Lean Six Sigma (LSS) is both a methodology and mentality to reduce waste from healthcare processes, helping to promote better outcomes and control costs. In the era of COVID-19, healthcare organizations can expect LSS to play an integral role in the shift from fee-for-service to fee-for-value, accelerating population health while better controlling quality, cost and patient satisfaction.
“Lean Six Sigma is not just about having the tools for improvement, it is the mentality and psychology to believe successful change is possible,” said Moshe Starkman, nThrive senior director, Value-Based Reimbursement. During the recent nThrive webinar titled, “Applied Lean Six Sigma Methodology Can Help Hospitals Thrive Beyond COVID-19,” he and Cindy Abraham, nThrive Lean Six Sigma Black Belt, took their audience on a journey to explore the impact Six Sigma can have on the healthcare revenue cycle in a post-COVID-19 world.
Understand your current state
First and foremost, Starkman emphasized the importance of understanding your hospital or healthcare organization’s current state. “This can get a little nuanced,” he explained, noting that “making process assumptions and leaving out ‘minor’ steps,” has the potential to compromise the ultimate value of the workflow diagram.
“The first thing you have to do is map your current state and you have to be honest, which sometimes hurts, detailing all the steps that happen in-between getting the job done,” he explained. “Another danger is thinking you’ve solved a problem – when you haven’t.”
Framework of communications and tools
When you are working within a group and everyone has a different solution in mind, it is imperative that you find common language to communicate ideas and the efficacy of any given solution. “These tools give teams the ability to take their work to the next level,” Starkman said. “This is of the most powerful aspects of Lean Six Sigma training and discipline. More specifically, it gives people the ability to work together better, as well as introduce a means to think beyond their natural limitations.”
This begins with three simple steps:
- Select a process to improve; map it
- Identify steps that do not add value; remove as many as you can at this time
- Repeat steps 1 & 2, as needed
While you may not be able to “get rid of” all non-value-added steps, which can include regulation or safety requirements, the idea is to focus on value, while removing waste, to achieve the highest impact.
“For example, provided healthcare isn’t valuable if the outcome requires corrective actions,” Starkman explained. “A Value activity is done right the first time, is something that the consumer wants and is something that makes a difference. Anything that doesn’t meet all three criteria is waste.”
Building a Six Sigma culture
Promoting operational excellence goes beyond tools, explained Abraham. “It should be part of your business strategy, how you look at data to drive process improvements.”
At nThrive, Abraham noted that this starts with training and mentorship. “At every level of the organization we speak the same language and approach problems in the same way. Data-driven change management fuels our efforts.”
To illustrate this, Abraham described applying Lean Six Sigma to Eligibility, helping to alleviate disruption occurring at the front of the revenue cycle due to COVID-19. The team used the Six Sigma framework to define, measure, analyze, improve and control new workflows. Process maps ensured all requirements were documented.
“Six Sigma helped us quickly offload and manage accounts for clients. Our team screens every possible opportunity a patient may be eligible for, identifies viable programs and completes the application, guiding patients through the process to get coverage for the care they need.”
Measurement dashboards also track key metrics and deploy corrective actions as needed. “We’re constantly documenting, measuring, analyzing and adapting so we’re as successful working remote as onsite.”
Leveraging Six Sigma post-COVID-19
Coming out of COVID-19, Starkman emphasized that Lean Six Sigma will be more relevant than ever, especially with a higher focus on population health, more widespread use of digital care and a continuing shift toward value-based reimbursement models.
“Medicare is now operating on Lean principles,” Starkman explained. “CMS has a goal to shift 100 percent of Medicare to value-based reimbursement by 2025. Medicaid and Commercial payors will follow at around 50 percent. In a value-based economy, healthcare providers will be required to provide quality care, i.e. great outcomes, while managing costs and promoting a better patient experience.
“Whereas traditional care is reactive, value-based care is about anticipating problems and intervening. If there are errors and rework loops in a care process, margins will be negatively impacted. Applying Lean Six Sigma is a way to successfully embrace two-sided risk models on the journey towards full population health.”