A national leader in caring for children with special health care needs, Franciscan Hospital for Children provides clinical, therapeutic, and educational programs for children with a variety of disabilities. The hospital staff promotes the integrity and well-being of children through exceptional care and a commitment to helping each child reach his or her full potential.
When it comes to the quality of care patients receive, the hospital’s leadership team is dedicated to fostering continuous improvement to improve all facets of care—from reducing patient waiting room times to boosting the efficiency of operating rooms. With the help of Lean Six Sigma and Minitab software, Franciscan Hospital for Children was able to analyze information about its processes and make data-driven decisions that increased operating room efficiency and enabled doctors to see more kids.
The hospital offers many different medical, educational and behavioral services, including dental services for children with special needs. Recognizing the opportunity to grow a key area of service, the hospital’s quality improvement team chose to focus efforts on the dental division, where the dental surgeries were not occurring as efficiently as possible. Previous analysis and studies done to assess capability indicated that the facility was capable of completing 12 surgeries per day, but it currently had an average daily rate of only 8.7 surgeries. The hospital team’s goal was to meet a daily average of 12 surgeries, and to reach this goal the team set out to complete a Lean Six Sigma project to increase the capacity of dental operating rooms.
The team chose to frame its project using the DMAIC approach, which divides improvement projects into five phases: define, measure, analyze, improve, and control. As part of the define phase, the team involved staff representatives from the nursing, scheduling, registration, and anesthesiology departments, and developed process maps using Quality Companion* (now Minitab Engage™), Minitab’s process improvement software. Process maps helped them to better understand current processes for scheduling, registration, and surgery preparation, and gave them insight into the factors affecting each process. They were able to narrow down both internal and external contributors to cancellations and no-shows, as well as idle time that occurred due to process bottlenecks. The team then prioritized factors for further investigation—directing their attention to the analysis of variables they could control.
"Engaging our staff, especially those deeply involved in the process, allowed us to better understand the current process and start to think about potential improvements," says Jennifer Fexis, vice president of performance improvement and safety at Franciscan Hospital. "Relying on the staff for their input, along with the quality tools in Minitab and Quality Companion* to analyze and visualize process data, gave our team the insight to dig deeper and find the cause of process bottlenecks."
For example, the hospital team compiled data and created a Pareto chart to analyze the reasons for cancellations. The Pareto analysis helped them determine which reason occurred most frequently, and aided them in understanding how daily cancellations affected overall cycle times and scheduling.
Individual Value Plots in Minitab helped the team clearly view the distribution of actual procedure time and the time originally allotted for each procedure. They found that shorter procedures tended to exceed scheduled time, while longer procedures tended to finish earlier than scheduled. Minitab graphs allowed the team to quickly view how much unused time occurred each day in each operating room.
"The ability to investigate data with graphs and charts made it easy for the project team, staff, and senior management—who all have varying degrees of statistical knowledge—to see where breakdowns in the process were occurring," Fexis says. "And when we moved into the ‘Improve’ phase, staff members affected by a process change understood why the change was happening."
Team members followed up with further analysis to understand other factors that contributed to unused time in the operating rooms, and used histograms to analyze turnaround times for procedures, noting significant variation in the times. They realized the opportunity to reduce both the variation and the average turnaround to allow for more time to do procedures.
By analyzing the data in Minitab and learning more about factors that negatively affect processes, the team was able to develop process changes, then test the effectiveness of improvements. They completed current state and future state Value Stream Maps to identify opportunities for improving the lead time and then began executing the new, leaner processes.
Within two weeks of starting the improvement phase, average surgeries per day jumped from 8.7 to 9.9, and then to 11.2 during the control phase. At the same time, day-to-day utilization rates stabilized. The Lean Six Sigma project also helped the team establish performance metrics that will be used to continually improve operating room capacity and utilization rates. By regularly plotting process data with control charts in Minitab, staff can easily monitor for any unusual variation in the number of surgeries per day.
Other improvements include new policies that have streamlined the scheduling processes for dentists, greatly diminishing the amount of unused operating room time and keeping the dentists apprised of any updates to daily patient bookings. The booking and registration process was improved by for organizing paperwork with special tags that highlight possible problems and indicate time-sensitivity.
As an organization dedicated to providing the highest quality of care for children with special needs, the Franciscan Hospital is focusing on additional data-driven performance improvement efforts to improve safety and increase efficiency. "We look to technology such as barcode scanning to match the patient to their medication and automated medication dispensing units to improve medication safety, and best practices such as proper hand hygiene to prevent the spread of infection," says Fexis. "And to further ensure we adopt the right solutions, we engage our staff, patients and families to help us understand the full scope of the impact of changes on all our stakeholders."
*This case study was created using Minitab Quality Companion, prior to the 2021 introduction of Minitab Engage.
The Franciscan Hospital project featured in this case study was completed with the assistance of Global Productivity Solutions "Giving Back" program.
Franciscan Hospital for Children
Improve the capacity of dental operating rooms