Lean Six Sigma Service Report Reports Example
The Mater Hospital is a 200 bed hospital that performs over one hundred and fifty thousand radiology procedures annually. The hospital sees over seven hundred and fifty thousand outpatient visits annually. The hospital has many departments that operate independently, although they are governed by the same overarching system. With the high number of radiology procedures, the hospital has been experiencing a backlog in the magnetic resonance imaging schedules. Even for the simplest procedures, the wait time was over twenty five days. This means that from the time a physician orders for a radiological test and the time the results of the test or procedure are given, there is a waiting period of at least twenty five days.
The service process in the imaging department contains many bottlenecks that result in wastage of time, hence to long wait time. After a physician orders a radiological test, there are seven steps in the service process. First, the radiology order made by the physician is generated in the Radiology Information System by the charge master. This process is done by one person. Estimates show that the degree of error is at 21% in the generation of the order. The wait period for this process is ten minutes. It is in the second step where the radiology examination is performed on the patient. Depending on the test and the number of people on the waiting list, the average waiting time is three hours.
Statistics from the department show that the propensity for error in this step is 7%. Some of the errors include a wrong test or exam performed on the patient. This is attributed to wrong codes from the previous step when the order was generated by the charge master. The exam is performed by between one and two people, and could take between ten minutes and one hour depending in the complexity of the exam. The third step in the service process is the interpretation of the radiology exam by the radiologists. There is 14% probability for error due to propagated errors from the previous step or due to inadequate or lack of documentation.
The period of time required for the interpretation of the radiological exam is approximately two hours. The fourth step in the service process is the coding of the radiological examination using the international classification of diseases codes and affixing the examination into the medical records. After the radiology exam is coded and filed in the medical records, the next step in the service process is the billing. The patient is billed at the department. The billing process is done by one individual, and takes approximately one hour depending on the pile up of other patient files waiting to be billed. Before the next stage in the service process, the technical charges for the department are either paid or denied n the patient.
In the case that technical charges accepted by the patient, the balance is billed against the patient. In the case the technical charges are denied, the exams will need to be redone. The next step in the service process is the coding of patient information using the international code for diseases. This exercise is carried out by one person, and is estimated to take half an hour. The likelihood for error in this step is shown at 14%. The final step in the service process is the billing of the professional component at the radiology department.
This exercise is performed by one person and is estimated to take half an hour. After the bills for the professional charge are prepared, the charge is either paid or denied by the patient. In the case the professional charge is paid by the patient, the patient gets their balance billed and the results of the radiological exam are relayed through the system to the ordering physician. In the case the patient denies the professional charge, the denied exams will require to be redone.
In the delivery of a service, many administrative steps might lead to wastages in resources. The lean six sigma seeks to identify wastes in order to eliminate them. By looking at the narrative of the service process and the service process diagram, one can easily identify the wastage in the service delivery. In order to identify the wastages, the TIMWOOD tool was applied on the service process
The Wastes of Transportation
The wastes of transportation in this service process entail the movement of the order details from the ordering physician and within the radiology department. As the patient is moved through the various stages in the service process, he is handled by different people. More steps in the service process imply that the patients will have to more compared to a scenario where the service process is made up of fewer steps. As indicated in the current service process diagram, there is an associated likelihood for errors in every step (Meisel 33).
The Waste of Inventory
Inventory as it applies in this particular service process involves the radiological procedures and exams that are in progress. As highlighted earlier, the hospital performs over one hundred and fifty thousand radiological exams annually through inpatient and outpatient requests. Due to bottlenecks further up on the service process, there is a backlog in scheduling. This leads to many radiological tests waiting in the system to be performed. As highlighted earlier, the backlog of radiological tests at the department is s that the waiting period between the time the exam is order by a physician and the time the results are relayed back to the physician, there is a waiting period of up to twenty five days depending on the complexity of the exam ordered (Meisel 33).
The Waste of Motion
The waste of motion in this case relates to the movement within the service process. As highlighted in the service process narrative and illustrated the process diagram, there are seven steps involved in service deliver within the radiology department. Although the department is housed under one roof, the various offices and rooms in which the various services are offered are in different parts of the same building. A patient is required to move from one room to anther while tracking the process. This calls for a lot of movement, sometimes taking up a lot of time, especially when the patients are not very mobile because of a disease condition or a physical condition. The movements have an impact on the quality of services offered, especially when the stress component on the patient is considered (Meisel 33).
The waste of Waiting
The waste of waiting refers to the time that the patients wait at the various points in the service process for the services to be offered. The wait time is influenced by various factors. In the case of the radiological department, the waiting period is the confluence of factors such as a large inventory leading to a backlog in scheduling, a high percentage of errors leading to a repeat of procedures and the wring exams performed on the patients, the use of different billing companies for the technical component and the professional component, by that resulting in some bills being denied and utter inefficiency in the service process resulting in a long wait time in one stage of the service process (Meisel 33).
The Waste of Overproduction
In the case of the radiology department, waste of overproduction relates to the inventory that the department has produced, resulting in a backlog of scheduling radiology exams. Given the fact that this is a service rather than a product, there are not many illustrations of overproduction. However, this waste is significant to the efficiency and bottom lines of the department in that it causes other kinds of wastes and also obscures the apparent need for improvement (Meisel 33).
