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Home > Lean-Six Sigma for Healthcare > Big Q Core Process Strategies

The "Big Q" Core Process Drivers

Below is a list of major core processes any hospital must master in order to achieve world class levels of operational, clinical and financial excellence.

Definition of Quality Waste:

The intended or unintended activities consuming time and resources which:

  • In-Quality Staffing > 95%
  • ED Length of Stay < 3 Hrs Discharge /4 Hrs Admit
  • Surgery Cut-to-Close >50%
  • 2:00 pm Discharge/ 1 Hr to Next Patient > 80%
  • Clinical Core Measures = 0% Denials/ Unreimbursed Care
  • Revenue Cycle Accuracy > 90% Clean Claims, 5 days post Discharge

Sub Process Critical to Quality Variables:

In-Quality Staffing > 95%

  • Meeting Definition of Quality > 95%
    (Right people, Right Place Right time)

Emergency Department Length of Stay < 3Hrs Discharged / 4 Hrs Admit

  • Walk-In to ED Bed < 30 Minute (USL)
  • ED Bed to ED Physician Assessment < 15 Minutes (USL)
  • Time to Last Diagnostic Order < 45 Minutes (USL)
  • Lab/X-Ray Order to Result < 60 Minutes (USL)
  • Diagnostic Results to ED Phys Review < 15 Minutes (USL)
  • ED Physician Request for Bed < 30 Minutes (USL)
  • Bed Notified to Transport < 30 Minutes (USL)
  • Discharge Order to Discharge < 20 Minutes (USL)
  • In-Quality Staffing > 95% (LSL)
  • ED Physician LOS Variation 3-Hrs /4 Hrs (USL) +/- 45 Min

Surgery Cut-To-Close > 50%

  • Incision Time No Later Than < 7:40 am Start Time (USL)
  • Room Turn-Around-Time (TAT) < 15 Minutes (USL)
  • To-follow Case Scheduling Variance +/- 15 Minutes (USL)
  • Surgeon Preference Card Accuracy > 95% (USL)
  • In-Quality Staffing > 95% (LSL)
  • Surgeon In Room to Scheduled Time +/- 10 Minutes (USL)

Surgery Cut-To-Close > 50%

  • Zero Missed Discharge Appt. / FMEA < 30 Minute (USL)
  • Lab Results Reviewed by Physician < 4 Hours Prior to Pat. Dis. (USL)
  • Patient Departure Transport Confirmed < 4 pm Prior Day (USL)
  • Next Patient in Room < 60 Minutes after last Dis.(USL)
  • In-Quality Staffing > 95% (LSL)
  • Physician Practice Variation Drivers

Revenue Cycle Accuracy > 70%

  • Percent Clean Claims
    5 DaysPost Discharge >90 Percent (LSL)

18 Change Concepts (out of 84 total) for Eliminating Quality Waste

Process engineers use 84 change concepts to evaluate a process. Below is a summary of the 18 change concepts most frequently applied to improve productivity.

  1. Eliminate things that are not used
  2. Standardize processes where possible
  3. Consolidate functions and job classifications
  4. Eliminate multiple entries
  5. Reduce or eliminate overkill
  6. Recycle or reuse
  7. Use substitution
  8. Use constraints and forcing functions
  9. Use reminder systems
  10. Reduce classifications
  11. Apply a default mode
  12. Minimize hand-offs
  13. Adjust to fluctuations demands
  14. Reduce setup or start up times
  15. Move steps in the process close together
  16. Find and remove bottlenecks
  17. Match staffing to demand
  18. Shape demand