“Six Sigma”

Methodologies Beth Gray, RDH, MS

Objectives

• Describe the DMAIC process to evaluate infection control

management and instruction in the educational setting.

• Analyze the effectiveness of the processes currently in place

and determine if changes would be advantageous related to

the DMAIC and “six sigma” approach.

• Identify and evaluate tools and applicable research related to

use of the “six sigma” approach in the healthcare setting.

History

• Carl Fredrick Grauss, mathematical theory

related to the bell curve

• 1920 Carl Shewhart, a statistical

mathematician, demonstrated need for

correction once a process deviated to “three

sigma”

• Motorola, 1970-1986 (Schroeder & Mikel, 2006)

• General Electric, 1995

Six Sigma Definitions

“a philosophy and methodology for

managing processes and

performance…best implemented using a

system of components designed to

clarify an organization’s goals,

stakeholders, and needs”

Six Sigma

“a highly disciplined process that helps

us focus on developing and delivering

near-perfect products and services”

3.4 defects in every million opportunities

Pyzdek, 2003

“Six sigma is, basically a quality goal,

where sigma is a statistical measure of

variability in a process. As such it falls into

the category of *process capability

technique.”

*“The ability of a process to meet requirements, either

internal or external, without process adjustment.”

Three Sigma (standard) Deviation

http://www.free-six-sigma.com/process-capability.html

Statistical Analysis

Defects per million chances / opportunities

• 2 sigma = 308,537

• 3 sigma = 67,000

• 4 sigma = 6,200

• 5 sigma = 233

• 6 sigma = 3.4

Level of Quality in Three Sigma

• 54,000 checks lost each night by a

single large bank

• 540,000 erroneous call detail records

each day from a regional

telecommunications company

• 10,800,000 mishandled healthcare

claims each year

• 270,000,000 erroneous credit card

transactions each year in the United

States Pyzdek, 2003

Engineering Example:

• Major issue causing

“scraping” of parts and

cost impact

• 33 sample statistical run

• Graph quality results

• Bell curve defines

sigma deviation

• Alteration of process

i.e precision hole size, or

vendor issues

http://ocw.mit.edu/courses/mechanical-engineering/2-007-design-and-manufacturing

Six Sigma vs. Lean Six Sigma

o remove flaws & waste

o increasing quality &

competence

o reorganizing &

improving processes

o streamlining manufacturing

& production processes

o cutting out unnecessary &

wasteful steps

o must add value to the

result

Six Sigma vs. Lean SS

• Strongly data driven

• Project management

framework

• Focus on variations

• Eliminate defects

• Improve quality at lower

costs

• Data not always necessary

• Intuitive framework

(current vs. future state)

• Focus on value stream

analysis

• Eliminate waste

• Increased speed and

efficiency

Lazarus, 2012

http://working-lean.blogspot.com/2011/01/lean-six-sigma.html

Value Stream

• Develop an understanding of a process

• Create a baseline to measure improvements

• Define a vision of the future processes

• Establish leadership/compliance objectives

• Identify opportunities for improvement

• Design an implementation plan

vvmech, 2014,slideshare.net

Infection Control

• Southwestern College

– Wipe, wipe, wait & barrier protocol

– OPIM identified on operatory chairs

– Surveys deployed

– Alteration of protocol

– Observation of effectiveness

– Updating procedures and training

Southwestern

College

Hospital Administration

ASQ, The Global Voice of Quality

“focuses on eliminating defects…in healthcare,

a defect can be the difference between life and

death…we use lean six sigma to improve

patient safety by eliminating life-threatening

errors” http://asq.org/healthcaresixsigma/lean-six-sigma.html

Johns Hopkins Medicine

http://www.hopkinsmedicine.org/innovation_quality_patient_care/areas_expertise/lean_sigma/about/