The Waste of Over-Processing
In different occasions, the department has performed radiology exams that were not requested by the patient or ordered by the physician. It is possible that such exams resulted from errors during the generation or the order by the charge master. However, such exams cost the department, and are not billed to the patient (Meisel 33).
The Waste of Defects
Waste emanating from defects in the delivery of service is very costly to the department. This statement does not just highlight the financial component of this waste, but also relates to the loss of time and other resources. The narrative on the service process and the process diagram highlight the percentage of errors in the various stages of the service process. Some of these errors lead to the propagation of inaccuracies in the subsequent stages in the service process (Meisel 33).
Reducing the wait time at the radiology department requires the implementation of various solutions. One of the pitfalls that result in the long wait time in the radiology department is the long time before the insurance preauthorization is acquired. A probable solution to this bottleneck is obtaining the insurance authorization beforehand. This will allow the radiographers the time to schedule and perform the exams within a limited time, thereby reducing the wait time. Another solution that can be implemented in order to reduce the wait time is streamlining the scheduling so that there is no backlog (Hall 280). It is imperative to improve efficiency rather than schedule radiology exams thereby building inventory. The third solution that can be implemented is the improvement of coordination between the staff involved in the service process. This serves to reduce the time required to perform the exams and the time between one stage to another. This also entails using the same billing company for both the technical and professional components, thereby reducing the number of bills denied.
6.1. Process diagram
The process diagram below details the recommended solution. The steps in the service process are reduced through the proposed coordination of the staff.
6.2. Implementing Specific Lean Techniques and Tools
Bottleneck analysis: One of the specific lean tools that will be implemented as part of the proposed solution is the bottleneck analysis. Bottleneck analysis as a lean tool is important in identifying the elements in the service process that limit the efficiency of service delivery in the department. This will help strengthen the weak links in the service process with an aim of improving the efficiency in service delivery (Plenert 240).
Kaizen: The kaizen is a tool that improves the coordination between the staff in order to proactively achieve incremental and regular improvements in the service delivery. By harnessing the talents of the departmental staff Kaizen will help to continually eliminate waste in the service process (Martin 281).
Key Performance Indicator: This entails the use of metrics towards the achievement of critical goals established by the department. The key performance indicators will effectively expose and quantify waste in the service delivery process (Joint Commission Resources 148).
6.3. Monitoring and controlling improvements
Monitoring and controlling improvements after the implementation of the recommended solution is paramount. The most suitable method to be used is the key performance indicators. This approach is appropriate because it uses metrics to track improvements. The metrics can also be used as a benchmark upon which the goals of the department can be based. Additionally, the key performance indicator approach helps identify impediments to efficiency and continuous improvement. Besides this, the use of key performance indicators as a monitoring and control tool saves the department the additional cost because the tool is already incorporated into the lean tools used in the department (Joint Commission Resources 148).
7.1. Summary of Before and After Process
The service process in the imaging department contains many bottlenecks that result in wastage of time, hence to long wait time. After a physician orders a radiological test, there are seven steps in the service process. Usually, there is a long waiting period after the physician orders a radiological exam and the time the results are relayed to have. The waiting period over the seven step process can take over twenty five days. This is because there is a lot of backlog in scheduling. Additionally, the service delivery through the various processes is inefficient.
The time taken from one stage of the service process to the next can be over ten to twelve days depending on the radiology exam ordered and the amount of inventory. The service delivery process is also tempered by numerous errors. Estimates show that that percentage of error is high in some stages. The extent of errors is captured under the defect wastage. The ramifications for the department are severe, as sometimes, a wrong exam is performed on a patient. There are also bottlenecks in the fact that the department uses two billing compares for the professional and technical components. This leads to many denied bills.
After the implementation of the solution, the new look process will have five stages. The coding of the disease and patient information is done by the same person in the same stage. Billing of the components is done at the same time. The scheduling of radiological procedures will be streamlined in order to prevent the building of inventory. The wait time will be reduced from twenty five days to at most three.
7.2. Wastes Eliminated or Reduced
The wastes to be reduced include:
Financial cost due to denied bills
Wastages in time
7.3. Risks to be addressed
The risks to be addressed include:
Poor management of the lean six sigma project
7.3. Cost Benefit Summary
The operations at the department will run efficiently because of integration of services. There will be continual improvement due to the effect of the lean tools and monitoring and control tools incorporated. In terms of finances, there will be increase revenue because of the increase in turnover resulting from the improved efficiency in the operations of the department. Inventory management will reduce the cost on the department, hence contributing to the bottom line of the department. The reduction in denied bills will also reduce the losses of the department, by that contributing to the bottom line of the organization. The customers also stand to benefit. For instance, the wait time is reduced significantly from twenty five days to three days. Additionally, the integration of services means the customers will not make unnecessary movements.
Hall, Randolph W. Patient Flow: Reducing Delay in Healthcare Delivery. , 2013. Print.
Joint Commission Resources. Advanced Lean Thinking: Proven Methods to Reduce Waste and Improve Quality in Health Care. Oak Brook, IL: Joint Commission Resources, 2008. Print.
Martin, James. Lean six sigma for the office. Boca Raton. CRC Press. 2008. Print.
Meisel, Robert M. The Executive Guide to Understanding and Implementing Lean Six Sigma: The Financial Impact. Milwaukee, WI: ASQ Quality Press, 2007. Print.
Plenert, Gerhard. Lean management principles for information technology. Boca Raton. CRC Press. 2014. Print.