Six Sigma Project Progress Report

Date 13-May-10 13-May-10 13-May-10 13-May-10 13-May-10 13-May-10 13-May-10 13-May-10 13-May-10 13-May-10 13-May-10 13-May-10 13-May-10 13-May-10 13-May-10

Project Team Lab OP Biomedical Nursing Pharmacy Stores Marketing Dietition Human Resource Ward IP Discharge Accounts Insurance Reception Billing

Timing 11.00am to 12.00pm 12.00pm to 1.00 pm 2.00pm to 3.00pm 3.00 pm to 3.30 pm 3.30 pm to 4.00pm 4.00 pm to 5.00 pm 5.00 pm to 6.00 pm 6.00 pm to 7.00 pm 11.00am to 12.00pm 12.00pm to 1.00 pm 2.00pm to 3.00pm 3.00pm to 4.00pm 4.00pm to 5.00pm 5.00pm to 6.00pm 6.00pm to 6.30pm

13-May-10 20-May-10 20-May-10 20-May-10 20-May-10 20-May-10 20-May-10 20-May-10 20-May-10 20-May-10 20-May-10 20-May-10 20-May-10 20-May-10 20-May-10 20-May-10

Maintenance Lab OP Biomedical Nursing Pharmacy Stores Marketing Dietition Human Resource Ward IP Discharge Accounts Insurance Reception Billing

6.30pm to 7.00pm 11.00am to 12.00pm 12.00pm to 1.00 pm 2.00pm to 3.00pm 3.00 pm to 3.30 pm 3.30 pm to 4.00pm 4.00 pm to 5.00 pm 5.00 pm to 6.00 pm 6.00 pm to 7.00 pm 11.00am to 12.00pm 12.00pm to 1.00 pm 2.00pm to 3.00pm 3.00pm to 4.00pm 4.00pm to 5.00pm 5.00pm to 6.00pm 6.00pm to 6.30pm

20-May-10 28-May-10 28-May-10 28-May-10 28-May-10 28-May-10 28-May-10 28-May-10 28-May-10 28-May-10 28-May-10 28-May-10

Maintenance Lab OP Biomedical Nursing Pharmacy Stores Marketing Dietition Human Resource Ward IP Discharge

6.30pm to 7.00pm 11.00am to 12.00pm 12.00pm to 1.00 pm 2.00pm to 3.00pm 3.00 pm to 3.30 pm 3.30 pm to 4.00pm 4.00 pm to 5.00 pm 5.00 pm to 6.00 pm 6.00 pm to 7.00 pm 11.00am to 12.00pm 12.00pm to 1.00 pm 2.00pm to 3.00pm

28-May-10 28-May-10 28-May-10 28-May-10

Accounts Insurance Reception Billing

28-May-10

Maintenance

3.00pm 4.00pm 5.00pm 6.00pm

to to to to

4.00pm 5.00pm 6.00pm 6.30pm

6.30pm to 7.00pm

Conusultant Jayabalan Jayabalan Jayabalan Jayabalan Jayabalan Jayabalan Jayabalan Jayabalan Rajarajan Rajarajan Rajarajan Rajarajan Rajarajan Rajarajan Rajarajan Rajarajan Jayabalan Jayabalan Jayabalan Jayabalan Jayabalan Jayabalan Jayabalan Jayabalan Rajarajan Rajarajan Rajarajan Rajarajan Rajarajan Rajarajan Rajarajan Rajarajan Jayabalan Jayabalan Jayabalan Jayabalan Jayabalan Jayabalan Jayabalan Jayabalan Rajarajan Rajarajan Rajarajan

Rajarajan Rajarajan Rajarajan Rajarajan Rajarajan

Project Team

Define Measure - Analyse Measure Phase Phase

Analyse Improve Phase

Lab

08-May-10, 13-May-10

20-May-10, 28-May-10

OP

08-May-10, 13-May-10

20-May-10, 28-May-10

Biomedical Nursing

08-May-10, 13-May-10

20-May-10, 28-May-10

13-May-10

20-May-10, 28-May-10 08-May-10, 13-May-10

Pharmacy Stores

08-May-10, 13-May-10

20-May-10, 28-May-10

Marketing

08-May-10, 13-May-10

20-May-10, 28-May-10

08-May-10, 13-May-10

20-May-10, 28-May-10

Dietition Human Resource Ward IP Discharge Accounts Insurance Reception

13-May-10

20-May-10, 28-May-10 8-May-10

13-May-10, 20-May-10

08-May-10, 13-May-10

20-May-10, 28-May-10

8-May-10

13-May-10, 20-May-10 8-May-10

Billing Maintenance

08-May-10, 13-May-10

Note: Nurse and Ward team can take process improvement project

Improve - Control Phase

Control Phase

8-May-10 20-May-10, 28-May-10

8-May-10

13-May-10

8-May-10 28-May-10

28-May-10 13-May-10, 20-May-10

28-May-10

08-May-10, 13-May-10

20-May-10, 28-May-10

20-May-10, 28-May-10 improvement project .