Bandyopadhyay & Coppens (2005) “Six

Sigma Approach to Healthcare Quality and

Productivity Management” International

Journal of Quality and Productivity

Management

Research

Chassin, Mayer & Nether (2015) “Improving

Hand Hygiene at Eight Hospitals in the United

States by Targeting Specific Causes of

Noncompliance” The Joint Commission Journal

on Quality and Patient Safety

Schweikhart & Dembe (2009) “The

Applicability of Lean and Six Sigma

Techniques to Clinical and Translational

Research” Journal of Investigative Medicine

Vest & Gamm (2009) “A Critical Review of the

Research Literature on Six Sigma, Lean and

Studer Group's Hardwiring Excellence in the

United States: the Need to Demonstrate and

Communicate the Effectiveness of

Transformation Strategies in Healthcare”

Implementation Science

Essentially, Six

Sigma is the

business

approach to using

the scientific

method…

http://www.learner.org/jnorth/tm/handouts/anchor_chart_sci_method.html

Define

Measure

Analyze Improve

Control/Verify

D-M-A-I-C

Define

• Create project from nonconformance,

feedback or audit

• Linked to strategic objectives of

organization

• Obtain goals from direct

communication with students, faculty,

staff, administration

Surveys

• Survey Monkey:

– Keep it short and focused

– Pre-test your survey to identify weaknesses

– Keep rating scale questions consistent

– https://www.surveymonkey.com/?ut_source=head

er

Google • Forms –

– Create survey

– See responses in real time

– Embed to a website

• Documents

• Slides

• Spreadsheets

• https://www.google.com/forms/about/

Popplet.com

iPad or Web

• In the classroom / home - a mind-map helps

students think and learn visually, capture

facts, thoughts, and images & learn to create

relationships between items

• Professionals - generate ideas, plan

projects, brainstorm or jot down notes,

develop creative solutions

Define

• Process map – graphic representation

• Flow chart – workflow, steps

• Check sheets – lists and frequency

• Pareto analysis – ranking opportunities

• Cause and effect diagrams – guide for

discussion

• 7M tools (Mizuno, 1988) – manage and

planning quality improvement activities

Measurement

• Numerical assignment to a non-

numerical element

• Assignment of numbers to observed

phenomenon according to rules

• Reliability and validity of data

Measurement

• Nominal: success/fail, accept/reject

• Ordinal: more or less of an attribute, position

in series

• Interval: temperature, distance in space,

period of time

• Ratio: elapsed time, relationship between two

numbers

Analysis

• Knowledge discovery or data

presentation tools

• Looking for patterns or trends

• Qualitative and quantitative

• Online tables or algorithms

Trend Analysis

http://blog.surveyanalytics.com/2011/04/enhanced-trend-reports-weekly-monthly.html

Improve

• To make or become better

• Requires transforming management

philosophy & organizational culture

• Implement changes to processes

identified in data analysis

• Utilize a timetable for progress or

change

Timetable

http://www.bplans.com/commercial_contractor_business_plan/strategy_and_implementation_summary_fc.php

http://www.slidegeeks.com/powerpoint-slides/81037-business_framework_action_plan_timetable_powerpoint_presentation/

Control

• Battle against entropy

• “Permanent” change

• Protect stability of new processes

• Revise systems to reflect new data

• Implement maintenance strategies

• Modify training for updated process

Monitoring

Application Creation

MediCards

http://www.pushinteractions.com/application/medicards-for-uofs-emergency-medicine/

Educational Tools

• Adaptive learning

– memorization

– remediation

• Adaptive quizzes

– advanced algorithms to adjust to learners

competence

• E-learning

– videos, interactive elements, narration

De Bra, 2009, Grapple, Adaptive Learning Environments

Benchmark http://www.educause.edu/ero/article/benchmarking-inform-planning-educause-core-data-service

f l ip you r cl assr ooM

wit h ease

Elsevier Adaptive Quizzing is an ideal tool for instructors seeking to “flip”

the classroom. Quizzes assigned before class can help ensure that students

understand the topics that will be discussed and can actively participate

in classroom exercises. Conversely, quizzes assigned after class can

assess students’ ability to apply concepts covered in class.

adapt Based on r esu l t s

Elsevier Adaptive Quizzing ensures every student receives a personalized

learning path based on their performance data, allowing faculty to monitor

achievement of established mastery levels.

