Journey to Zero : Six Sigma Interdisciplinary Team Successes

Title:  Journey to Zero: Six Sigma Interdisciplinary Team Successes 

Purpose:  Hospital acquired (nosocomial) pressure ulcers present a problem for patients and a significant care management challenge for clinicians as evidenced by a nosocomial pressure ulcer rate greater than zero.  Consistent and reliable skin integrtiy documentation is difficult to achieve, and policies and procedures are not consistently followed.  Six Sigma methodology enables the systematic examination of data and care processes and development of an infrastructure and support systems to enable provision of the highest level of patient care and optimal patient outcomes.

Objective:  The Team set a goal of improving patient outcomes with evidence-based best practice.  Specific goals and deliverables were identified as follows: 

•  Engaged, educated staff
•  Simple, consistent documentation
•  Compliance with policy & procedures
•  Nosocomial pressure ulcer rate at zero 
•  Improved patient outcomes
•  Improved documentation to enable demonstration of compliance by physicians and nursing 
•  Avoid the risk of negative regulatory & legal consequences
•  Decrease variable costs

Method:  The Six Sigma methodolgy and tools were utilized to develop a high-level process flow map, analyze current processes and data, and focus on the prioritized issues considered "critical to quality."  From a cause and effect diagram, the team identified the critical components and selected criteria-based interventions and improvements. 

Outcomes:  A decrease in nosocomial pressure ulcer rate was achieved to below the national rate of 4.5% and has been sustained between 0 - 2.7% for 2007 to present.  Compliance with policy and procedures and documentation has also improved, and variable costs have been reduced by over $100,000.  Further improvements and current initiatives are focused on development and implementation of shared documentation (physician/nursing), improving patient "handoffs" (interdisiplinary careplan and SBAR tool), critical event analysis, and interdisciplinary education and care delivery across the care continuum (e.g., partnering with community facilities).