PROJECT

PROJECT 1

PROJECT 2

PROJECT 3

PROJECT 4

PROJECT NAME

Billing : Inpatient billing process time reduction

Outpatient Department- Lab delay

Patient registration time reduction

Discharge Delay Reduction for cash patients

PRESENT STATE Remarks

Improve Control phase

Process has improved from 16.6 min to 12.7 min. New improvement initiative has been taken ; circular to collect ward wise per visit per patient Doctor fee. Process is STABLE, NORMAL, and Cpk 0.5.

Define Measure Phase

1. One way ANOVA for tests and One way ANOVA for lab technician is done and there is a significant difference in atleast one test and one technician. Need to sort out the same, as some of the technicians are consistently having less time difference.

Analyse Improve Phase

Peak hours have been identified to be 10hrs to 20hrs. Process Capability has improved from 0.6 Cpk to 1.6 Cpk, due to an improvement initiative of Direct Registration in computer without using registration form.

Measure Analyse Phase

Not able to get special cause with reason for Receiving billing card by billing department. Inititative taken to send billing card directly to billing department.

PROJECT 5

Reducing the time of Cashless Insurance approval

Analyse Improve Phase

Investigation document, Details of management, Previous consultation, Past history, Cause of illness, Final diagnosis are the fital few cause for delay in insurance approval. Remedy steps such as sending preauthol twice a day, FIRST at 11 hrs to 12 hrs for the patient admited previous day after 13 hrs. and Second at 18hrs to 19 hrs for the patient admited on the same day before 13 hrs. Mayor insurance cause delay was TTK,Star (gen), VIPUL,Medicare, MD india.

PROJECT 6

Employee's satisfaction

Define Measure Phase

Shameem absent, Shiva kumar is not aware of 6sigma.

PROJECT 7

To reduce the breakdown time of maintenance equipments

Measure Analyse Phase

Identified 367.369,370,368 as the major power consuming services. A/C outdoor unit, All Rooms as the power consuming division of 367 services.

PROJECT 8

Pharmacy

Measure - Analyse 1. ABC inventory analysis and Profitability Phase Analysis of all goods in stock is done.

PROJECT 9

PROJECT 10

PROJECT 11

To provide timely, tasty hygienic dietary care

Analyse Improve Phase

Increasing the reliability of the test results Measure

To provide reduce the billing card time given to Define billing department

Not visited

1. Actual process of Gauge R & R is clearly explained to Mr. Hari. 2. Need to create 5-S system in consumables and other racks in lab 3. Need to implement the action plan New project

PROJECT 12

PROJECT 13

Improve Nursing care satisfaction

Increase No. of Referral Cases

Improve Control phase

Not visited

Define Measure Phase

1. Process owner has completed getting 25 data points and the performance is still dipping. He has some reasons like off season for special cause in control chart of actual/targeted number of patients. 2. Have mooted the idea of wearing corporate uniform for brand identity and improving the consultant feedback forms for business development

PROJECT 14

PROJECT 15

1. Could not meet, as the process owner is out on an exigency purchase. He has to continue with previous suggestions and still improve his volume utilization.

Improving quality of purchase process

Measure Phase

To improve account receivable of insurance

Medicare TPA, TTK, Star health, MD India Measure - Analyse are the Vital few insurance causing 50% of Phase delay in insurance sum to 70% of insurance value.

ACTION PLAN

1.Improvement initiative; fee for medical consultant has to be freezed.

1. Control chart's special causes needs to be addressed properly to improve process stability.

1.Standardized schedule 2. Queue formation. 3. Swapping of billing and reception team. 4. Introducing notificaiton period as 2month 5. Implementation of 5S

1. Check the One way anova B/W ward Vs Total discharge time, Total temprory bill, total final summary, Total final bill , Receive billing card by pharmacy, take final summary, receive written summary. 2.Doctors Vs total final summary.

1. Modify check list including the vital few delay caused document. 2. Identify the causes for the vital few authorizdelaying insurance.3.Identify the average delay time for all the vital few insurance.

To Make the ratings as 4 3 0 and plot individual moving range chart and look for special cause. 1. Basement Consultant A/C Usage during the break monitor chart ( 14,15,16,17 hrs).2. Rooms extra bulb no. 3.Rooms A/C temperature at 9, 12,17.20.30 hrs 4. Understanding Operation theater A/C usage during non operation period 5. Operation theater data ( Date, Operation, Doctor, opertaion time, duration) 1. He has to identify both ABC class inventory items and fast moving/slow moving inventory items. 2. He has to set reorder levels and max inventory levels for the items. 3. Take Visual pictures to demonstrate the improvement. 4. Have an arrangement of medicines facilitating FIFO movement. 5. High cost non moving items and low profitability non moving items SKUs to be taken out immediately. Find alternate methods of procurement for non-returnable narcotics drug.

1. Twenty One Point Lessons for visual management. 2. Including visual pictures such as training and feedback collection of all the phases of improvement 3. Create a Dash board with photos and charts. Include only recent and penultimate data/six-packs. 4. Document all the improvements made in the recent past to demonstrate the sudden improvement in CpK from .53 to 1.53. 5. Make a presentation in the model given by Mr. Jayabalan for preparation towards ANQ meet discussed with C.O.O 6. Clock idea for knowing the locality of the department head to be discussed with C.O.O

1. Investigate the special causes and take necessary corrective and preventive actions 2. Do one Gauge R& R in biochemist or hepatology departmental machines. 3. Create a quarantine zone for disposing hazardous waste. 1. Project charter 2. Project Milestone chart 3. Data 4.Control chart with special cause.

1. Start 5-S as a starting point for Voice of Business. 2. Twenty One Point Lessons for visual management. 3. Including visual pictures such as training and feedback collection of all the phases of improvement 4. Create a Dash board with photos and charts. Include only recent and penultimate data/six-packs. 5. Make a presentation in the model given by Mr. Jayabalan for preparation towards ANQ meet discussed with C.O.O 6. Create a documentation(either in soft or hard format) in chronological order for the project for project replication. 7. Toyota type shoe cleaner to be installed in the visitor area. Initiate the feasibility talks of buying such an instrument with C.O.O

Two control charts. 1. X-MR chart for both patients per week / no of doctors 2. Actual/Targeted number of patients per week. Both the control charts are explained to Ms. Banu Rekha. The control charts plotted shows definitive dip in the performance of the marketing in the last two months. The process owner needs to investigate the reasons and take counter measures.

1. Identification & Traceability of stores is found to be OK. Checked the Fevi gum SKU in R7 C13 Rack 4 . 2. Reorder levels and max inventory level of the stores is also checked. 3. He has to put a pareto to identify A class items contributing to 80% of stock value. 4. Volume is still not effectively utilized in the storage areas of stationery rack. 1.Find the average delay time for the insurance company. 2. Implement improve intiative, such as consistent reminder well in advance. Daily phone call and mail 20 days before for TTK and Medicare and 14 days before for Star health and MD india.

PROJECT

PROJECT NAME

PRESENT STATE

PROJECT 1

Billing : Inpatient billing process time reduction

Improve Control phase

PROJECT 2

Outpatient Department- Lab delay

Define Measure Phase

PROJECT 3

Patient registration time reduction

Analyse Improve Phase

PROJECT 4

Discharge Delay Reduction for cash patients

Measure Analyse Phase

PROJECT 5

Reducing the time of Cashless Insurance approval

Measure Analyse Phase

PROJECT 6

Employee's satisfaction

Define Measure Phase

PROJECT 7

To reduce the breakdown time of maintenance equipments

Measure Analyse Phase

PROJECT 8

Pharmacy

Measure Analyse Phase

PROJECT 9

To provide timely, tasty hygienic dietary care

Analyse Improve Phase

PROJECT 10

PROJECT 11

Increasing the reliability of the test results Measure

Effective record maintenance

Define Phase

Improve Nursing care satisfaction

Improve Control phase

PROJECT 13

Increase No. of Referral Cases

Define Measure Phase

PROJECT 14

Improving quality of purchase process

Measure Phase

PROJECT 15

Define To improve account receivable of insurance Measure Phase

PROJECT 12

REMARKS

Process was unstable and had ppk less than zero till march 23rd. Pareto on special cause have taken. Found the following vial few special cause responsible for billing process delay Doctor phone not pick up(DPNP)55% ,Unable to find a doctor due to busy in surgery (UCD-A) 15%, Discussion with internal staff (DIS) 10% . Management has helped billing team to take the following action, a) Update the billing amount in billing card from doctor before discharge b) Give prior intimation to doctor for collecting the doctor fee. This action has resulted changes from 26 th march 2010.The process is stable with Mean = 16.6 minutes, ppk = 0.39, ppm =130560 . By this process , billing department were able to bring process from 36 min to 16.6 min, and save Rs.36 per hour.

Refinement in data collection and monitoring needed Phone call interruption, New staff and Direct enquiry where found to be the vital few special cause. Phone instrument has been shifted from registration spot. But still reception team were distracted by phone call.

IP discharge process has been expressed in equation as below, Total temporary bill (60min) = Receiving discharge slip (15 min) + Receiving billing card by ward secretary (5min) + Receiving billing card by pharmacy(20 min)+Receiving billing card by billing (5 min) +Generate temporary bill (15min). Total discharge summary (45 min) = Receive written summary(20 min)+ Take final summary (20 min)+ Hand over summary to ward (5 min).Pareto was drawn on frequency of target failed incidence on the above activity. It was found the vital few cause for delay in Total temporary bill was Receiving billing card by billing department, Receiving billing card by pharmacy. Also the vital few cause for delay in Total discharge summary was Take final summary and receiving written summary.

Data collection process have got refined with No. of query, Reason for query, % of approval and Query type by the team.GOPINATH CAN ALSO SHARE THE PROJECT OWNERSHIP OF THIS PROJECT WITH VIJAYALAKSHMI.

Plotting and interpretation of chart has to be improved. Control chart for all the nine services data show they are stable. Major power consuming services was identified to be 367,369, 337 and 368.

Needs to do 5-S in stores. Could see a marked improvement in the arrangement of the items in the pharmacy.

Find out special causes in the recent control charts for further improvement. Please enumerate all the hypothesis testing and ANOVA used to improve /identify the problem points.

Plot the control charts and bring in stability and histogram for normality.

Project owner not available

Sustain achieved 6 sigma level of quality. Please enumerate all the hypothesis testing and ANOVA used to improve /identify the problem points. Enumerate the turning point of your project. What did you do to achieve six sigma quality. In specific, how the variation has gone down. Please create a campaign among all the hospital employees.

Understanding of the chart is yet not clear. Team Leader has the responsibility of making him understand the importance of drawing control charts and their interpretations.

Communication of the time of request should be standardized and authorized by C.O.O to effectively monitor the time of issue. Control chart understanding is not very clear. The inventory records and reorder level should be automated by the software alarms. The location of the stock is not yet updated in the system.

Operational definition on the delay date on receivable of insurance.

ACTION PLAN

1) Draw Pareto with inference for medical case. 2) Brainstorm actions for the vital few.

1.Plot difference(target time to actual time) with XMR chart. 2.Pareto on types of test. 1) Identify the peak hours using pareto. 2) Refine schedule with one receptionist dedicated for attending phone call and enquiry during peak hour. 3) Implement 5S to arrange the most needed item near to your hand.

1) Draw control chart with special cause for Receiving billing card by billing department, Receiving billing card by pharmacy, Take final summary and Receiving written summary. 2) Pareto for the special cause and find the vital few special cause.

1) Redefine query type 2) Pareto based on query type 3) Pareto on the frequency of delay on insurance company.

To Make the ratings as 4 3 0 and plot individual moving range chart and look for special cause. 1) Identify major power consuming devices in each identified services. 2) Brainstorm on methods to reduce power consumption on these identified devices. 1. He has to identify both ABC class inventory items and fast moving/slow moving inventory items. 2. He has to set reorder levels and max inventory levels for the items. 3. Take Visual pictures to demonstrate the improvement. 4. Have an arrangement of medicines facilitating FIFO movement.

1. Twenty One Point Lessons for visual management. 2. Including visual pictures such as training and feedback collection of all the phases of improvement 3. Create a Dash board with photos and charts. Include only recent and penultimate data/six-packs. 4. Document all the improvements made in the recent past to demonstrate the sudden improvement in CpK from .53 to 1.53. 5. Make a presentation in the model given by Mr. Jayabalan for preparation towards ANQ meet discussed with C.O.O 6. Clock idea for knowing the locality of the department head to be discussed with C.O.O

1. Investigate the special causes and take necessary corrective and preventive actions 2. Do one Gauge R& R in biochemist or hepatology departmental machines. 3. Create a quarantine zone for disposing hazardous waste. Management need to take call on this project

1. Start 5-S as a starting point for Voice of Business. 2. Twenty One Point Lessons for visual management. 3. Including visual pictures such as training and feedback collection of all the phases of improvement 4. Create a Dash board with photos and charts. Include only recent and penultimate data/six-packs. 5. Make a presentation in the model given by Mr. Jayabalan for preparation towards ANQ meet discussed with C.O.O 6. Create a documentation(either in soft or hard format) in chronological order for the project for project replication. 7. Toyota type shoe cleaner to be installed in the visitor area. Initiate the feasibility talks of buying such an instrument with C.O.O

Two control charts. 1. X-MR chart for both patients per week / no of doctors 2. Actual/Targeted number of patients per week. Both the control charts are explained to Ms. Banu Rekha. The control charts plotted shows definitive dip in the performance of the marketing in the last two months. The process owner needs to investigate the reasons and take counter measures. 1. Identification & Traceability of stores is found to be OK. Checked the Fevi gum SKU in R7 C13 Rack 4 . 2. Reorder levels and max inventory level of the stores is also checked. 3. He has to put a pareto to identify A class items contributing to 80% of stock value. 4. Volume is still not effectively utilized in the storage areas of stationery rack. 1.Pareto on frequency of delay from insurance company. 2. Stratify Insurance company based on the pending amount.

PRESENT STATE Measure Phase Define Measure Phase

PROJECT

PROJECT NAME

PROJECT 1

Billing : Inpatient billing process time reduction

PROJECT 2

Outpatient Department- Lab delay

PROJECT 3

Patient registration time reduction

Analyse Improve Phase

PROJECT 4

Discharge Delay Reduction for cash patients

Measure Analyse Phase

PROJECT 5

Reducing the time of Cashless Insurance approval

Measure Phase

PROJECT 6

Employee's satisfaction

Define Measure Phase

PROJECT 7

To reduce the breakdown time of maintenance equipments

Measure Analyse Phase

PROJECT 8

Pharmacy

Define Measure Phase

PROJECT 9

To provide timely, tasty hygienic dietary care

Analyse Improve Phase

PROJECT 10

Increasing the reliability of the test results Measure

PROJECT 11

Effective record maintenance

PROJECT 12

Improve Nursing care satisfaction

PROJECT 13

Increase No. of Referral Cases

PROJECT 14 PROJECT 15

Define Phase Improve Control phase

Define Measure Phase Measure Improving quality of purchase process Phase Define To improve account receivable of insurance Measure Phase

REMARKS Too many special cause, Not clear stratification of special cause. Refinement in data collection and monitoring needed Vital few special cause have been identified using Pareto. Counter measure need to be refined. Countable non value adding activity. Need good Co-ordination among Ward secretory, Nursing, Billing and Pharmacy

Data collection need to be improved

Plotting and interpretation of chart has to be improved.

Understanding of chart need to be clear.

Need to find areas of improvements Understanding of chart need to be clear. Project owner not available Sustain achieved 6 sigma level of quality.

Understanding of chart need to be clear. Understanding of chart need to be clear. Control chart plotting and interpretation.

ACTION PLAN Month wise Control chart with special cause and Month wise Pareto on Special cause 1.Plot difference(target time to actual time) with XMR chart. 2.Pareto on types of test. Implementation of counter measure. Assess process improvement due to counter measure change using control chart and Pareto . Pareto on IP discharge delay based on support team wise. Control chart with special cause on IP discharge and support team. Number of queries before approval, categories the queries, and draw pareto for the same. X MR chart for time taken for pre authorization form filling. Enhancemennt queries categorisation and pareto. To Make the ratings as 4 3 0 and plot individual moving range chart and look for special cause. 1.To use multiline chart. 2.To record benefits due to change lift operation. 3.To record data on a) IP per day, b) No. of OT1 and OT2 operation per day, c) No. x-rays per day. 4. To explore possibilities of motion sensor light in basement on trail basis. To send complete data start to end time in excel. Application of Analitical tools to statisticaly highlight the process state. Control chart with special cause. Pareto chart based on special cause Management need to take call on this project Project on reducing defects and rework in Discharge card. Month wise data - a) No. of doctors refered b) No. of IP refered data. Control chart with special cause. Pareto on insurance company based on no. of patient refered. Control chart for Insurance claim time.