Tools, Technologies and Training for Healthcare Laboratories

Interview with a Black Belt: Charleston Area Medical Center & GE

We are lucky to have an interview with both a Black Belt in training and a Master Black Belt. This not only gives us a chance to discuss the process of becoming a black belt, it also gives us the opportunity to view a Six Sigma project as it is being implemented.

Shannon McCracken Roberts, Master Black Belt

Melda J. Brown, MLT, Black Belt

Interview by Sten Westgard, MS

The Charleston Area Medical Center (CAMC) in West Virginia brought in GE Medical Systems to bring Six Sigma to their health system. The CAMC system includes more than 900 beds, more than 4,000 employes, and three hospitals, including the largest hospital in West Virginia. Melda Brown works at one of those hospitals, Braxton County Memorial Hospital (BCMH), in Gassaway, West Virginia. BCMC is a 25-bed Critical Access Hospital with approximately 150 employees.

Melda Brown is a rare gem: she is both an MLT and a Black Belt. Employed by Braxton County Memorial Hospital for 15 years, she recently began training by CAMC/GE as a Six Sigma Black Belt and CAP/WorkOut Coach (which denotes additional experience in healthcare Safety and Quality).

Shannon McCracken Roberts is Melda's Master Black Belt. Shannon trained as a Black Belt, CAP/Workout Coach, and finished Master Black Belt training with General Electric.

CAMC contracted with GE in the fall of 2000 to provide consultation for implementation of Six Sigma. This was initiated by Cynthia Neely, VP of Quality and Systems improvement. They were looking for a better way to roll out performance improvement, in a way that was data-rigorous, cost-driven, and quality-driven. At that time, they hired Deborah Smith, a Black Belt from GE who had worked at CAMC as Radiology manager prior to leaving for GE. She came in to drive and initiate Six Sigma, and has since moved back to GE.

CAMC created 7 positions for Black Belts from within the system, and these folks were trained during the first phase of projects at CAMC, with the help of a Master Black Belt from GE. The current Black Belt team includes: 2 registered nurses, both with MBAs; 2 industrial engineers with MBAs, one lab tech with an MBA, 1 Radiology Technologist with MBA, and one other person with a Master's in Industrial Relations..

How many Six Sigma projects are ongoing at CAMC, BCMH?

Shannon Roberts, CAMC: About 30 projects at any one time.

How many people are involved in Six Sigma?

Shannon Roberts, CAMC: 2 Master Black Belts, 5 Black Belts, 20+ Green Belts, 60+ Foundations members, 200+ Managers trained in Intro to Six Sigma, 4000+ Employees have viewed performance improvement video.

Melda Brown, BCMH: There is one Black Belt and 15 managers trained in intro to Six Sigma.

How much training does each "level" of Six Sigma receive?

Shannon Roberts, CAMC: Employees receive basic training in the form of a 20-minute video discussing basic Six Sigma terms, philosophy and understanding what DMAIC means. New employees watch the video and also gain exposure from a Black Belt in new Employee orientation; they receive a 30 minute lecture on the importance of performance improvement, and a brief explanation of Six Sigma language and terms.

Foundations training is aimed at training Six Sigma team members in what they need to know to help on a project. They learn the significance of statistical tests, the importance of listening to the Voice of the Customer, how to effectively collect valid data, how to facilitate the project to gain buy-in, and how to participate in brainstorming sessions regarding the project.

Leader's Training is a 2-day training session aimed at teaching Managers to understand the Six Sigma Philosophy, how to participate in a Work Out, the importance of data, the reason we want to reduce variation rather than just improve the mean, Six Sigma roles and what they do, and overall performance improvement at CAMC.

Leader's Training 102 is a 2-day workshop aimed at letting managers identify a problem in their department and using the DMAIC process to improve their problem in two days. They learn how to apply the tools rather than just what they are. They also learn teamwork skills and the importance of getting the voice of those who do the work in order to improve the problem.

Green Belt training is identical to Black Belt training except Green Belts execute projects part time, and Black Belts execute projects full time. Green Belts typically run projects that is in their immediate realm of control and are usually of smaller scope than Black Belt projects.

What kind of impact has Six Sigma had on CAMC?

Shannon Roberts, CAMC: $3.2 million to bottom line. Improved errors in quality: reduced medication errors, reduced cycle times in hiring employees, reduced cycle time in results reporting to physicians, improved denials, improved supply costs, reduced ED wait time, reduced blood utilization, improved customer and employee satisfaction.

Could you describe your introduction to and training in Six Sigma?

