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Presented By
Dr. Vinod Prabhu & Sameer Murdeshwar
Institute of Management Technology, Dubai (DIAC)

 Objectives of the Study
 Brief History of Six Sigma
 Six Sigma in the Healthcare Industry
 Time frame
 End Outcome
 The DMAIC Methodology
◦ Define
◦ Measure
◦ Analyze
◦ Improve
◦ Control

 To look for an existing process in the hospital
which has a scope for significant
improvement

 Six Sigma methodology would be the choice
for the process improvement

 Chosen focus area is the Medication Delivery
Turnaround Time for newly admitted patients

 Blakslee (1999, July) refers to Six Sigma as “a
high-performance, data-driven approach to
analyzing the root causes of business
problems and solving them”

 Originally developed by Bill Smith, a reliability
engineer working for Motorola in 1986

 Adopted by GE in the 1990s

 Ever-growing number of health care
organizations are using Six Sigma to improve
processes from admissions to discharges and
all the administrative and clinical processes in
between
 Driven by several factors including the need
to improve the organization’s bottom-
line, eliminate medical errors and position
themselves for an imminent global customer
- centred health care revolution

 Using the DMAIC methodology, the study was
spilt into five phases

◦ Define phase (10 days)
◦ Measure phase (30 days)
◦ Analyze phase (10 days)
◦ Improve phase (15 days)
◦ Control phase (5 days)

 Significant improvement in the existing
process
 Greater customer & employee satisfaction
 Streamlining of the process
 Savings in terms of time – Medication Delivery
Turnaround Time for newly admitted in-
patients

 Flexible, but powerful set of five steps for
making improvements happen and stick

 The team works from a statement of the
problem to the implementation of the
solution, with statistical driven activities in
between

 Define the problem
 Identifies potential projects, selects and
defines a project, and sets up the project
team
 Selection of the project depends on it’s
feasibility, significance and measurability
 Started out with mapping the complete
process for three processes
◦ Patient admission (IP)
◦ Outpatient procedure
◦ Working of pharmacy

 Initially chose OP process but…
 Finally, focus area shifted to the IP process
for newly admitted patients requiring
medications upon admission
 Main reason being the complexity of
interactions & process flow and the larger
number of variables
 Drew up a timeline & chalked out a project
blueprint

 Organization: Zulekha Hospital, Sharjah
 Champion: Dr. Suresh Menon
 Project Owner: Dr. Alexander Varghese
 Project leader: Ms. Pooja George
 Project: Medication Delivery TAT for Newly admitted
patients
 Problem statement: Long waiting times for a newly
admitted patient to receive their first medication
 Project objective: To reduce the patient waiting times
for medication
 Project Team: Dr. Vinod Prabhu & Sameer
Murdeshwar
 Metrics: Minutes
 CTQ: Quicker drug dispensation

 Data is gathered to validate and to quantify the problem /
opportunity
 Begin testing out facts and numbers that offer clues about
the causes of the problem
 Identify key parameters and process characteristics
 Process was observed for 3 – 4 days
 Questioned people involved for clarification
 Process was divided into 9 distinct steps and individually
measured
 Total of 40 cases were measured, across all three wards
and different shift timings
 Daycare cases and delayed medication cases were not
taken into consideration
 Took care to be as discreet as possible so as to not
introduce bias into the study

Medication Delivery Turnaround Time

 Identifies the causes of the problem
 From the various causes, the focus will be on the
root cause(s)
 Begins by combining data, experience, a review
of the process, and then forming an initial
hypothesis of the cause
 Root Cause analysis performed
 Ishikawa (Cause & Effect) Diagram was
constructed
 Pareto Analysis performed
 Quantitative drill down of the measured numbers
– Averages, Max time, Min time & Frequency
distribution

25.00
Average Time of Each Process

20.00
Time in Minutes

15.00

10.00

5.00

0.00
1 2 3 4 5 6 7 8 9

Series1 5.99 10.61 6.40 2.58 0.78 8.15 3.26 2.69 23.73

% Contribution of each Step to Total Time
40

35

30

25
Percentage

20

15

10

5

0
1 2 3 4 5 6 7 8 9

Series1 9.33 16.54 9.97 4.01 1.22 12.7 5.07 4.19 36.97

Pareto Chart for Stage Wise Delay
120

100

80
Percentage

60

40

20

0
k c h de ab i j f g

Series1 36.974878 16.535150 12.699513 9.9696202 9.3324245 5.0726387 4.1850048 4.0144109 1.2163583
Series2 36.974878 53.510029 66.209542 76.179162 85.511587 90.584225 94.769230 98.783641 100

Major Causes Instances
Multitasking-doctor enquiries and patient room calls 10
Nurses handling other recent admissions 9
Nurses focus on doing the paper work 6
Indent not kept on shelf immediately after print out taken 6
HK busy with their primary work 5
Distractions-Telephone calls 2

 Designs a remedy, help prove its
effectiveness, and prepares an
implementation plan
 Several potential solutions have to be
proposed
 Criteria, including costs and likely benefits
are used to select the most practical solutions

 Process Re-Design
 Dedicated Housekeeping staff to deliver
medications from pharmacy to all wards
 Medical file re-design
 Use of digital clocks
 Printing priority
 Discharge sheet proposal

 Avoiding the “snap” back to old habits and
processes
 Ensuring that the solution has a long-term
impact
 Developing a monitoring process to keep
track of the changes
 Creating a response plan for dealing with
problems that may arise

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Medication Delivery Turnaround Time

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