eliminated the potential for misreads. It also eliminated the ASC’s use of dispos- able thermometers and possible risk of infection as the new thermometer did not come into physical contact with patients. “By changing thermometers, we achieved better outcomes, cut costs and improved staff satisfaction.” Logan says Six Sigma uses a meth-

odology called “DMAIC,” which stands for “define, measure, analyze, improve and control.” He frequently applied the DMAIC process to his ASC’s Quality Assurance Performance Improvement (QAPI) program. For example, his ASC performed

many cataract procedures and relied heavily upon drop-shipping to get the proper implants. “We were spending a lot of money having implants delivered in this manner. So, we used DMAIC to address the problem.” The problem was defined as high spending on implant shipping, Logan says. The ASC measured its spend on the shipping and then analyzed the pro- cess that required having implants drop- shipped the night before a procedure. “We worked with surgeons to get them to identify the lenses they needed earlier in the process so we could improve ship- ping,” Logan says. “In three months, we saw an over 50 percent reduction in our implant shipping costs.” Logan recalls another problem that

was improved thanks to the DMAIC process: a growing percentage of accounts receivable attributable to patient responsibility. “Once we iden- tified the problem—collecting copays and

deductibles—we measured the

current amount. We analyzed why that amount was increasing. The cause: growing patient responsibilities in the form of increased copays and deduct- ibles. We could not change patients’ insurance plans, so we had to change our process.”

At the end of preop calls, nurses

began reminding patients to bring what they owed with them to their pro-

Moving Up the Ranks

Understanding the Six Sigma Belt System Working one’s way up the ranks of the Sig Sigma system requires a great deal of work, but the benefits can be substantial, says Erin Huston, RN, the Lean Six Sigma Black Belt continuous improvement specialist for The Urology Group and its ASC, The Urology Center, in Cincinnati, Ohio.

White Belt Has a limited overview of Six Sigma and its tools.

Yellow Belt Has more significant, hands-on exposure to Six Sigma tools and uses them to make small projects successful. Supports green and black belts during larger projects.

Green Belt Receives more in-depth training on how to use the tools and lead projects. Supports company-wide projects led by black belts.

Black Belt Goes through the entire Six Sigma program. Learns the tools and performs in-depth data analysis to help choose the projects and improvements coupled with the least amount of risk. Responsible for leading and tracking projects and reporting progress to executive leadership.

Master Black Belt Has multiple years of black belt experience and five-plus years of business experience and has completed at least five black belt projects with significant business results.

cedure, he says. “Communicating this information up front was the improve- ment. We did an analysis three months later and found we were able to reduce patient-related accounts receivable by at least 25 percent.”

Substantial Benefits Logan says his Six Sigma training helped not only his ASC, but himself. “We were accredited by the Accred- itation Association for Ambulatory Health Care, and Six Sigma supported our efforts to meet the requirements for our internal QAPI program.” In addition, Six Sigma helped Logan in his pursuit of the Certified Adminis- trator Surgery Center (CASC) creden- tial. “The portion of the CASC exam that focuses on QAPI looks at how you analyze and perform process improve- ment,” he says. “Six Sigma provides an

effective, measurable approach to pro- cess improvement, and what can get measured, can get improved.” Huston says her ASC received praise for use of Lean Six Sigma during its last Joint Commission accreditation survey. “The surveyors were impressed with the way Lean Six Sigma teaches you to make the quality component of your care the priority and streamline processes for patient outcomes.” Wallace says Lean Six Sigma has

directly contributed to improvements in staff morale, efficiency and cost con- tainment.

“Once you get in the mindset of looking at your ASC’s processes through the eyes of Lean Six Sigma, it is amazing how many wasteful activ- ities you will identify and then can improve,” he says.


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