"When we looked at the results they were all very middle of the pack, and that wasn't good enough," Miller explains. "I wanted to change us to a culture of excellence."
So in 2001, Miller took a bold step, and after doing a year of Six Sigma targeted pilots, he rolled management philosophy out system-wide. They invested just $1 million, which went toward training managers to be "black belts" in process improvement parlance. Once trained, the managers began to look for inefficiencies and ways to streamline the system.
They looked at all processes in all four hospitals—concentrating on areas of quality and safety. "Now we use this tool relentlessly. But it's really important that people understand that this tool isn't a short-term measure you turn to in tough economic times," he says. "You need the consistency to see the full results."
And they did see results, to the tune of $28 million overall since implementation as well as quality and patient safety improvements. For example, since applying theSix Sigma Toolbox the system has seen their core measures improve in areas such as dysphagia screening for patients being assessed for a stroke.
Virtua's clinical assessment rate is 90%, which exceeds the American Heart Association's "Get with the Guidelines" benchmark of 85%. Virtua was also part of the Joint Commission's Center for Transforming Health Inaugural Six Sigma Project for adherence to the World Health Organization's guidelines for hand hygiene—improving their hand hygiene by 118%.
"It's really a misnomer in healthcare that if we take the money out of the system that you reduce quality. Every other industry has shown that they improve quality when they reduce costs. You have to take the variation out of the process and reduce fragmentation, and then you'll reduce your costs," says Miller.
Healthcare IT implementation is a good example, Miller says, "We spend a lot of money on IT and use 20% of it. It's because we are implementing this technology into an already fragmented process. You need to correct your processes before you add the technology so you don't repeat the same mistakes."
Those who healthcare leaders look to roll out this type of process improvement initiative may want to start by analyzing their infection rates, medication errors rates, and readmission rates, according to Miller.
"Those are the areas that offer a broad brush for cost savings," he says.