a waste of
time!
Hacking Six Sigma Training
You Don’t Need to Learn Formulas
You Don’t Need to Learn Decision Trees
Attribute
(counted)
Defects People Events
Type of Data
Variable(measured)
XmRIndividuals
XbarR
XandS
Sample Size
1
time/project
2-10
diameters, lengths
11-25
diameters, lengths
Time
Length
Weight
Money Averages
Individual
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Learn the Patterns – Reduce Variation
Errors
Per
Million
UCL
LCL
CL
Good
Time
Move Center Line Down or Up
Errors
Per
Million
UCL
LCL
CL
Good
Time
Move Center
Line
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Why Pivot Now?WHY DO WE NEED TO CHANGE SIX SIGMA?
TO AVOID EXTINCTION
Agile Lean Six Sigma
Traditional
•
•
•
•
•
•
Agile
•
•
•
•
•
•
YOU CAN BE HERE
STEP 1GUT FEEL
COMMON SENSE
TRIAL AND ERROR
PROBLEM
SOLVING
ABILITY
STEP 2COLLECTING
DATA
STEP 3ANALYZING
DATA
STEP 4IMPROVE
STEP 5HASSLE-FREEHEALTHCAREDenial-No Appeal Charges
$150$109,813$336,270
$750,766$1,295,032
$2,516,508
$7,849,569
100%99%97%
91%
81%
61%
$-
$1,607,264
$3,214,527
$4,821,791
$6,429,054
$8,036,318
$9,643,582
$11,250,845
$12,858,109
Timely Filing Medical
Necessity
No Auth Partial Auth Invalid Auth ET ES
Memo Code
Am
ou
nt
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
n=12858108.93
MONEYBELT
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Key Takeaways
Lean Six Sigma Can Be Fast and Fun!
Hack Lean By Eliminating the Arrows
Hack Six Sigma By Using Softwareand the Magnificent Seven Tools
Questions
QI Macros – Affordable Toolsfor the Statistically Challenged
KnowWare International Inc.
2696 S Colorado Blvd. Suite 555
Denver, CO 80222
303-756-9144 888-468-1537
www.qimacros.com
qimacros.com/pdf/Agile-Lean-Six-Sigma.pdf
www.lssyb.com