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CHC SACHIVOTHAMPURAMTechnische Universität MünchenSix Sigma Project-Story-Bookfor the project: Quality Improvement in Rural HealthcareGreen-Belt Candidate:Tony V RajuDr Neeta Paul Alice reiner.hutwelker@sigmaLogic.deSix Sigma Project-Story-Book for: Tony V Raju (E-tonyoct97@gmail.com)1

CHC SACHIVOTHAMPURAMSix Sigma Project-Story-BookContentTopicPageIntroduction Green-Belt candidate, Sponsor, Company, critical product/ serviceProject-DefinitionDEFINE410161719SIPOCVoC/ VoB/ CtQ (Voice to Criticals)Project-CharterStakeholder isProcess-Mapping/ -AnalysisC&E-Matrix & -HeatmapData-Collection-Plan & HypothesisMeasurement-System-Analysis VECONTROLGraphical l Tests of aphical l Test of ImprovementProject-Management-PlanSummary & Benefits reiner.hutwelker@sigmaLogic.deSix Sigma Project-Story-Book for: Tony V Raju (E-tonyoct97@gmail.com)742

CHC SACHIVOTHAMPURAMSix Sigma Project-Story-Book reiner.hutwelker@sigmaLogic.deSix Sigma Project-Story-Book for: Tony V Raju (E-tonyoct97@gmail.com)3

CHC SACHIVOTHAMPURAMSix Sigma IntroductionMy introduction as a Green-Belt candidate and my Project SponsorGreen Belt:Company:Tony V Raju CHC sachivathomapuram is arural hospital in Kerala state,India. The hospital provide medicalservice mostly in NonCommunicable Disease (NCD)catagory. The hospital has 4 doctors andaround 370-430 patient visitdaily in this hospital.Education-B-TECH Mechanical Engineering (June 2019)Projects 1. Ultra-sonic based Imaging of fractured bones2. Chalk Recycling Device3. Optimised Transportation model for Kelchandra Pipe IndustrySponsor:Dr. Neetha Alice PaulEducation-MBBS,MSPosition-Medical Officer,CHC SachivothamapuramPicture of your sponsor reiner.hutwelker@sigmaLogic.deSix Sigma Project-Story-Book for: Tony V Raju (E-tonyoct97@gmail.com)4

CHC SACHIVOTHAMPURAMSix Sigma Confirmation of my Project SponsorScan of the signed confirmation eMail of my sponsorCONFIRMATION MAILMy name is Dr Neetha Alice Paul from the Hospital CHC SACHIVOTHAMAPURAM. I amresponsible for the medical services offered in this hospital and treatment of patients. Iconfirm, that Tony V Raju (tonyoct97@gmail.com) will implement the Six Sigma project in myarea of responsibility and will support Tony V Raju in the DMAIC phases (DEFINE, MEASURE,ANALYSE, IMPROVE, CONTROL), in the role of a Sponsor.For the Lean Six Sigma Green Belt certificate he/ she will measurable solve:- a Quality-Problem of the output,- an Availability-Problem (reduce cycle time or increase volume) and- a Consumption-Problem (better utilization of inputs and/or resources and/or eliminationof waste in the process).I allow Tony V Raju to conduct interviews with internal customer of (intermediate) outputs,to involve experts of the topic and to conduct at least one workshop a) in the MEASUREphase to analyze the inputs and the process and b) in the transition of the ANALYSIS to theIMPROVE phase to determine the root causes of the problems and to develop solution ideasto eliminate the root causes.At the end of each DMAIC phase, Tony V Raju will present the most important results of thisphase in his/ her Project-Story-Book. Based on these results, I will decide on the success ofthe project so far, either to require adjustments in the current phase or to recommend thetransition to the next DMAIC phase.The decision about the implementation of solutions in the IMPROVE-Phase is up to me. Inote, however, that a project in which no solutions are implemented and which does notlead to measurable improvements cannot be certified. Therefore, I will check the financialand other benefits for plausibility after the approved solutions are implemented.I accept that the application and registration at the TUM School of Management begins withthe sending of this e-mail, and that the course fee has to be transferred if the Project-Topicand Project-Definition have passed the suitability check. reiner.hutwelker@sigmaLogic.deSix Sigma Project-Story-Book for: Tony V Raju (E-tonyoct97@gmail.com)5

