Background | Medical &Wellness Clinic
The Davis Medical Center (DMC) is a primary care medical clinic in a small town. It provides all the aspects of a medical clinic including checkups and minor medical procedures. Because it is some distance from a hospital and most medical specialty offices it incorporates some basic diagnostic capabilities such as X-Ray, MRI, basic blood work, etc. As with most current medical facilities in the US, it suffers from a wide variety of inefficiencies such as scheduling issues, delays, long patient waits and movements within the facility, cumbersome, time consuming, and error prone medical record and other data handling processes, high levels of medical errors, etc. To address these issues, DMC has implemented a Lean Six Sigma program and you have been hired as a Black Belt to work in the program.
DMC is currently in the preliminary planning stages of expanding to offer its clients more comprehensive wellness services including diet and nutrition counseling, fitness evaluation, activity and exercise planning including related physical therapy, etc. Goals are to include:
Assist clients to develop a sustainable wellness lifestyle
Develop diet, exercise stress management, and other lifestyle programs which are more comprehensive of the individual patient especially injuries and medical condition
Business model based on high volume of clients
Modalities
Client history
Measure current wellness parameters
Evaluate possible medical problems
Recommend and coach lifestyle changes (stress reduction, diet / nutrition
Develop and coach an personal physical activity (exercise) program
Exercise 1
To implement these new wellness services, current physical facilities must be altered and expanded. Management wants to implement Lean concepts in this design process. You are to propose a project to facilitate this. You are to work through the Define and initial Measurement phases of the DMAIC process. Since the wellness project is in the preliminary design stages, you will have time to perform evaluations of current processes, take measurements of identified metrics, and possibly some small DOE type characterization and improvement evaluations.
A. Write a Problem Statement for the projects. And define the Scope (what will be included and not included).
B. Define the Team requirements in terms of the functional skills and knowledge areas required.
C. Create a high level SIPOC map to identify all significant Inputs, Outputs, and Customers. This map should reflect the Scope defined in question A
D. Define critical Metrics to be measured
E. Create a Data Collection Plan (from Tool Book) to obtain the required information.
F. Identify any other LSS tools which would use in this project. Explain each of your choices and how you would apply it. You can perform analyses based on hypothetical “possible” data if it aids your explanations.
Exercise 2
Measure;
One of the initial steps in the wellness program is -the patient evaluation processes. An important metric is quantifying a patient’s current level of “wellness” is the measurement of Total % Body Fat. . The “skin-fold” technique is currently used in which a technician pinches the fat layer on several locations on a client’s body and measures them with a plastic caliper. This has been determined to be a slow process and in addition is perceived to be embarrassing and invasive by many clients. A conductivity measuring device (CM) is available which the patient simply holds in two hands for a 15-30 second interval. It is much faster, requires much less technical training and is much more acceptable to most clients. The accuracy and repeatability of this technique has been questioned.
Gage R&R’s are performed to compare the techniques using the 2 methods with:
2- operators
10 Clients
2 repeats
DATA: in Excel Sheet
- Analyze this data using MINITAB
- What do the results indicate?
- Can you determine the Capability of the CM process?
- What additional data might be collected to further evaluate the viability or the proposed conductivity instrument?
Exercise 3
Analyze
One of the ultimate objectives of a Wellness Program is to improve patient’s health through life style changes. Management would like to investigate using diet and exercise to lower patients’ blood pressure without the use of medicines such as “Preslo”. Extensive data show that a standard dosage Preslo reduces blood pressure 20 points with a standard deviation of 3points. Some limited data are available (below) on the reduction of blood pressure through standard diet and exercise modifications. Management would like to have a 95% confidence before beginning rigorous testing of life style modification programs for blood pressure reduction.
Data in Excel Sheet
A. Analyze this data to see if it supports a 95% confidence that diet and exercise can be at least as effective as Preslo?
B. What additional comments would you offer to management concerning this decision?
Exercise 4
Improve
Problem scenario with defect frequency data?
Because of its remote location from full service test laboratories, DMC performs certain blood tests in-house. All other tests are sent out to the nearest laboratory which has a minimum turn-around time of 2 hours, depending on the test. The tests performed at DMC are simple and each requires only a few minutes to complete. Although there are not a high number of these in-house tests, nevertheless, patients still frequently experience long delays waiting for results. A month long investigation of the causes of these delays indicates the following:
Reason for Delay
Occurrences (1 month)
Paperwork not complete
70
Sample mislabeled
10
Technician not available (other duties)
40
Backlog for specific test
20
Specific test equipment not ready (warmup etc)
90
Paperwork lost
5
A. Create a Pareto Chart
B. What does this chart indicate
C. Create a Cause and Effect Diagram (from Tool Book) for one of the most significant Causes of Delay.
D. Create a Root Cause Analysis Matrix (from Tool Book)
E. Propose solutions for 3 of the identified root causes
Exercise 5
Control
Part of the Integrated Wellness Program is the creation of an Activities Plan and Schedule for each client to promote overall wellness. This Plan can include sports, outdoor activities, exercises, stretching, etc.; along with recommended frequencies and durations.
Perform a partial Failure Modes and Effects Analysis (FMEA) on this process.
A. Define and explain 1-5 scales for Severity, Occurrence, and Detection
B. Brainstorm at least 3 Failure Modes and a total of at least 10 Effects (ex. 5 FM with 2 Effects each, or10 FM with 1 Effect each, or any combination)
C. Complete the RPN ranking of each Effect
D. Choose the highest 3 risks and propose possible mitigation strategies. Revise the ranking for each based on improvements from your proposed solutions.
E. Create a Response Plan based on the results of your analysis.
Sample Solution
