Six Sigma has made such a difference at Virtua Health that the four-hospital system based in Marlton, N.J., is about to embark on a seventh round of cost containment and quality improvement projects using the techniques, according to a physician leader of the process improvement system there.
Mark VanKooy, M.D., a family physician and geriatric specialist, was the director of the residency program at Virtua Memorial Hospital Burlington County in Mount Holly when he was recruited to join the first class of Six Sigma trainees four years ago.
"I was intrigued by the methodology," VanKooy said.
Now his business cards read "Master Black Belt" for the Virtua system. It means VanKooy and nurse and fellow master black belt Susan McGann work full time as Six Sigma trainers.
They soon will lead six teams with eight to 10 people per team to undertake Virtua's "seventh wave" of Six Sigma projects. The pair oversees six black belts who are full-time Six Sigma project leaders and 29 green belts, full-time managers trained in Six Sigma.
The new projects will include efforts to improve Medicare benefits handling for inpatients and outpatients, a case management tracking system, operating room throughput and efficiency and human resources functions.
Six of the eight new projects were chosen because they have the potential of dropping at least $100,000 in what VanKooy describes as measurable "hard dollars" to the bottom line through performance improvements.
VanKooy said Virtua has tackled 60 project in four years with the application of Six Sigma.
"We've had great successes in quality and productivity, but we've had home runs in the financial realm," he said.
Why should a doctor get such an obvious charge out of administrative improvements?
"My CEO does not have a walnut-paneled office," VanKooy said. "If we save $100,000 on a project, it goes to two things: buying equipment and salaries. We need to leverage every dollar that we can to create a good patient experience. That's what lights my fire."
A memorable clinical win using Six Sigma was the improvement his team made during three months in the summer of 2002, analyzing clinical outcomes of patients on the anticoagulant heparin.
"We had occasional bad outcomes, and every three years we had a significant bad outcome," VanKooy said. Fingers pointed at turnaround time between nurses and the lab, but by breaking down the problem, the improvement team learned the problems were not related to turnaround times at all.
"It took out the urban legend part of it and showed the labs and nursing were doing a pretty good job working together," VanKooy said. The true tale it told was that the negative outcomes were related to gross failures of the system, an alignment of bad planets that statistically was bound to happen with such a complex procedure.
"There were 92 process steps to go through for the first 24 hours of receiving heparin," he said. "The answer there was simplification." The hospital standardized procedures around a low-molecular-weight heparin and reduced the complexity of the process from 92 steps to 21.
The switch raised expenses, but it was easy to make the argument for the change through increases in employee productivity and patient safety, according to VanKooy. The number of incidents since the change has dropped so markedly, Virtua has stopped tracking them, he said.
"What you really learn from Six Sigma is how to approach any process," VanKooy said. "The technical competencies are all over in healthcare. But the management skills, the analysis, the process deconstruction, moving in an organized fashion from problem analysis to implementation, are not widely available. This is a great way to take people and give them a core set of competencies."