CHC SACHIVOTHAMPURAMSix Sigma Requirement TUM Lean Six Sigma Yellow Belt CertificateScan of my TUM Lean Six Sigma Yellow Belt Certificate reiner.hutwelker@sigmaLogic.deSix Sigma Project-Story-Book for: Tony V Raju (E-tonyoct97@gmail.com)6

CHC SACHIVOTHAMPURAMSix Sigma Requirement Our Hospita in a NutshellKey Figures to our Hospital18/03/2020 reiner.hutwelker@sigmaLogic.deSix Sigma Project-Story-Book for: Tony V Raju (E-tonyoct97@gmail.com)7

CHC SACHIVOTHAMPURAMSix Sigma Requirement Our Hospita in a NutshellKey Figures to our Hospital1.Based on a survey (figure left ) about type of disease patient havewe found that there are two type. One communicable diseasesand second non communicable diseases.2.Communicable disease are disease which spread by air, water,human contact etc. In case of our hospital they include viralfever(14.9%) ,active diarrhea (2%) and active gastric (4.9%).Theyform around 20% of total patients.3.Non communicable disease are life-style disease means they won’tspread by contact. Diabetes, cholesterol, hypertension are some ofits type. They form roughly 80% of total patient.4.In case of communicable disease patient will go directly topharmacy after consultation but in case of non communicabledisease patient will go to lab and based on lab result they will go topharmacy.5.Since non communicable disease (NCD) form 80% of patients wecan focus on that group and it will be beneficial in long run.18/03/2020 reiner.hutwelker@sigmaLogic.deSix Sigma Project-Story-Book for: Tony V Raju (E-tonyoct97@gmail.com)8

CHC SACHIVOTHAMPURAMSix Sigma Our HospitalMedical Service in our HospitalQueue at consultation RoomQueue at PharmacyThe average Length of stay of patient in hospital is around 1.75-2.5 hours a particular day as doctors have to handle a large populationand it cause poor medical service. The workload on lab is very high and also frequent unavailability of medicine occurs. reiner.hutwelker@sigmaLogic.deSix Sigma Project-Story-Book for: Tony V Raju (E-tonyoct97@gmail.com)9

CHC SACHIVOTHAMPURAMSix Sigma Demonstration of the Problems in our HospitalSurvey among patientsResults1. Based on the survey conducted amongpatient it is found that2. Waiting time is the major problem theysuffer the most.3. Lab capacity which in turn affect thewaiting time also contribute a majorpart.4. Medicine quality a problem which wecannot address as it is out of controlbecomes third most raised problem.Interpretation and implicationFrom the survey we can conclude that solving waiting time and lab capacity can improve the quality of medical service offered to a higher level. reiner.hutwelker@sigmaLogic.deSix Sigma Project-Story-Book for: Tony V Raju (E-tonyoct97@gmail.com)10

CHC SACHIVOTHAMPURAMSix SigmaIdentification and Definition of a Six Sigma Project reiner.hutwelker@sigmaLogic.deSix Sigma Project-Story-Book for: Tony V Raju (E-tonyoct97@gmail.com)11

CHC SACHIVOTHAMPURAMDMAIC Project-TopicProject-Topic reiner.hutwelker@sigmaLogic.deSix Sigma Project-Story-Book for: Tony V Raju (E-tonyoct97@gmail.com)12

CHC SACHIVOTHAMPURAMDMAIC Project-DefinitionProject-Definition (1/2) reiner.hutwelker@sigmaLogic.deSix Sigma Project-Story-Book for: Tony V Raju (E-tonyoct97@gmail.com)13

CHC SACHIVOTHAMPURAMDMAIC Project-DefinitionProject-Definition (2/2) reiner.hutwelker@sigmaLogic.deSix Sigma Project-Story-Book for: Tony V Raju (E-tonyoct97@gmail.com)14

CHC SACHIVOTHAMPURAMSix SigmaSIPOC, Voice to Criticals, Project-Charter, Stakeholder Communication reiner.hutwelker@sigmaLogic.deSix Sigma Project-Story-Book for: Tony V Raju (E-tonyoct97@gmail.com)15

