ORLANDO - It may be surprising to hear a chief information officer champion something other than a technological achievement, but Chuck Spurr is all about processes these days.
"You have to take a hard honest look at what you are doing today. Six Sigma is good at that," said the chief information officer at Shields Health Care Group.
Six Sigma, a process improvement methodology that has its roots in manufacturing, has found a lasting home within healthcare as a way to get the myriad units within provider organizations working as one.
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According to Spurr, Shields, an MRI and ambulatory health chain serving the Boston area, was looking for an agent of change in its revenue cycle business. People were operating in silos, and data seemed to change depending on which department you spoke too. At the same time, changes in reimbursement and the rise of patient financial responsibility made it more urgent to collect payment.
"First we were throwing software at the problem, but that's a problem with IT. We build to the specs we are given," he said, speaking at the Revenue Cycle Solutions Summit at HIMSS17 in Orlando on Sunday. So when software alone doesn't solve issues, "we blame everybody, the users, the specs, we blame all over the place."
In Six Sigma, "all over the place" doesn't cut it, especially when it comes to the data leaders need to been able to trust in order to make decisions.
Breaking it down, Six Sigma is all about organizing processes and fostering open communication. For example, Spurr said Shields previously grappled with a low rate of payment from patients, but there were concerns that removing patients who wouldn't pay would cause an uproar among the referral community. The problem, though, was Shields didn't have any real data to support those concerns.
So Shields isolated one pilot location to measure complaints, and in the end, they really didn't have many. Couple that with the launch of a pre-service collection process and Shields ended up getting 30 percent of payments up front. Something they had not expected.
Six steps to Six Sigma
While Spurr said an organization can go deep into Six Sigma methods, there are some top-line elements that really speak to the core of the program.
First, organizations must know exactly what they are trying to accomplish. While open-ended brainstorming may bring about a few good ideas, a more targeted approach is far more effective, he said.
However, that means organizations must know their current state, which means identifying with certainty the issues that need fixing.
Next, avoid silos at all costs, he said. That doesn't mean avoiding small teams. Instead, make sure those teams include stakeholders from all corners of the organization.
Also, meetings are important, but make sure the C-suite is represented in those ongoing check-ins.
That means communication is essential. While a strong data infrastructure will reliably surface the issues that need tackling, nothing can get fixed if there isn't a communication mechanism in place.
Finally, never become complacent. Always be tweaking, he said.
"Change is driving healthcare, and either you are an organization that handles changes really well or you need a process to drive that change," he said in an interview ahead of the conference. "Six Sigma can really drive that change for you. You get buy-in from all parties, you get an instant process for handling conflicts, you get a methodology to test your experiments and you have the idea that data drives everything."
Difficult, but necessary
Spurr, who joined Shields in 2007, wasn't the only leader to tout process improvement methods at Sunday's event.
Leigh Williams, administrator for business systems at the University of Virginia Health System, also said Six Sigma thinking is essential to streamlining. Especially when it applies to technology purchases. While it may be tempting to buy something, make sure it doesn't create data silos.
"Be mindful and don't create confusion and separation between the systems that you have," she said. "Make sure the data flows easily."
Kevin Adams, revenue cycle director at Anderson Regional Health Medical Center, in his presentation credited Lean, another process improvement method often lumped in with Six Sigma, with helping his organization turn around a $15 million shortfall. Much like Shields, Anderson Regional turned to a financial status desktop to provide them that essential data stream. Coupled with workflow changes, the results were so dramatic that for fiscal 2017 the system is counting on a $2 million positive margin.
"We feel more strategic and agile, employees have ownership in their individual roles, we have continuous monitoring of financial status," he said.
Of course, nobody said change is easy, and it took some effort to get staff behind Six Sigma. However, Spurr said it eventually smoothed out.
"Resistance to change was big. In any organization it's big," he said. "But Six Sigma gives you a structured approach so people didn't take it personally. You weren't doing it in silos. You were putting customer service people in with revenue cycle people, reimbursement folks with IT folks. Everybody's in the same room."
Shields has increased patient collections 622 percent in the last five years and Six Sigma projects have saved the company nearly $6 million.
As a parting point that might seem dramatic given in the context of the HIMSS Annual Conference, the largest gathering of health IT firms in the country, Spurr made it clear that software isn't the answer. It may help with solutions, but the answer comes before you install software.
"It's not a software problem, it's bigger than that," he said. "You're throwing software at it and it's not going to solve your problem."