Utilizing Six Sigma Management Strategy to Improve Compliance to the Time Out Protocol in Kensington Interventional Pain Management Center, Kaiser Permanente.Aweke DubiBowie State UniversityDepartment of NursingSeminar in Critical Issues for Advanced Practice NursingCourse Instructor: Dr Doris Clark, PhD, RN, CNEMarch 15, 2019Background In this service improvement project, Six Sigma management strategy will be utilized to improve compliance to the time out protocol and thereby improve the time management and the safety of chronic pain patients who are undergoing interventional pain (IP) procedures. The project will take place in the interventional pain management center of Kaiser permanent Kensington Medical Office, Maryland. Six Sigma is a state-of-the-art management strategy that employs an organized stepwise method known as DMAIC (define, measure, analyze, improve and control) to tackle sources of disparities or errors and to improve methods that would lead to lessening chances for failures and defects in the process of a system (Chaurasia & Garg & Agarwal, 2017). During an interventional pain procedure, time out protocol is an important and key requirement to be performed to safe guard patient safety and minimize any accident. In addition to an appropriate and timely clinical and lab screening of a patient undergoing an interventional pain procedure, the time out procedure or protocol is an important mechanism to manage time and ensure patient safety. The time out process mainly starts with identifying the patient and includes identifying the right supply for the given procedure, the correct body location and side, identifying the procedure to be done, assuring correct position, addressing the right medication, route, dose, allergy and reporting if there are any implants and contraindications (Schub & Heering, 2018) Keywords: Six sigma, DMAIC, time out, Patient safetyScope and Setting Kaiser Kensington Medical center is located at 10810 Connecticut Ave. Kensington, MD 20895. The interventional pain center is in the second building and on the second floor. The staff in the interventional pain center consists of nurses, pain trained anesthesiologists, pain psychologist, medical assistants and administrative staff. Once the management is informed and consent is obtained, these key members of the interventional pain will be trained on the Six Sigma management strategy and I will be conducting an awareness creation workshop. The initial steps I will be following include developing Six Sigma project concept paper to reflect the existence of the need, set the goal and the scope of the project (Bedgood, 2018). Define Phase This is the phase where I will be identifying the process and defining the scope of the problem. During this phase, I will be forming a team and select the team members who will be involved in the project and describe the role of each team member. Identifying the right person for the right time and role is a paramount step in working towards the success of the project. Moreover, this is the phase where I will be determining the supplier, input, process, output and customer for my project (Karakhan, 2017). In this context, the supplier can be an individual or organization that provides interventional pain medical supplies, the input can be a material or a training, resource and information needed for the time out process, the process is the time out process or the time out activity itself, the output is the product or service that results from the process and the customer is can be the staff and the patient undergoing interventional pain procedure (Morland, Breslin & Stevenson, 2019). In this project, the main goal of Six sigma management style is to improve the time out process and patient safety and the quality of the care delivered to patients. The most important component of this define phase is it helps to define the baseline performance and design the goals for the project (Trakulsunti & Antony, 2018). I will be using the baseline performance to determine compliance to the time out protocol and the time required to complete the time out protocol. Measure phase The main purpose of the Measure phase is to obtain as much information as possible on the existing process to have an in-depth understanding of how it is working and how well it is working (Trakulsunti & Antony, 2018). To have a clear picture of how to go about this, I will be developing a diagrammatic process map and collect appropriate data to answer the what and how of the process. I will be collecting data through safety checklists, observation and chart review or retrospective extraction of patient information (Sandra, 2018). The data collection tool to be used will be an accurate, repeatable and reproducible data collection tool that has been used by other well-established interventional pain programs. Staff survey and focused-group interviews with current staff and with affected chronic pain patients will also be considered. The number of patient charts to be reviewed retrospectively will be decide on the time and other resource needed in a meeting