WHAT Tools ARE in Your Toolbox to Promote Change?

The landscape of healthcare is changing as healthcare providers continue to be faced with providing proficient care to complex patients as well as meeting standards and requirements established and endorsed by federal agencies, insurance companies and our patients. Hospitals are striving to ensure they create an environment that promotes safety, accessibility, efficiency, affordability and overall cost-effectiveness. Leaders in healthcare are challenged to look for innovative and efficient ways to provide this care. The manufacturing industry has effectively used Lean and Six Sigma methodologies as the backbone of their quality improvement initiatives. They have a slight different approach but combined can be effective tools to be used for problem solving, developing rapid improvement cycles, lowering costs and increasing productivity. Lean methods attempt to eliminate non-value added waste in a process with the goal of improving performance and lowering costs. Six Sigma is an approach that uses mathematic techniques to reduce process variation. In todayŐs healthcare environment it would be prudent to look at other industries for new methods to improve processes that affect patient and staff safety, workflow, costs and overall efficiencies. At Dana-Farber ChildrenŐs Hospital Cancer Center within the Hematopoietic Stem Cell Transplant program there has been significant increase in the patient volume. This increase has placed new demands on the multidisciplinary staff and contributed to delays in workflow particularly with chemotherapy ordering and communication breakdowns. With the increase in patient volume it became apparent that in order to increase efficiency, the admission process needed to be evaluated; from when the patient is identified as a candidate for a stem cell transplant to their admission to the inpatient unit. Using the Lean and Six Sigma methodology and applying it to the typical autologous, allogeneic related and allogeneic unrelated transplant referrals we identified 125 process steps and 66 gaps in our admission processes. These gaps are areas of potential risks. A risk priority matrix was used to prioritize areas of improvement and the most important 5 issues were then categorized into common themes, which are related to institutional information systems, multiple ways for patient referral and dissemination of internal information. Small workgroups are being formed to address the issues. The potential impact on medical care, cost savings and improved information flow will be demonstrated in this presentation as well as potential for adapting Lean and Six Sigma methodology to other medical academic institutions.