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IE 509 SIX SIGMA QUALITY�CASE STUDY: THE MIDDLE COUNTY HOSPITAL

Presented by Brightspace Group #9 | CATME Team #11

Mukul Karandikar
Sainadh Reddy Sathi
Saleem Asfour
Alok Varhadi

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Main Objective

1^st Continuous Quality Improvement (CQI) Project:

Present practical solutions to reduce the number of redo in the imaging area (MRIs, X-rays, CT scans, ultrasounds). Imaging redo occurs when the first image is deemed unsatisfactory. This leads to additional costs, longer stays and dissatisfaction for the patients. Hence, such instances must be minimized.
Update Jack on the new testing method's efficacy and provide deliverables that highlight the improvements that have been made through sound analysis of the data.

2^nd Continuous Quality Improvement (CQI) Project:

To improve the current food delivery service at the Middle County Hospital’s.
To analyze the feedback from patients through comment cards and propose feasible measures that could significantly improve patient satisfaction/ minimize complaints with the hospital’s in-house food service.

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Recommendation

1^st Continuous Quality Improvement (CQI) Project:

Conduct a thorough root cause analysis to identify any special causes that might be contributing to the points touching the LSL. This can help in making targeted improvements to prevent such occurrences in the future.
Dig deeper into imaging methodology and working schedule to assess the root cause for the high number of redo and take corrective actions such as documenting SOPs, retraining staff, lowering work fatigue, implementing 5S principles and undertaking kaizens, etc.
There were two instances of zero non-conformity and three instances of only one non-conformity in the new method. The cause of such low non-conformities deserves investigation, and the best practices can be emulated across the imaging area.

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Recommendation (continued)

2^nd Continuous Quality Improvement (CQI) Project:

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S.N.	Comment	Action(s) to mitigate
1	Bad Taste	- Review and update existing recipes ‘food items’ rated for bad taste. - Consider adding taste enhancer in consultation with the head dietician. - Investigate if the bad taste is due to wrong temperature or low quality.
2	No Choice	- Add more food options to the menu. - Replace existing food options with popular options.
3	Late delivery	- Prioritize delivery for severely ill, elder patients and children.
4	Wrong temperature	- Preheat the batch before commencing delivery operations. - Likewise, use refrigerator for serving cold food items. - Segregate and deliver hot meals and cold meals separately. - Use clamshells of better design.
5	Late pick-up	- Pick-up the food trays within 1 hour for young and non-severe patients. - Pick-up the food trays within 1.5 hours for elder and severe patients.

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Conclusion

1^st Continuous Quality Improvement (CQI) Project:

MCH should proactively work on improving the imaging quality to the 4σ level. Thereafter, MCH should sustain and review its imaging quality and attempt the 6σ level if deemed financially feasible.
From the analysis, we conclude that every time Jack warned imaging during Day 1 to 30, the number of redo's are reduced a bit which shows that frequent inspection and warnings are effective and can help improve the process.
The improvement with the new imaging methodology is evident in the control charts, however, there is still room for improving the quality of imaging. MCH should work on reducing the average proportion of nonconforming items further to enhance the quality of the process and continue monitoring the process to ensure consistent performance.
Provision of more data for better EDA.

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Conclusion (continued)

2^nd Continuous Quality Improvement (CQI) Project:

Based on Pareto chart, bad taste followed by no choice, late delivery, and wrong temperature top the chart.
The current data has an overlap of ‘noise’ and ‘signal’ that prevents us from performing detailed analysis. Consider reviewing the comment card from bland-diet patients separately for unbiased analysis.
No choice, late delivery, and wrong temperature should be promptly addressed by altering and restructuring the food delivery process (refer our recommendations).
Other reasons (such as protocol breach, wrong delivery, impolite behavior, etc.) also deserve investigation.

Since CQIs lead to fulfilment of long-term and sustainable goals, MCH employees need to seek continuous improvement in every aspect of the project, otherwise, they run the risk of resolving the same issues again.

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P Chart (old procedure)

The process is in control, but the p-value is 0.1027.
The process passes the Shewhart control chart tests, suggesting that it is in control with only common-cause variation present.

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P Chart (new procedure)

The new p-value is 0.0527.
The two points in the graph at day 42 and day 54 lie on the LCL, which can be deemed acceptable.

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P Chart (comparison)

The improvement in the process with a before and after comparison .The UCL drops from 0.2314 to 0.1471, whereas p-value drops from 0.1027 to 0.0527. There is no change in the LCL.

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Time Series Plot

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Errors Per Million Opportunities and Sigma Level

Total Opportunities = 60*50 = 3000
Total Defects = 233

EPMO = (Total Defects/ Total Opportunities) * 10^6

= 77666.67

Sigma Level = NORM.S.INV (1 – Total Defects/ Total Opportunities) + 1.5

= NORM.S.INV (1 – 233/ 3000) + 1.5

= 2.92

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Current food service workflow at MCH

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Bad taste, no choice, and late delivery alone account for around 80% of the complaint reasons.
Least complaints are recorded for late pick-up and other reasons.

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Pareto Chart

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Pie Chart and Bar Chart

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Time Series Plot

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Time Series Plot

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Proposed new food service workflow at MCH

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Proposed new food service workflow at MCH (contd.)

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Thank You!

Thank you for your time and attention.
We are open to taking your questions.

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