suppo r t indiv idual apt it ude l ev el s

The adaptive nature of Elsevier Adaptive Quizzing helps level the class aptitude level by allowing students

to progress at their own pace along a personalized learning path. This unique approach leads to increased

student engagement with course materials, as well as improved course exam scores.

t he Key

t o assessing

Mast er y and

appl icat ion

13-NHPdl-0815 TK 9/13

A dap t ive Learning

A dap t ive Quizzing

A dap t ive Learning

A dap t ive Quizzing

A dap t ive Learning

A dap t ive Quizzing

A dap t ive Quizzing

Elsevier Adaptive Quizzing

A

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P

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V

E

Q

U

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ensu r e l ong -t er M

MeMor y st o r age

Unlike learning by “cramming,” Elsevier Adaptive Learning constantly

leverages scientifically backed principles to determine an appropriate

schedule for each student to learn and review, which ultimately leads

to permanent knowledge.

adapt based on r esu l t s

Elsevier Adaptive Learning’s instructor and student performance dashboards offer at-a-glance access to

data on individual knowledge usage and retention at the course, chapter, and item level. Plus, customizable

reporting capabilities enable educators to track individual and group performance, as well as learning trends

over time, to identify students in need of additional help and ultimately improve outcomes and retention.

r egu l at e Cogn it iVe

wor k l oad

Elsevier Adaptive Learning manages the amount of content each student

is expected to absorb, helping them to be more efficient and effective

with their study time and ensuring they learn faster and remember longer.

t He key

t o iMpr oVing

Cont ent

r et ent ion

13-NHPdl-0814 TK 9/13

A dap t ive Learning

A dap t ive Quizzing

A dap t ive Learning

A dap t ive Quizzing

A dap t ive Learning

A dap t ive Quizzing

A dapt ive Quizzing

Elsevier Adaptive Learning

A

D

A

P

T

I

V

E

L

E

A

R

N

I

N

G

Demonstration of Elsevier Adaptive

Learning Educators/Student Site

Bird & Robinson (2015) Modern

Dental Assisting, Elsevier

Dental Hygiene Adaptive Learning …coming in June 2015

Elsevier Adaptive Learning & Quizzing

Positioning the two in tandem:

Adaptive Learning

• Content Retention

• Pure knowledge acquisition

• Targeted study aid

• Remediation tool for

adaptive quizzing

Adaptive Quizzing

• Application of knowledge

• Assessing their mastery

through quizzing

• The next step in preparing

for course exams

(instructor created or HESI)

Strategies for Best Practice w/AL or AQ

• Memory permanence – 15-20 min.

• Match classroom discussion to

Adaptive learning ideas and concepts

• Utilize both inside and outside the

classroom

• Content online will allow for more

focused lectures

Flipping the Classroom

• Pre-study tool / test – “ticket”

• Adjust lecture to low response areas

• Mastery levels can be completed

during group activities (level 1-3)

• Students prioritize top 3 topics for

discussion

• Clinical application for pt.

management at mastery level

Summary

• DMAIC can be utilized for determining areas of

improvement and verification of protocols

• Constant analysis of techniques and

methodologies is integral to advancing your

instruction and infection control management

• Utilize the tools and resources available

through research and web-based support

systems

References

• Villanova University, University Alliance (2015). Bisk Education: accessed on April 29, 2015.

• Schweikhart, S. & Dembe, A. (2009). The applicability of lean six sigma techniques to clinical and translational research. Journal of Investigative Medicine; 57(7): 748-755.

• Ruiz, J, Mintzer, M, Leipzeg, R. (2006) The impact of e-learning in medical education. Academic Medicine. 81(3) 207-212.

• Elsevier Adaptive Quizzing and Learning, Transforming Education, (2015)

PowerPoint Presentation, Elsevier Inc., Atlanta GA.

