Six Sigma — A Case Study - Express Healthcare.pdf

8/14/2019 Six Sigma A Case Study - Express Healthcare.pdf

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"The first phase ofSix Sigmamethodologystarted withdeciding anddefining themetrics to beimproved"

- Anjan RoyPresident & CEO,

QitsUSA

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Business Accent

Six Sigma A Case Study

Six sigma application to decrease utility costs and improve engineering system reliability

in a healthcare setting

Dr LH Hiranandani Hospital, Mumbai is a 130 bed multi speciality

tertiary and quaternary care hospital. It is the first hospital in the

city of Mumbai and the western region of India to have received

the prestigious National Accreditation for Hospitals and Healthcare

Providers (NABH). Among other specialties, the hospital has energy

efficient structure design to achieve day light harvesting and to

reduce HVAC load, rain water harvesting system and integrated

building management system (IBMS).

The Need

The hospital is in the process of expanding from current 130 beds to additional 71 beds to caterto its growing patient base by constructing and adding additional six floors of 90,000 sq feet

space. The senior management of the hospital felt that it would be crucial to control and reduce

its utility costs with the current expansion plan to meet its strategic objectives that included

providing ultimate patient services. Therefore, it was decided to implement the Six Sigma

methodology in its engineering operations and maintenance services to control and contain the

operations and maintenance budget.

ProjectObjectives

Metrics Units KPI

UtilityConsumption

Water and PowerConsumption

KL andKWH

FWS/PO,DWS/PO,

KWH/PO

EngineeringSystemReliability

Engineeringcomplaints

No. ofcomplaints

No. ofcomplaints /day

FWS= Flushingwater supply

DWS= Drinkingwater supply,

KWH=Kilo-watt-hour,

PO= PatientOccupancy

Approach

The six sigma DMAIC methodology was used for achieving the desired improvement in engineering

system reliability and utility costs.

Phase-I: Defining the Opportunity for Improvement

The first phase of Six Sigma methodology started with deciding and defining the metrics to be

improved. The engineering team of the hospital decided to improve the power consumption and

water consumption (both flushing and drinking). In terms of engineering system reliability, the

team decided to reduce the no. of engineering complaints received per day.

Metrics and Key Performance Indicators

The table shows the various metrics and their associated key performance indicators that were

targeted for improvement. Traditionally, utility consumption has been reported in terms of per

square feet of consumption. However, the team felt that it would be more appropriate to
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measure and monitor the metrics in terms of per patient consumption.

Opportunity Statement for Improvement

Benchmarks for each of the metrics were established based on historical data. Table 1 shows the

benchmarks established for power, water (flushing and water) and gas consumption. The data

shown in the table are reflective of average consumption per patient per month. The table also

shows the average number of engineering complaints received per day.

Table-I: Benchmarks for utility consumption and engineering system reliability based on twelve

months data (March'08-Feb'09)

Table 1

KPI Monthly Average STDEV

KWH/PO 104 12.1

FWS/PO 1.12 0.3

DWS/PO 0.93 0.2

No. of engineering complaints 19 5

Phase-II: Measure: Monitoring and Measuring Day to Day Performance

The second phase of Six Sigma involved mapping out the processes and then monitoring and

measuring the performance indicators in a predefined and planned manner. Each of the above key

performance indicators were tracked by the Six Sigma engineering project team on a daily basis.

Utility Consumption Monitoring

The Key Performance Indicators for utility consumption were monitored for stability using

statistical process control (SPC) charts. Individual control charts (Average and Moving Range)

were used on a daily basis.

The control limits for the charts were established using historical process data. The teammonitored the process performance using these charts on a daily basis.

Monitoring of Engineering System Reliability

Monitoring and measurement of engineering system reliability was done by monitoring the number

of complaints received on a daily basis. Further the number of complaints receive on a monthly

basis were stratified into various types of system complaints.

The Table 2 shows the stratification of total number of engineering complaints in the month of

March'09 into various types of complaints.

Table 2 TRADEWISE TOTAL

ELECTRICAL 263

HVAC 52

PLUMBING 96

CARPENTRY 35

GAS OPERATION 34

PAINTING 47


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PHONE 40

A Pareto chart for the above data is shown in Figure-3:

It can be seen from the above Pareto chart that about 65 per cent of the engineering complaints

in March'09 were of plumbing and electrical type. The total number of plumbing and electrical

problems was further stratified (second level of stratification) into problems or complaints

received from each floor. The Table 3 shows the stratification of plumbing and electrical problems

per floor.

