1

Six Sigma Class Exercises

Alameda County EMS September 14 & 15, 2005

Group 1: Patient

Voice of the Customer Interpretation Critical to Quality (CTQ)

Get here fast! Quick response Response time*

Know what youre doing Competence Continual training with evaluations

Clean and Confident Professionalism Uniformity: well-groomed, uniform clean & pressed

Listen and Care Compassion Understand patient needs

Make me better Solve the problem Customer satisfaction

Is there a charge? Cost effectiveness Taxes: Effective use of taxpayer dollars

*Problem statement: Over the last six months, we received 25 complaints that we were slow to respond. Project statement: We will reduce complaints of slow response by 50% during the next quarter.

Complaints of Delayed Response

Fire Station Dispatch

People Travel

Appropriate company assigned

Rotating station closures

Call transferred

Dispatch staffing levels

Dispatcher training

Size of apartment complex

Traffic

Inclement weather

Major road construction

Knox boxes

Time of day

Alert devices

Gear on rig

Workout, sleep, shower

Equipment failure

Station layout

Personal protective equipment

Run card

Burnout

Operational readiness

Turnout policy training

District familiarization

Traffic calming devices

VOC Group 1: Patient

Cause and Effect Diagram

2

Receipt of call to PSAP

Fire/EMScall?

ACCRECDispatch

Take EMDinformaiton

Route call

Turnouttime

Responsetime

Arrival atpatient

Transferred to Police Department

yes

no

VOC Group 1: Patient Response time flowchart

3

Group 1: Causes of Delayed Responses

48

35

84

2 0.5

49%

85%

93%97%

99% 100%

0

10

20

30

40

50

60

70

80

90

"Brown outs" Locution failure Traffic calmingdevices

New mapping system Equipment failure Policies/Procedures

Contributing Factors

Perc

enta

ge

All data in the class exercises were made up by the workgroups

4

Group 2: Medical Director

Voice of the Customer Interpretation Critical to Quality (CTQ)

Increase cardiac arrest survival rate

Competent CPR Witnessed v.fib survival rate up to 30%

Improve advanced airway success rates 95% successful

Quality shortness of breath care

Excellence in assessment; Appropriate treatment and care

Quality cardiac care

Appropriate assessment Appropriate lead interpretation Appropriate treatment Appropriate destination

Data collection analysis and procurement of outcome data from

hospital

Collect data* Accurate and timely Complete documentation and reporting

Data collection system System software, hardware and training to achieve this

*Problem statement: Over the past three months, it has been noted that 50% (PCR/bubble)

paperwork/documentation has been submitted. Project statement: Assess potential causes by process evaluation over 90 day period

Design (user friendly) Behavior Measurement system

PCR not leftat hospital

Responders

Station/Quarters Routing

Transport

Personnel

Equipment

Billing

System Status

Personnel(behavior)

VOC Group 2: Medical DirectorProblem: PCR not left at hospital

Cause and Effect Diagram

Courier

Equipment

Hospital

Available time

Turnaround time

Personnel(Triage)

Patient condition(critical)

Equipment Failure(e.g. CT Scanner)

Call/Dispatch

Personnel

System status

On Scene

QA

Training Competency Fatigue Behavior

Equipment

CAD Clocks Phone Computer

Personnel

Equipment

PatientCondition

ETA to ER

Resources

Patient condition

Available time

5

CALL

FirstResonders Transport

On scene

Pt.condition

(time)

Transport

Hospital

Pt.condition

(time)

Station

Routing

Billing Q.A.

Complete?

Complete?

Turnaround/complete?(system status)

Available time/complete?

BEHAVIOR

DESIGN

RESOURCES

VOC Group 2: Medical Director Flowchart: Leaving PCRs at Hospital

6

Group 2: PCRs Not Left at Hospital

30

2017

10

53 3

1

34%

56%

75%

87%

92%96%

99% 100%

0

10

20

30

40

50

60

70

80

90

100

TransportAgency

Hospital First Responder Enroute Station Dispatch Routing On Scene Time

Contributing Factors

Perc

enta

ge

AAll data in the class exercises were made up by the workgroups

7

Group 3: Hospital

Voice of the Customer Interpretation Critical to Quality (CTQ)

Billing information* Reimburse me $ Bring insurance cards

Complete PCR No missing pertinent info (Hx, meds, allergies, treatments)

Time to complete PCR Fax access User friendly PCR

Good patient report Pertinent details Short and concise: MIVT Standardized report outline

Equipment compatibility Smooth transition & interface No time lost changing tubing, pacer pads

Equipment standardization process

Ringdown concise and timely Timely, pertinent info. so we can gather appropriate resources

Early notification with standardized report format (necessary info).

