Rural American Healthcare – A Willing Group Needing Six Sigma Assistance
In the heartland of America the population of residents is shrinking. Along with a decline in population comes the fading economic market of consumers to support the service businesses of these communities. Due to aging populations and fewer people migrating to rural America, small towns confront real threats to their ways of life. Economies are fragile, tax bases are smaller and populations that are already underserved find it difficult to attract healthcare professionals. If there ever was a time to apply Six Sigma-style problem solving, it is now.
A Six Sigma Black Belt (BB) was transferred to a small town in rural Kansas in 2007 and spent five years there. The lessons he learned working on Six Sigma projects inside his community can be applied in any environment. Whether in a business, civic organization, school, or church – when people work together and processes are not established, the outcomes are unpredictable.
He was a BB and worked as a plant manager for five years before accepting the new position. He was working as the new plant manager for one of the larger employers in our community. Little did he know when he accepted the position the people in the community had expectations that leaders of businesses in the town were needed in leadership positions for everyone’s benefit. This was contrary to a large metropolitan city where leadership of the community is normally a career. Whether working for the city, state or hospitals, there are large organizations in large cities doing this type of work.
He became interested in rural healthcare in our community after our small county hospital could not find doctors to come to our town and work. The community relied on traveling doctors to provide services from larger cities in Kansas. He had visited the emergency room on one occasion and had to pitch in to help work on a friend after the BB had checked on his friend at home. When the BB checked on the friend, the friend was having a seizure. Most of us in larger cities do not experience this often.
He began working closely with some other proactive business leaders and they decided to approach the hospital leadership and build a Physicians Recruiting Committee. They all understood that no one was coming to save them and that they needed to work together to help themselves. This turned out to be the start of our community’s first Six Sigma project.
All Six Sigma projects start with a problem statement, objective statement and a team. This knowledge stated openly in a group of business professionals caused the plant manager to be appointed the leader of the team. Many on the team understood that the business for which he worked used Six Sigma and that they were able to so much with the methodology running the day-to-day operations. He had spoken at the Rotary Club on Six Sigma topics before and many in the group were sold on the problem-solving process.
The team’s first task was to do a SIPOC (suppliers, input, process, output, customers) diagram and define the project – to improve physician hiring processes. Several candidates had been in the hiring process, but for several reasons the candidates took positions in locations very similar to ours. After cursory analysis, the team and the hospital leadership understood they needed to work on the problems together.
The team met for several weeks in a row early before their regular work days. The team was made up of five hospital leadership staff and five business people from the community. These community members had been invited to join the team by the hospital leadership. The hospital board of directors approved the plan to gain buy-in to the process. This was essential for the team to know the hospital staff would act upon the solutions recommended at the end of the project.
The first exercise was to do a value stream map of the hiring process. The team went through the processes involved from identification of needing to hire a physician through the physician on-boarding process. Many subprocesses were defined and opportunities for improvements identified. One example was that background checks happened too far downstream in the process, which resulted in candidates making it though the process where an offer was tendered before background checks were completed. This led to several disappointing events where a good fit was found only to have the whole community find out the physician they were working hard to hire could not be brought aboard. This had dire impact on the morale of the hospital and community. The momentum was lost each time this occurred.
Another issue identified was the hospital was paying too much for recruiting fees. The hospital renegotiated the fees and saved $60,000 per year by developing a better fee schedule. The success came about during discussions in the process-mapping exercises.
The team then worked on developing solutions to issues identified using structured brainstorming techniques and building cause-and-effect matrices to prioritize efforts. Issues affecting physician recruitment centered around suitable housing options, too many on-call hours, developing social peer groups, medical decision-making support cohort development, and others.
The issues identified were root cause reasons why physicians were not accepting positions and were reasons physicians had left the positions in the past. The reasons were placed into a basic Pareto analysis to prioritize the issues. Then the team built plans for counteracting the problems identified. Several of the issues were complex and needed subteams built to address the problems. As an example, we developed networks with local realtors and banks to streamline the housing issues. The team decided they would treat a new physician as a high-priority client when they were visiting and looking for a home. This ensured that the low numbers of suitable homes inventory in the area were seen in their best light, instead of being a problem.
Because of this new approach using Six Sigma methods in the leadership of the community, the business leaders, hospital staff and board of directors hired doctors, physician assistants and nurses who have been in the community for more than two years. The new hospital members are thriving and a vital part of the community. Six Sigma tools need to be used not only in our businesses, but routinely in a person’s civic role as well.