9.9 End-of-Chapter Case: A Hearty Improvement Project

Dr. Taeeun became the new operations executive at the local university children’s hospital. She had been exposed to lean principles during her dual graduate program, which included a healthcare MBA. Upon discussing with her staff the situation at various departments at the hospital, she noticed a significant and increasing challenge concerning patient no-shows at the pediatric cardiology department. In this case, no-shows are patients that schedule an appointment but neither use nor cancel it.

There were no-show rates at similar departments averaging 6.1% across the nation, but it was hovering around 40% in the last several months at the given children’s hospital. Patients would wait months for an appointment, but the waiting rooms were typically empty due to no-shows, causing frustration in the customers and the staff and waste of resources.

Dr. Taeeun decided to tackle the issue through a lean six sigma improvement project. She partnered with the university’s business college and hired you as an intern to lead the initiative. Besides, she assigned a few staff members to the team to work with you on the project. Your goal was to examine the patient scheduling process in the pediatric cardiology department at the children’s hospital. Your CTQ was “patient no-show per month.”

After working on the first stages of the DMAIC process, you arrive at the Analyze step. You devised a plan to facilitate your team’s process of identifying potential causes for the problem. Your initial goal was for the team to come up with as many possible culprits as they could. You were delighted to see your team working diligently in producing potential causes for the problem of interest.

Upon completing the initial activities in the DMAIC Analyze phase, your team produced a list of four possible causes. They included staff making reminder calls to patients (X₁), time of appointment (X₂), physician (X₃), and insurance company (X₄). The team produced a hypothesis for each of these possible causes. For X₁, the team hypothesized that there might be a correlation between reminders and no-shows. The team reasoned that many patients forget they have an appointment, but they will show up if they receive a reminder call. You devised a data collection plan to assess the hypothesis. The following table displays the results.

Questions:

1. Describe how you would facilitate your team’s process of identifying potential causes for the problem?

2. Which tools do you think you could use during the process of identifying possible causes?

3. Considering the list of possible causes your team identified, would you need to use FMEA is this cause? Why or why not?

4. Assess the X₁ hypothesis. What conclusion do you reach?