Leadership: First, Get an Expert to Start ED Overhaul

Those new eyes mean it's possible to entirely change a department, while retaining the same walls, layout, staff, and equipment.

Other improvements:

• The percentage of patients who left the ED without seeing a physician dropped from 8% to 3%.
• Patient satisfaction skyrocketed: Prior to Six Sigma in the ED, patient satisfaction hovered at 67%, and jumped to 97% afterward.
• Positive responses to wait times climbed from 44% to 85%.

Targeting the right areas
When selecting where the Six Sigma resources would be used first, it came down to a balance of two things, Schaffer explains: strategic imperative and pain.

"When I say pain, it's either clinical, financial, or customer service," says Schaffer.

EDs are a pain point all across the country. It was obvious the organization needed to make a major improvement here based on dissatisfaction across the board—physicians, staff, patients, and families.

EDs also come with a strategic imperative. To drive volume up and improve efficiency and effectiveness, it was easy to combine both the pain and strategic imperatives.

"The other thing we did was a lot of length-of-stay projects," says Schaffer. "Again, the shortage of beds—it's a strategic imperative to your community to serve more people and maximize resources."

Building buy-in
The real key to Six Sigma success is the backing of senior management.

"If you really believe in it, then the support is completely natural," says Schaffer. "You don't hesitate to allocate resources."

To obtain buy-in, Providence made use of success stories told by colleagues. The ED nurse executive made a presentation at the department managers meeting and leadership meeting to share positive experiences. They become champions for the cause.

"The colleagues drove it. And success stories are not hard to find," says Schaffer.

The entire Six Sigma process is driven by middle management now. At all times, there are 50 projects in the queue waiting to be given the Lean Six Sigma treatment.

Overcoming challenges
When first starting out, consider bringing in a black belt from outside healthcare, suggests Schaffer.

"Our first pitfall was trying to train our initial cadre of black belts from our own staff," says Schaffer. "I think it kept it too insular to healthcare, too accepting of how and why we did things."

The organization tried too hard at first to duplicate another organization's program. Although a lot can be learned from the successes and mistakes of others, it is more beneficial to tailor the process to the needs of your own organization, Schaffer recommends.

The buy-in initiative had its challenges at first, as well. It took some effort to convince management that Lean Six Sigma wasn't the flavor of the month, but would have real staying power.

Another unexpected challenge was terminology. Because it comes out of the business world, Six Sigma terminology skews toward the aggressive. Even the titles "black belt" and "green belt," with their martial arts connotation, can put healthcare workers on edge.

"It takes a while to get over those humps, but trust develops over time," says Schaffer.