Table 1 DMAIC (Define-Measure-Analyze-Improve-Control) Framework
Element of each step | Actions Performed by Core Investigators | |
|---|---|---|
Define | Problem statement | Project Charter was drafted, including a problem statement that articulated the background, specific needs, and aims of the project |
Goal statement | Articulated in the Charter: “Decrease number of days between the PCP entering an order for any type of nephrology consult and the nephrologist completing a consult note from 48.9 days to 30 days, by August 2019.” | |
Project scope | Articulated in the Charter: “This Lean Six Sigma project will take place 360 days from start to validated solutions” | |
Identification of project sponsor | The Chief of Medical Services was identified and designed as the project sponsor | |
Identification of process owner | The telenephrology Case Manager was identified and designated as the process owner | |
Primary impact measure | Articulated in the Charter: “Number of days between primary care practitioner entering a consult and nephrologist performing chart review” | |
Secondary impact measures | Travel time and costs saved by Veterans Number of telenephrology consults generated | |
Measure | Baseline operations | Chart review determined baseline number of days to completion of nephrology consultation Pre-Intervention Process Map |
Impact data | Project charter updated regularly based on performance | |
Analyze | Process mapping | Current process map from PCP entry of lab order to completion of consult order is shown in Fig. 2 |
Voice of the customer | Veterans, PCPs, and Nephrology clinical staff (practitioners and case managers) interviewed Point-of-care observations performed | |
Improve | Future state maps | Future state map from PCP entry of lab order to completion of consult order is shown in Fig. 2 |
Plan-Do-Study-Act cycles | Five PDSA cycles were performed | |
Pilot results | Gaps between predicted and actual performance analyzed | |
Control | Development of a control plan | A control plan was drafted to summarize the process and take steps to ensure that the level of improvement is maintained and sustained |
Impact summary | A one-page impact summary was drafted with simplified language and diagrams for dissemination within the institution | |
Recognition of work accomplished | Results of quality improvement project disseminated locally at institutional grand rounds and nationally at annual conferences Celebration of short-term wins |