Melda Brown, BCMH: I was introduced to Six Sigma through my hospital administrator, Tony Atkins. As an employee of CAMC, he was introduced to Six Sigma during a leader's retreat. He provided an article for me to read from the September 2001 Trustee magazine (for hospital governing bodies), entitled "Six Sigma: Exploring New Territory in Quality Improvement" citing Virtua Health's implementation of Six Sigma through GE. (Virtua is located in New Jersey) I was given the opportunity to go to CAMC for Six Sigma training, and my first exposure was to attend a lecture at CAMC given by Dr. Mark Van Kooy, an MD Black Belt from Virtua. He referenced a Six Sigma project at Virtua on Prothrombin times, which as a lab tech, captured my interest.

I began training October 2001, and simultaneously went through Foundations, Green Belt, and Black Belt training, completing the formal training in January 2002; however, the project I was involved with at CAMC is still in the "Improve/Control" phase. This project was on Employee Satisfaction at CAMC's Women and Children's Hospital. Training consisted of several intermittent days/weeks of classroom training in Define, Measure, Analyze, Improve, and Control. Teams would receive classroom instruction in each phase, and then apply the training to their respective projects throughout the training period. Formal project reviews were scheduled throughout each phase of the training schedule.

I came into the picture during the second phase of projects and was included in training at that time. I am actually employed by BCMH, but we merged with CAMC a few years back, and I've developed a close working relationship with the Black Belts there. Earlier this year, 2 of the Black Belts from CAMC went for training through GE to become Master Black Belts, and one of them is the mentor for my current project in the lab.

CAMC has invested many resources into the Six Sigma methodology, but one of the barriers for the Black belts is that the perception from employees is that this is just another "fad"...All of the managers at CAMC are being trained in the DMAIC [Define-Measure-Analyze-Improve-Control] methodology, and many of the managers, quality nurse specialists, and other key personnel are being trained as Green Belts. What we've found is that most of those who receive training, are no longer "naysayers", but convinced of the power harnessed by the use of Six Sigma. Healthcare personnel are so used to measurements based on "averages", and it's difficult for them to grasp the concept of measuring "variation" to gain a more realistic view of the issues.

What is your current Six Sigma project? What is its goal?

Melda Brown, BCMH: My current project, which is my first project on my own, is on Laboratory Chemistry Quality Control Cycle Time. The goal is to improve the morning quality control run process on the Vitros 250 Chemistry Analyzer by reducing variation in the cycle time. The biggest contributor to variation in cycle time was the last step of the process, verifying controls. Due to the lack of a Standard Operating Procedure, techs were interpreting control results inconsistently, and false rejections were very common.

I was inspired to do this project upon reading an article on Dr. James Westgard & Six Sigma in the Nov. 2001 Clinical Lab Products magazine. Since then, I have found valuable information on your website pertaining to Six Sigma and the medical laboratory. This is an exciting project from my perspective, as I have the opportunity to combine my skills in the laboratory with my newfound knowledge of Six Sigma. The data is very conducive to the Six Sigma methodology, and I'm continuing to learn as I go. I appreciate your willingness to share Six Sigma information as it applies to the laboratory, as our lab also continues to utilize Levey-Jennings charts with 2 SD control limits.

What are the hardest obstacles to overcome in a Six Sigma project?

Melda Brown, BCMH: In healthcare, many of the obstacles are related to the fact that patients must be cared for 24 hours a day, 7 days a week. Much of the Six Sigma philosophy requires input from frontline staff, who know and do the processes. There is no downtime for staff training and/or participation in Six Sigma projects, therefore, any staff participation leaves a shortage of workers, which has potential for causing resentment and frustration for those not involved in the project, and leaving those working on the project with feelings of urgency and pressure to complete the assignment. Six Sigma projects are expected to move along at a rapid pace, which is one of the factors setting Six Sigma apart from traditional quality improvement efforts, but again, in healthcare, barriers such as staff shortages, limited resources, no downtime, lack of staff traing in Six Sigma methodology, lack of physician interest, etc. make implementation of Six Sigma a real challenge. Additionally, since Six Sigma is data-driven, it is very difficult in small hospitals to obtain data (due to many manual methods), and in large facilities it is often difficult to access the data. I chose the current lab project because of my prior knowledge of lab processes, and a good working relationship with the lab staff, in addition to the abundance of data available in that area.

If there's one thing about Six Sigma you think people should know, what is it?

Shannon Roberts, CAMC: Six Sigma is more than just a quality program. It is a way we work, a way of life that will benefit our patients, employees and organization as a whole. Not only do we improve our bottom line and quality outcomes, but we train and develop our own people to become leaders in continuous quality improvement. Six Sigma allow us to never be satisfied with the quality of our work and to have a constant hunger to improve.

Melda Brown, BCMH: Six Sigma is not about improving means/average. It's about decreasing variation. Variation is what the customer feels, and Six Sigma provides a means of improving consistency of services delivered, leading to improved quality, customer satisfaction, and better patient outcomes.

Once again, we thank Shannon Roberts, Melda Brown, BCMH, and CAMC for letting us present this interview.