CHC SACHIVOTHAMPURAMDMAIC SIPOCSIPOC with the core process steps included in the projectResults1. First process steps represent ticketcounter operation1.2.3.2. The process steps 2-4 representconsultation,testing &pharmacyactivity respectively4.5.3. The process step 5 representsprocurement of equipment andmedicine respectively.Interpretation and implicationSince the process is a service system, actual process may not work in systematic fashion. The laboratory testing are only for NCD category patients and othershave to go to pharmacy directly. reiner.hutwelker@sigmaLogic.deSix Sigma Project-Story-Book for: Tony V Raju (E-tonyoct97@gmail.com)16

CHC SACHIVOTHAMPURAMDMAIC Voice to Criticals Summary and detailsVoice of Customer & Business, Customer & Management Requirements and ProblemsResults1. Three critical problems areidentified under three domain.2. Two problem are based oncustomer and one based onmanagement.Interpretation and implicationThe quality and consumption problem are critical and are need to be effectively addressed and the availability problem can improve patient situation a lot.The most important problems are: Patients length of stay & Facility usage inefficient reiner.hutwelker@sigmaLogic.deSix Sigma Project-Story-Book for: Tony V Raju (E-tonyoct97@gmail.com)17

CHC SACHIVOTHAMPURAMDMAIC Voice to Criticals ChartsCTQ Bar Chart for the Problems and their evaluation by the KANO ModelPlease add the labels hereY CTQ Bar ChartKANO MODELInterpretation and implicationThe focus of my project is on the Must-Be problems (CtQ’s): Length of stay and Facility usage reiner.hutwelker@sigmaLogic.deSix Sigma Project-Story-Book for: Tony V Raju (E-tonyoct97@gmail.com)18

CHC SACHIVOTHAMPURAMDMAIC Project-CharterPROJECT CHARTERProject-NameProject-CharterResultsQuality Improvement in Rural HealthcareBusiness-CaseProcess & OutputThe Service MEDICAL SERVICE is an intangible final Output for external Customers and is in the CreationProcess TREATING PATIENT within a year 53 - 365 times generated. Important Input of the Process togenerate the Product MEDICAL SERVICE is: TICKET,MEDICINE,LAB FACILITIES,DIAGNOSIS DEVICES.Voice of Customer (VoC)1. The business case is clear2. The three main problems areidentified3. The Voice of customer isquantified4. Scope, targets (upside downproblems) and team definedProduct/ Service: Medical ServiceProcess: Treating PatientProblemsThe satisfaction of the external customers with the:Y 01 Patient (medical treatment) Length of stay too longY 02 Patient (Lab Report) Facility usage inefficient- Quality of MEDICAL SERVICE is: 40%.- Availability of MEDICAL SERVICE is: 30%.Y 03 Medicine (Delivery) Availability stock level demandVoice of Business (VoB)Solution-IdeasThe satisfaction of the process-owners with the Consumption in the Creation Process of the MEDICALSERVICE is: 50%.An effective study on which area cause bottle neck in the patient flow from ticket counter to pharmacy isneed to be identified and improving that stage for example pharmacy or labortarycan reduce the problem.The total costs of the specified 3 problems are estimated by 2500 / year.The efficency of the device and operator are need to be analysed and the inabilities are need to berectified.The solution of the problems is rated as:The critical medicines are need to be identified and provide provision for stocking them- medium URGENT (70%-Level) / - major IMPORTANT (80%-Level)CommentCommentIn ScopeOut of ScopeManagementin:Non communicable diseaseout: Communicable diseasein:Medicineout: Labortary equipmentsA ccountable Dr Latha Yohananin:Labortary sample.out:A ccountablein:Sponsor Dr Neetha Alice PaulSupplier Pharmaceutical companyCustomerControllingout:.?TargetsTimelineY 01 Reduce length of stay (minimum 45 min & max 1 hour)1.11.2019Y 02 Improve lab utilisation (Process atleast 15 samples in 1 hour)1.11.2019Green-BeltY 03 Determine an EOQ for desirable tMaster-Black-Belt Dr Reiner rolEnd1 August 201930 August 201925 September 201928 October 201905 November 201917 November 201901 December 2019days expired: 54days expired: 25days remaining : 1days remaining : 34days remaining : 42days remaining : 54days remaining : 68 reiner.hutwelker@sigmaLogic.deInterpretation and implication.? Nilok AmrthSix Sigma Project-Story-Book for: Tony V Raju (E-tonyoct97@gmail.com)The length of stay and laboratoryefficiency are related whileavailability of medicine is relatedto an external supplier.19