A Pareto chart for the data is shown in Table 3. The Pareto chart above shows that about 65 of

the complaints came from four floors, viz. 2nd floor, ground floor, 4th floor and 1st floor. In other

words, almost 65 per cent of the complaints can be reduced by focusing improvement efforts on

these four floors only. Maximum complaints i.e. almost 20 per cent of the electrical and plumbing

complaints were received from second floor itself.

Table 3

TRADEWISE

BASEMENT GROUND1STFL

2NDFL

3RDFL

4THFL

5THFL

6THFL

ELECTRICAL 40 58 43 68 28 33 30 18

PLUMBING 8 13 10 12 13 26 9 5

Phase-III: Analyse

The purpose of this phase of Six Sigma methodology is to analyze the root causes of process

deficiencies in an effort to completely eliminate them or at least reduce the effect of the root

causes on process parameters.

Utility Metrics

In the initial phases of the project, the team focused on understanding and investigating the

reasons for day -day-variations observed in the performance of the utility metrics as shown by

the control charts. The intent was to understand and eliminate all sources that caused unusualvariation in day-do- day performance of the key performance indicators showing utility

consumption i.e. power, gas and water.

A close watch was kept on the Moving Range chart to observe the variation in performance

between two consecutive days of operation.


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System Reliability

The Six Sigma team also investigated and brainstormed various factors and root cause(s)

resulting in higher plumbing and electrical complaints coming from ground, first, second and fourth

floor.

Table 4 shows the various electrical complaints and their root causes identified by the Six Sigma

team.

Table 4

ElectricalProblems

Commoncomplaints

Root Cause (s)

Central MonitorProblem

Biomedical work

Tube light problem Reuse of Blast

Call Bell Problem Misuse by user

Power supply trip Overloading

PlumbingComplaints

Flush leakage Algae/SIPON

Geyser problemIncorrect thermostatsetting

Phase-IV: IMPROVE

Once the root causes were identified, then team moved on to the next phase of Six Sigma i.e.

improvement phase. The purpose of this phase is to plan and implement various measures to

eliminate various root causes of problems identified in the analyse phase.

The team successfully achieved the following tasks in this phase of the project:

a) Brainstorm various countermeasures to eliminate the root causes.

b) Develop an implementation as well as contingency plan to implement the countermeasures.

c) Plan and measure the improvement resulting from the implementation of the countermeasures.

This phase took almost two months i.e. May-June'09.

Benefits Achieved

As a result of the implementation in May and June, the team recorded significant improvement in

almost all of the utility metrics consumption as well as engineering system reliability in the third


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quarter of 2009.

The Table 5 shows the results for third quarter performance of 2009 compared to that in 2009.

The last column in the table shows the % improvement in third quarter of 2009 performance.

Table 5

KPI Q3-08 Q3-09 % Improvement

KWH/PO 89.5 82.7 7.60%

FWS/PO 0.82 0.8 2.40%

DWS/PO 0.78 0.58 25.60%

No. of engineering complaints per day 21 13 38%

It can be seen from the above table that Six Sigma methodology implementation in a short span

of six months has led to following improvement at the hospital:

a) Engineering complaints has reduced as much as 40 per cent per day.

b) Drinking water consumption per patient has decreased as much as 26 per cent.

c) Power consumption has decreased by almost 8 per cent per patient per day.

d) Flushing water shows a marginal improvement only. The consumption has reduced by about 3

per cent per patient per day.

It must be noted that the above improvements i.e. reduction in utility consumption were

achieved without any compromise on patient care services and patient satisfaction. As a matter

of fact, in October 2009 the hospital has won the Malcolm Baldrige Quality Award (Asia Pacific)

for its outstanding quality services to patients. This is the only hospital in India to have won this

prestigious award.

Phase-V: CONTROL

Quality is dynamic and not static and hence Six Sigma pursuit is a journey and not an end result

in itself. The hospital management realises that the benefits achieved so far must be sustained

by maintaining strict vigilance on the underlying systems and processes. Therefore the team has

successfully implemented several process control checks on the day to engineering operations

and maintenance tasks. These checks includes detailed procedures, audits, training of operators,

training of end users and last but not the least the measurement and monitoring of all the KPI's

on process control charts on a daily basis.

With inputs from Anil Dhamdhere, Manager, EngineeringHiranandani Hospital

[email protected]
mailto:[email protected]

Documents

Six Sigma — A Case Study - Express Healthcare.pdf