Doctor’s orders for Six Sigma excellence

by Catalyst Consulting on 1st August 2008

provided by

Catalyst Consulting

Introduction

The efficiency of general practice (GP) surgeries has long been in the public eye and the most recent plan proposed by Lord Darzi, the health minister, aims to amalgamate GP surgeries into large polyclinics, each offering services to around 50,000 patients.

The new structure proposed by Lord Darzi would mean huge changes in how the UK’s healthcare services operate, with efficiency as the main driver. At the same time as this new proposal, there have been other recent changes to general practice, with the introduction of a new contract for paying general practitioners (GPs) and regularly changing criteria for how a surgery is run.

South Street Surgery in Bishop’s Stortford, Hertfordshire is larger than average, with 20,000 patients opposed to a typical GP surgery which offers services to around 5,000 to 6,000 patients.

Milinda Tennekoon is a GP principal at the surgery. He is well aware of the continuous changes and what they might mean for his surgery. He says: ‘There has been quite a lot of change in service provision dictated from above, changing what we as a general practice have to achieve. We’ve had to realign our services to meet these changes; our funding is now associated with delivering services and if we don't manage this our funding is reduced.’

A quality and outcomes framework has been introduced to GP practices, which takes into account different clinical and management areas and allocates points relating to the level of attainment achieved within each criteria.

‘The more you attain, the more points you are awarded and at the end of the day “points means prizes,”’ Milinda explains. ‘The thrust of this is to make funding more results orientated, rather than just activity based. We have been able to use this extra funding to improve even further the monitoring and treatment of many of our patients with chronic diseases, there by improving their overall health now and into the future. So basically it’s a good thing, a move to measuring the health service in a better way.’

Improving services

As well as changes to funding, GP surgeries have been given additional resources in order to improve the services that they provide. South Street Surgery chose to invest these resources in a sustainable approach to manage the continuing change. The practice feels that industry changes, such as the increase in private providers entering the healthcare market, make it essential to embrace the changes and use the new opportunities to the greatest effect.

‘Traditionally,’ says Milinda, ‘GPs carry out the clinical work and run the business on the side, but we decided that in order to embrace new opportunities, such as funding, we needed to change our mindset and become more professional about the way we run the surgery.’

The structure of the surgery revolves around 14 GPs (including nine partners), nine nurses, and a large reception and administrative team.

The practice operates from two different locations due to its large size. With the size of the surgery effective communication within the practice has always been an issue, and this was highlighted in our initial assessment. With changes in practice managers and other members of the team over the last few years, the ease with which services can be managed has become more difficult.

In an attempt to improve leadership and business practices, the surgery decided to adopt a more process-based management structure, to involve all partners and staff in different parts of managing and developing the practice. However, it was quickly identified that this wasn’t a GP’s area of expertise, so the decision was made to bring in a consultant to structure thinking and carry out an organisational audit to uncover the various problems affecting the efficiency of the surgery.

Through a simple approach to organisational development – assess, improve and maintain (AIM) – several key problems became apparent in the initial assessment stage. Although some problems had already been realised, various things showed up that might never have appeared without a systematic audit. This provided the necessary shake-up and six sigma was identified as a process which could make changes to the system that the whole practice could work with.

‘We knew something wasn’t working,’ reflects Milinda, ‘but not the extent of it. After the organisational audit we moved on to developing leadership skills and identifying our own team roles. As this started to fit in with where we wanted to go, we thought, lets see how it fits into six sigma.’

Author Name:

Organisation: Catalyst Consulting

Project Objective:

Estimated Cost Benefit: