Six sigma project

Supervised By
Dr/Islam Miss/ Rahma

Dr/Waleed Miss/Mai

Dr/ Faten
 Surgical Inpatient discharge time is the
time from written discharge order to
patient leaving the hospital .
 The process of discharging patients is
complex requiring the coordination of
multiple different groups including
physicians, nurses, patients, their
families, and the finance/billing every
customer.
Delays in discharging inpatients can cause inefficient
use of beds, increases in waiting lists, higher re-
admission rates, patient and career distress as well as
increased workloads
impact admissions from the operating room, and the
general admitting unit.
It also affects our whole image & reputation
We found in our hospital that there is increase in
patient discharge time average 80 min which lead to
Decreasing patient satisfaction as the survey showed
Our aim that through 6 sigma project to decrease
patient discharge time to be 65 min
For understanding perception of customers on
inpatient discharge time , VOC was collected from 32
patients.
 Define
Phase

Communication
Plan
Charter may be updated if values changed through out the
project
 DPU =TOTAL NO.OF  DPMO
ERRORS/TOTAL NO.OF =DPUX1MILLION/
CASES =60/32=1.9 TOTAL
OPPORTUNITIES =1.9
X1MILLION/15=
133,333

Sigma level 2.61

Using six sigma tools • no . Of saved minutes in a day
we can decrease (in a 6 hours of work /day)
patient discharge =15x6=90 minutes /day –if
time from 80-65 we suppose that in
minutes .that will (90)minutes (5)patients
save 15 minutes will admit the hospital
each one will pay
which will affect the (200)pound then no. of
annual profit of our saved pounds per day =
hospital 5x200=1000 pound then
saving in a year (annual
profits) =1000x26x12
=312,000 pound
Project Title: Decreasing surgical inpatient discharge time from 80-
65 minutes
Team members Champion :Dr. Mahmoud El-Damaty
Team members : Dr.Islam
Miss Rahma
Miss Mai
Dr.Waleed
Dr Faten
Business Case / Impact :
Too long discharge time affect new admission negatively so decreasing
patient flow rate ,affect occupancy rate ,decrease patient satisfaction with
more waste of time and resources so fore sure will affect the hospital
annual profits negatively
Project Scope: Problem/Opportunity Statement:
Process Start Point: Written discharge order by
physician
Our current six sigma level is (2.61)

Process End Point: PATIENT DISCHARE AND Goal statement (S . M . A . R . T)

LEAVE THE HOSPITAL
Our goal is to decrease surgical
Results for the company inpatient discharge time from 80-65
min in 6 months
OUR ANNUAL PROFITS = 312.000 POUND
 Analysis of
Plans to Primary
Stakehol present Plans to improve Frequenc
communi point of Information
der relationshi relationship y
cate contact
p

• Get him to be
more involved in
• Daily workflow
process by 1.Direct
• Obstacles and
attending six contact
Physician Supportive E-mail solution Weekly
sigma meeting 2.Mobile
approach
• Decrease 3.E-Mail
• Schedule plan
workload
• Training program

nurses neutral •More comfortable 1.Direct Whatsap • Daily workflow Daily

working hours and contact p Daily progression of
less work load 2.Mobile the project
• training programs 3.Whats • Obstacles and
app solution approach
• Schedule plan

Pharmacis • Consideration in 1.Direct • Obstacles in

t Dissension making contact unused drug
• Free parking 2.Mobile return
3. E-Mail • Amount of
Supportive 4.Meeting Mobile monthly errors weekly
occurs
• protocol for drug
dispensing and
 Analysis Primar
of Plans to y point
Stakehold Plans to improve Frequen
present communi of Information
er relationship cy
relations cate contac
hip t

• Divide work shift • Daily workflow

1.Direct
time to be on 3 • Obstacles and
Senior contact Direct
Resistant not only 2 solution Weekly
receptionist contact
• 50% discount of approach
2.Mobile
medical service • Schedule plan

Senior IT Supportiv • Training program 1.Direct E-Mail • Follow up Weekly

manager e • Flexible working contact • System integrity
hours 2.Mobile • Periodical upgrades
3.E-Mail and trouble shooting
errors .Daily progression
of
the project

Senior Resistant • Make a feasibility 1.Direct Meeting • Amount of monthly Monthly

Finance study to show contact loss caused by errors
Manager him amount of 2.Mobile • Financial statement
money and 3. E-Mail • Annual audit
resources saved 4.Meeting
• Free parking
1.Direct
Medical • Training • Follow up
neutral contact Mobile
record program • Monitoring external Daily
2.Mobile
officer • customer feed back
3.E-Mail
 Agree

Voice Of Customer
Unsatisfied
Satisfied
Because……
But…
Discover customer needs of internal and
external customers SO We try to collect
customer needs by many ways:
1) Observing.
2) Being a customer.
3) Personal interview.
4) Focus group
5) Questionnaire with open ended question
6) Survey
7) Questionnaire for satisfaction and dissatisfaction
FLOW CHART 1
SIPOC 2
DATA COLLECTION
PLAN
3
CONTROL CHART 4
FLOW
CHART
 Start
Consultant written
discharge order
End
Patient
discharge

Preparation of hospital
discharges and return
of unused medication

Patient go to
Complete patient respective ward to
medical record and collect medication
sent to finance

Patient settles the bill

and receive payment
Process of final bill slip
Supplie Input Outpu Custome
r
Process
s t r

1. Clinical 1. Consultant 1. Discharge

1. MOH 1. Patient
examination written summary
2. Medical 2. Patient
2. Filling medical discharge order 2. Complete
Insurance families
record 2. Nurse prepare medical
company 3. MOH
3. Nurse round patient and record
3. Pharmaceut 4. Insurance
4. Accounting patient file 3. Financial
ical company
billing 3. Complete bill
companies
5. Insurance patient medical 4. Patient
4. Maintenanc
state record satisfactio
e company
6. Insurance 4. Billing n
category 5. Patient collect 5. Medication
7. MOH audit medication collected
8. Prescription 6. Patient
9. Maintenance discharge
of beds
system
8.Price listing
SIPOC DIAGRAM
 Operational Definition & Sampling
Data
Procedures Notes

Where &
How Who will Sample
What Data type when Frequency
measured do it Size
collected

In surgical
Patient Quantitati inpatient
By stop Six sigma
1 discharge ve ward at 32 Once
watch team
time Continuous 12pm and
4 pm
Patient no Discharge time Patient no. Discharge time
1 45.5 17 100
2 55 18 109
3 85 19 99
4 50.25 20 88
5 77 21 56
6 75 22 75.35
7 78 23 78.40
8 89 24 80.25
9 65 25 89
10 55 26 64
11 67 27 42.40
12 78 28 63
13 90.5 29 77
14 88.6 30 69
15 57.5 31 102
16 87 32 98
 Surgical Inpatient discharge time is the time
from written discharge order to patient leaving
the hospital .
  Start
 Consultant
written
discharge

Preparation of hospital
charges

ANY
End
UNUSED YES
DRUGS Patient
RETURN TO
discharged
NO PHARMACY

Complete patient
medical record and SEND HOUSE KEEPING
sent to finance TO PREPARE THE
ROOM

INSURANC
E EXSISTS
NO Patient settles the bill Patient go to
YES and receive payment respective ward to
REVIEWS BLLS AND slip collect medication
SENT TO INSURANCE
COMPANY
Analyze phase
 Delayed
physicians
Delayed lab
Insufficient reports
nurses
Intolerable
receptionist
behavior
Defects in
filling medical
records Inaccurate
bill

Bad
physician Overloaded
Unqualified Pharmacy
handwriting nursing staff
physicians delays

MOH audits Medical

Insurance file delay
state
Patient no Discharge time Patient no. Discharge time
1 45.5 17 100
2 55 18 109
3 85 19 99
4 50.25 20 88
5 77 21 56
6 75 22 75.35
7 78 23 78.40
8 89 24 80.25
9 65 25 89
10 55 26 64
11 67 27 42.40
12 78 28 63
13 90.5 29 77
14 88.6 30 69
15 57.5 31 102
16 87 32 98
Descriptive Statistics:
Mean: 76.05
Stdev: 17.37
Variance: 301.70
Range:66.60
Median:77.50
Mode:55,77,78,89
Inputs Frequency Weight Total

