Lean, Six Sigma experts leading quality, safety improvements at Via Christi
Wichita is known as the “Air Capital of the World” because of its history of aviation innovation and manufacturing.
Now, Via Christi Health, the largest health care provider in Kansas and Wichita’s second-largest employer behind Spirit Aerosystems, is tapping into the expertise of the aviation industry to improve the quality and safety of the care it provides.
A small cadre of aviation experts trained as black belts and master black belts in the Japanese quality improvement methodologies of Lean and Six Sigma have joined Via Christi’s Center for Clinical Excellence. They are working with Via Christi’s clinically trained quality improvement experts, physicians and other clinicians to propel a leap forward in quality, safety and service to patients.
As part of its Vision 2020 strategic plan, Via Christi’s goal is to eliminate medical errors and other incidents of preventable harm to patients by using industrial engineering techniques and appropriate technology to improve the processes of care, says Jeff Korsmo, president and CEO of Via Christi.
“Patients and their families put their trust in us to heal them. They have a right to expect to never be harmed by anything we do,” Korsmo says. “We’re working with urgency to become a high-reliability organization that consistently provides the safest, highest-quality care and great service to our patients and residents.
“We do a very good job of caring for most patients and residents today, but we believe we can — and must — be better,” Korsmo says. “The beauty of this effort is it will help us achieve dramatic, consistent improvements in patient outcomes, safety and service throughout Via Christi. Our success in quality improvement will have far-reaching effects, making Via Christi an even better place to receive care and to work as a physician, nurse, pharmacist, therapist or other clinician.”
Improving quality and safety
Korsmo has championed the quality improvement initiative and meets weekly with staff members in the Center for Clinical Excellence to learn, provide direction and support their work.
Steve Nesbit, DO, chief medical officer for Via Christi’s Wichita hospitals, and Al Miller, the center’s executive director, are leading the quality improvement work and say that health care can learn from aviation and other manufacturing industries.
“It’s the right thing to do to improve health care,” Dr. Nesbit says, noting that Lean and Six Sigma methods have long been used in aviation, the auto industry and other manufacturing businesses. “We’re late in our industry in adopting these techniques. But other health care systems have used Lean, Six Sigma and other techniques to make dramatic improvements in quality and patient safety.”
Miller, a master black belt in Lean Six Sigma, spent 30 years working for General Electric in quality and reliability engineering roles before starting a new career in health care seven years ago at Blessing Hospital in Illinois, where he worked with Dr. Nesbit.
Over the past six months, Via Christi has hired five additional Lean Six Sigma black belts with a combined 72 years of experience in Wichita’s aviation industry.
“Why would we choose aviation rather than using our own expertise in health care? Aviation has established itself as a high-reliability industry with excellent safety and performance,” Miller says. “There aren’t going to be any work processes that we can’t improve with the expertise of our clinicians partnered with our black belts.”
Miller says the aviation black belts will be teamed with clinical quality experts and use the Institute of Healthcare Improvement’s “rapid-cycle improvement” approach to re-engineer how medical care is delivered so it is consistently safe and of the highest possible quality. When needed, the teams will use the Lean and Six Sigma process improvement tools pioneered by Toyota and other Japanese manufacturers.
Safer and more efficient
These methods can be employed to improve virtually any process within a health care organization — from reducing hospital-acquired infections and medication errors, to making the workplace in hospitals and senior care facilities safer, to improving the turnaround time for pharmacy orders and the safety of surgical procedures.
Lean focuses on removing wasted effort from work processes, while Six Sigma techniques eliminate variations in the way medical care is provided — because variations lead to inconsistencies in quality and patient safety.
Via Christi has formed four “performance improvement teams” (PITs) to improve the quality of surgical care, cardiac care and pneumonia treatment, and to reduce incidents of hospital-acquired infections. It will soon form two more teams, focused on improving patient safety and service.
The teams will utilize established best-practice processes needed to improve quality and create a high-reliability, patient-safety culture. Each team includes physicians, nurses, other clinicians, a quality manager, a black belt, a board member — and at least one patient or patient family member. To set an example and contribute to the process improvement efforts, all Via Christi senior leaders will complete PIT training and a performance improvement project in their area of responsibility in 2013.
The black belts and quality managers work with other PIT members to analyze the individual components of a clinical process — such as how a time-out and checklist are conducted before a surgical procedure begins.
They then develop new processes to ensure that medical care is consistently high quality and error free. After each change is implemented, the black belts review data showing how well patients fared to make sure the new process measurably improves the quality of care.
Korsmo wanted patients to be involved in Via Christi’s improvement efforts because of the perspective and experiences they bring.
Karen Fifer, who credits Via Christi clinicians with saving her life when she suffered a ruptured brain aneurysm in 2011, serves on the team working to improve treatment for patients suffering from heart attack or heart failure.
“It gives me confidence, as a patient, to know that Via Christi is undertaking this effort,” Fifer says. “I think it says Via Christi truly is concerned about the quality of patient care because it wants a patient involved. It says that we’re important.”
Laura Thompson, who became Via Christi’s director of Process Improvement after a 25-year career in aviation, says she has found many similarities between health care and aircraft manufacturing.
“In aviation and health care, everything is focused on safety and looking at those very rare bad events that happen — in aviation, accidents, in health care, major harm — and figuring out how we can prevent those,” she says.
Gretchen Blake, Via Christi’s director of Quality and Patient Safety, has more than 20 years of clinical experience in health care and is Thompson’s colleague in the Center for Clinical Excellence.
“It truly is a partnership,” she says. “You take the quality methodology that is specific to health care and pair that with the performance improvement skills of the black belts. We work together to improve our quality and then to sustain those improvements. I think the black belts will help us create a paradigm shift in culture in the way we think about safety.”
Rob Dreiling, a black belt with 20 years of aviation experience, says building new care processes that ensure patient safety is the most important part of the team’s work.
“If I’m going to pick an airplane for my family to fly on, I’m going to choose the one that is the most reliable and that I trust the most. It’s the same thing with health care,” Dreiling says. “We want to be the place our communities trust to care for their loved ones safely and effectively.”
Photo illustration caption:
Gretchen Blake, front, Laura Thompson and Al Miller “break” boards representing barriers to quality care. In Six Sigma, titles such as black belt are given as levels of training are completed. Photo illustration wardrobe courtesy of Kim’s Academy of Tae Kwon Do of Wichita.
The Lean approach to quality improvement blends a philosophy, a framework, a methodology, techniques and tools to help organizations make continuous, incremental improvements that reduce variation and waste in their work processes. Because Lean is more than just techniques, organizations using Lean successfully apply its practices as a way of thinking — a way of approaching issues and challenges.
Often used in conjunction with Lean, Six Sigma is a five-step problem-solving method intended to significantly improve the key outcomes of a work process. The Six Sigma methods are used to improve performance by continuously reducing variations, defects and errors in an organization’s work.
High reliability ensures that employees, the technology they use and the processes they follow will accomplish the intended tasks without error and that, if mistakes are made, they will be caught before any harm or damage is done. High-reliability organizations use continuous training, continuous improvement and frequent safety and process audits to ensure the work they perform is consistently safe and of the highest quality.
The Rapid-Cycle Improvement method uses a technique called PDSA, or “plan-do-study-act,” to create quick, measurable improvements in quality and safety. A PDSA cycle involves testing a change in the real work setting by planning it, trying it, observing the results, and acting on what is learned. This is the scientific method adapted for action-oriented learning.