*Problem statement: Loss of 30% of billable revenue over past four months, resulting in $___ loss. Project statement: Increase billable revenue by 20% (to 90%) over the next six months, resulting

in an increase in revenue of $______.

Lost Revenue

SNF Patient

Patient Prehospital

Nurse left room

Chart AWOL

Staff language barrier

No cards

LanguageBarrier

Altered level of

consciousness

VOC Group: HospitalProblem: Lost revenue

Cause and Effect Diagram

Notavailable

Notbrought

No walletbiopsy

ForgotTo ask

No information

No family

Hospital

Non-compliantpersonnel

Patientacuity

Face sheetincomplete

Staffingpatterns

Patientload

Copier

Location Broken

Transfer of careFor transport

If no go(to hospital)

Didnt pass oninformation

Billing process

Its in the mail

8

Do you have insurance?

Locate insurance

documents(bring wallet)

Prehospital field

personnel

Facilitiesclerical staff(Available?

Busy?)

Patient Interview

LOC, Age,Kaiser?

Bystander, family

provides info(Language

barrier)

Inputs (xs)

Cards brought

Copies made

Document oral/verbal info

Clerk makes face sheet

Complete billing info

= $ reimbursement

Process (f)Output (y)

Y = f(x) + f(x) + f(x)...

VOC Group 3: Hospital Factors impacting ability to get billing information

The output is a function of the inputs

9

Group 3: Providing Insurance Information

30

20

1512

7 6 52

31%

52%

67%

79%

87%

93%

98%100%

0

10

20

30

40

50

60

70

80

90

100

Cards available Family Historian Communcation EMS asks Copy machine Staff Face sheetcomplete

SNF chart

Contributing Factors

Perc

enta

ge

All data in the class exercises were made up by the workgroups

10

Group 4: Local Government

Voice of the Customer Interpretation Critical to Quality (CTQ)

Take too long! Quick response 4-6 minute response time 95% of the time

Cost too much! Fiscally responsible Operate within budget*

You dont care! Professional conduct Appropriate behavior and appearance Dou you know what youre doing? Competent care

Trained (initial and ongoing) Certis & qualifications

*Problem Statement: As local government, our tax base is reduced by 10%. Project Goal: Reduce operating costs by 10%

11

Group 4: Local Government Brainstorming solutions (Reducing staffing costs) Mind Map graphic based on the teams outline

Group 4: Expense Reduction

40

20

105 5 5 5 5 5

40%

60%

70%75%

80%85%

90%95%

100%

0

10

20

30

40

50

60

70

80

90

100

Labo

r/Ove

rtime

Sick L

eave

Org C

hart

Fleet

Maint

.

Lost/

Stole

n/Brok

en

Offic

e Was

te

Redu

ndan

t Equ

ip.

Infreq

uentl

y Use

dOt

her

Contributing Factors

Perc

enta

ge

All data in the class exercises were made up by the workgroups

12

Group 5: Employees

Voice of the Customer Interpretation Critical to Quality (CTQ)

I want quality training We want reality-based training! Evaluate training methodologies We need equipment thats right for field providers

Equipment that is lightweight, appropriate, current and works

Field test prior to purchase or deployment

I have the paperwork! PCR & forms are time intensive and repetitive Easy to complete and avoid repetition

I dont know what you want* They want clear expectations Clear documentation policy

*Problem statement: Quarterly survey reports show that 80% of employees feel expectations of

performance are unclear. Project statement: During the next survey period we will reduce this measure from 80% to less than

or equal to 20%

13

Expectation(Policy)

Send to company officers for comment

Comments(Revisions)?

Finalize(Put in book)

Send out final copy to officers

Revise

Review withindividuals

Resource Person forquestions

Place instandardlocation

Resurvey

yes

no

VOC Group 5: Employees Flowchart: Development and

communication of policies

14

Group 5: Poorly Understood Policies

12

10

8

6

33%

61%

83%

100%

0

2

4

6

8

10

12

14

Volume of Policies Complexity of Policy Location of Policy Poor Dissemination

Contributing Factors

Num

ber o

f Occ

urre

nces

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Perc

ent

All data in the class exercises were made up by the workgroups