Physician delay 20 10 200

Inadequate number of 15 10 150

nurses

Delayed lab reports 4 5 20

Inaccurate billing at the 13 1 13

finance department

Pharmacy delays 6 5 30

Prescription errors 1 10 10

Delayed medical record 5 5 25

Inputs Total
Physician delays 200
Inadequate number of 150
nurses
Delayed lab reports 20
Inaccurate billing at the 13
finance department
Pharmacy delays 30

Prescription errors 10

Delayed medical record 25

Vital few from
Pareto chart

physician
delay

inadequate
no. of
nurses
Scatter plot &
correlation
Patient Physician Discharge Patient no. Physician Discharge
no delay time delay time
1 10 45.5 17 40 100
2 15 55 18 44 109
3 25 85 19 37 99
4 12 50.25 20 29 88
5 20 77 21 17 56
6 17 75 22 20 75.35
7 22 78 23 22 78.40
8 30 89 24 46 80.25
9 16 65 25 37 89
10 15 55 26 28 64
11 23 67 27 35 42.40
12 22 78 28 29 63
13 35 90.5 29 41 77
14 29 88.6 30 24 69
15 15 57.5 31 45 102
16 30 87 32 42 98
 Scatterplot of physician delay vs discharge time
50

40
physician delay

30

20

10

40 50 60 70 80 90 100 110
discharge time
Patient Nurses Discharge Patient no. Nurses no. Discharge
no no time time
1 2 45.5 17 2 100
2 4 55 18 3 109
3 3 85 19 1 99
4 3 50.25 20 2 88
5 2 77 21 4 56
6 2 75 22 3 75.35
7 2 78 23 3 78.40
8 3 89 24 2 80.25
9 5 65 25 2 89
10 5 55 26 2 64
11 4 67 27 2 42.40
12 2 78 28 2 63
13 3 90.5 29 2 77
14 4 88.6 30 3 69
15 6 57.5 31 1 102
16 2 87 32 4 98
ROOT
CAUSE physician
IS delay
 IMPROVEMENT
PHASE
01

BRAINSTORMING
02

EVALUATE
03 ALTERNATIVES
PILOT

04
 Afteridentifying the root cause(physician
delay) of our problem we will try to solve it.
During the improve phase we will be using
the following tools to find out the proper
solution

 1- Brainstorming
 2- Pilot Testing.
 Increase no.
of shifts

Incentives for
physician Increase no
of physician

Physician delay
possible solutions
Physician
attendance
schedule with
penalty for late Order
attendance written at 12
pm exactly

Free transportation
Review all Possible solutions with
management, and we have
his acceptance only for
(Physician attendance schedule with penalty
for late attendance )
 Afterapplying the recommended
actions on a small scale (physician
attendance schedule with penalty
for late attendance )over two
weeks Improvement of the new
process was approved and meets
desired outcomes
Patient no Discharge time Patient no. Discharge time
1 58.00 17 65.00
2 55.00 18 64.00
3 65.00 19 67.00
4 50.25 20 65.00
5 64.00 21 64.00
6 67.00 22 71.00
7 66.00 23 78.40
8 70.00 24 67.00
9 65.00 25 66.00
10 55.00 26 64.00
11 67.00 27 63.00
12 67.00 28 63.00
13 70.00 29 66.00
14 67.00 30 69.00
15 57.50 31 70.00
16 65.00 32 65.00
 CONTROL
PHASE

CONTROL 01

PLAN
02
CONTROL CHART
( AFTER
SIGMA LEVEL 03 IMPROVEMENT )
CALCULATION
Before After
 Control Plan
Project Name DECREASING PATIENT DISCHARGE TIME

Measurement Sample Sample

Process Control Method Reaction Plan
Technique Size Frequency

•Daily check for

1- on call
Physician No of schedule
physician when
physician Daily • Penalty
attendance Visual needed
in shift
schedule inspection 2- management
(5) •Documentation referral
Then audit