• University of Texas at Dallas, Masters of Science in Healthcare Management, Six

Sigma philosophies, http://jindal.utdallas.edu/masters-programs/ms-healthcare-

management/

• Lazarus, I. (2012) Six Sigma, 10 Years on: Was “the Promise” Realized? Becker

Hospital Review. Accessed on May 6, 2015:

http://www.beckershospitalreview.com/hospital-management-administration/six-

sigma-10-years-on-was-qthe-promiseq-realized.html

• Ferryanto, L. (2004). Organizing Six Sigma Projects, ASQ, The Global Voice of

Quality, Accessed on May 6 2015: www.asq.org/sixsigma

References • De Bra (2009) “Adaptive Learning Environments” Grapple-Eindhoven University

of Technology, Power Point Presentation. Accessed on May 3, 2015

• Elseveir Adaptive Learning Tools, Adaptive Technologies, (2015).

http://www.elsevieradvantage.com/article.jsp?pageid=12277

• Top 10 Benefits of Adaptive Learning Tools, Elsevier,

http://www.elsevieradvantage.com/article.jsp?pageid=12232

• Susan Sportsman, PhD, RN, ANEF, FAAN, Director, Academic Consulting

Group, (2014). Adaptive learning in nursing education. Elsevier.

• Chassin, M., Mayer, C Nether, K. “Improving Hand Hygiene at Eight Hospitals in

the United

• States by Targeting Specific Causes of Noncompliance,” The Joint Commission

Journal on Quality and Patient Safety, Volume 41, Number 1, January 2015, pp.

4-12(9)

• Koming, H, Verver, J, van den Heuvel, J, Does, R. (2006). Lean Six Sigma in

Healthcare. Journal of Healthcare Quality, volume 28, number 2, pp. 4-11.

• Qwak, Y, Anbari, F. (2004). Benefits, Obstacles, and Future of Six Sigma

Approach. Project management Program, George Washington University,

Elsevier, Inc. www.sciencedirect.com

References • Do you Know what Adaptive Educational Tools are?, video, The Knewton Blog.

Accessed on April 23, 2015:

http://www.elsevieradvantage.com/article.jsp?pageid=12277

• Pyzdek, T. (2003). The six sigma handbook, The complete guide to green belts,

black belts, and managers at all levels. 3rd edition, McGraw-Hill, New York.

• Pyzdek, T. (1989) What every engineer should know about quality control. New

York: Marcel-Dekker, Inc.

• https://www.surveymonkey.com/?ut_source=header

• Push Interactions, www.collegemobile.com

• Woodward, T. (2004). Addressing Variation in Hospital Quality: Is Six Sigma the Answer?, Hill-Rom Undergraduate Essay Contest, Hill-Rom Company Inc.,

Chicago IL: http://www.hill-rom.com/usa/

• Reibling, N, Condon, S, Gopen, D. (2004). Toward Error Free Lab Work. Six

Sigma Forum Magazine, www.asq.org

• Arthur, J. (2005). Seduce Them With Success. Quality Progress, www.asq.org

• Caldwell, C. (2006). Lean-Six Sigma; tools for rapid cycle cost reduction.

Healthcare Financial Management Association, Westbrook, IL. www.asq.org

References • http://www.educause.edu/ero/article/benchmarking-inform-planning-educause-core-

data-service

• http://www.bplans.com/commercial_contractor_business_plan/strategy_and_imple

mentation_summary_fc.php

• http://blog.surveyanalytics.com/2011/04/enhanced-trend-reports-weekly-

monthly.html

• http://www.villanovau.com/resources/six-sigma/six-sigma-vs-lean-six-sigma/#.VUE_1pOCiSo

• http://www.brighthubpm.com/six-sigma/29923-steps-in-six-sigma-methodology/

• http://en.wikipedia.org/wiki/Six_Sigma

• http://www.sixsigmadaily.com/what-is-six-sigma/

• http://www.sixsigmaonline.org/six-sigma-training-certification-information/articles/what-is-six-sigma-an-overview-of-six-sigma-methodology.html

• http://www.tutorialspoint.com/six_sigma/six_sigma_introduction.htm

• http://www.free-six-sigma.com/process-capability.html

• http://www.slidegeeks.com/powerpoint-slides/81037-business_framework_action_plan_timetable_powerpoint_presentation/