with members (Laureani & Antony, 2019). In this phase, I will be determining the frequency and severity of the event’s effect on the patient safety, employee safety, morale, interventional pain procedure schedule or day to day work flow and associated cost (Barkley, 2018).Analyze Phase The analysis phase is the third stage where the interventional pain team members will identify the potential factors that impact the time out process and conduct a root-cause analysis to better visualize the causes and pitfalls (Godley & Jenkins, 2019). This stage will facilitate the strategies that the interventional pain team members can implement to eliminate risks and improve our patient safety performance by complying to the time out protocol (Amerine, Khan & Crisp, 2017). For better understanding, the root cause analysis will be categorized into input, method and resource related causes. Graphical tools like fishbone diagrams, game chart and histograms showing cause and effect will be developed (Murray, 2017). In this analysis phase, I will be analyzing and identifying the most significant factor that is influencing the performance of the time out process. The Fishbone Diagram is a structured brainstorming technique that helps teams identify, explore, and visually display the possible causes related to an event (Murray, 2017). Figure 1: Adapted and developed based on Murray (2017)Improve Phase The main reason for exploring events of the time out process is to spot causes of a failure and implement the effective remedial to prevent future incidents from occurring and is to improve the safety (Shokri, 2019). Based on the analysis made in the last 3 phases, possible counteractive and precautionary interventions will be designed and implemented during the improve phase. During the improve phase, I will be working with the team to standardize the time out process and protocol, discuss the acceptance and the feeling of the interventional pain team members about the safety process, discuss on how and when to start the improved time out protocol, document related safety concerns and communicate for the staff and key stakeholders (Morland, Breslin & Stevenson, 2019). I will be training the staff on the difference between corrective and preventive actions. Corrective actions will be those actions intended to comprehend incident impacts and preventive actions are actions to foresee and prevent incidents before they happen (Godley & Jenkins, 2019).Control Phase The control phase is the stage where I will be validating, communicating and supporting the achievements so far gained after implementing the preventive countermeasures. Supporting and sustaining the improvement performance is very crucial for implementing the change and making it the institutional culture (Karakhan, 2017). In this phase, I will be designing a schedule on when and how the key stakeholders (management, providers, staff) will meet periodically to discuss how to continue to maintain the success and improve the quality performance further. Result and discussion Six Sigma is a process improvement management strategy that provides organizations with detailed analysis of the time out and patient safety process within the interventional pain procedure center. The Six Sigma management strategy is an evidence-based data-driven improvement strategy that primarily recognizes the input of customers, stakeholders, data, statistical analysis and other improvement approaches to identify the factors that are very critical to the quality improvement process (Bedgood, 2018). As the Six sigma management strategy requires, responsibility and constant evaluation, I will be paying attention for the sustainability of the project. Involvement of key stakeholders like anesthesiologists, nurses, administration and management is my main approach to the sustainability of the project. It requires preventing regressing into the old and past approaches and I will be working on engaging all stakeholders to hold into the gains. I will be focusing on low hanging and motivating achievements. I will be holding a regular, monthly, meeting and create awareness creation educational materials like flyers to provide consistent updates about the change and improvement (Karakhan, 2017). Finally, I will be working on replicating and working on experience sharing with other sister departments within Kaiser Permanente Kensington Medical office and to the Mid-Atlantic Kaiser Permanente.ReferencesAmerine, J. P., Khan, T., & Crisp, B. (2017). Improvement of patient wait times in an outpatient pharmacy. American Journal of Health-System Pharmacy, 74(13), 958-961.Barkley, P. (2018). Six Sigma sticks patients less: Black belt project improved emergency department’s processes for drawing blood. ISE: Industrial & Systems Engineering at Work, 50(2), 28.Bedgood, C. (2018). Is your aim on target? Selecting the right lean Six Sigma projects is a foundation for healthcare success. ISE: Industrial & Systems Engineering at Work, 50(9), 37. Chaurasia, B., Garg, D., & Agarwal, A. (2017). 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