MMHA 6900 Week 4 DMAIC Project Plan Example

One Defined Defect: A DMAIC Project Plan for Heart Failure Discharges Home Without Services

Student Name

Walden University

MMHA 6900: Healthcare Quality Management

Instructor Name

Month Day, Year

One Defined Defect: A DMAIC Project Plan for Heart Failure Discharges Home Without Services

Why DMAIC, and Why One Defect

The Week 3 diagnosis located Cobalt Ridge Medical Center's excess heart failure readmissions among patients discharged home without services, concentrated in the first week, with low rates of early follow-up. The hospital, the composite setting for this course, now needs a structured project. This plan uses DMAIC, the five-phase method from Six Sigma: define, measure, analyze, improve and control. When DelliFraine and colleagues weighed the published hospital projects using these industrial methods, they found plenty of success stories but thin evidence behind many, with projects most successful when they target a clearly defined problem with good data (DelliFraine et al., 2010). The plan therefore begins by defining a single defect precisely, so that every later phase measures and improves the same thing.

Define

The defect is defined as follows: a Medicare patient aged 65 or older, discharged alive from Cobalt Ridge to home without home health or facility services after a heart failure admission, who does not have a completed visit with a clinician who manages their heart failure within seven days of discharge. A discharge either has the defect or does not, which makes it countable.

Why this defect, rather than readmission itself? Readmission is the outcome the hospital cares about, but it has many causes, some outside the hospital's reach, and it is too infrequent in a monthly sample to show change quickly. Early follow-up is a process with a documented association with lower readmission at the hospital level (Hernandez et al., 2010), it is under the hospital's influence and it occurs often enough to measure monthly. Readmission will be tracked as the project's outcome.

Table 1

Project Charter Elements

The charter fixes the defect, scope and goal so the team cannot drift toward a broader problem.

Measure

The measure phase confirms the baseline and checks the data. The team will pull three months of discharges from the scope, about 70 patients a month, and determine for each whether a visit occurred within seven days, using scheduling records from the hospital's clinics and claims or calls for visits elsewhere. Because outside visits may be missed, the team will call a random sample of 30 patients to confirm whether they saw a clinician, which tests the accuracy of the data source. Each week's defect rate goes onto a run chart, dated by discharge, so the starting level is visible before anything changes.

Analyze

The analyze phase asks why discharges have the defect. The team will review every defect case in one month for where the follow-up process broke: no appointment made before discharge, an appointment made but too late, an appointment made but missed or no clinician available. A process map of how follow-up appointments are made today, built from observation and interviews with case managers and schedulers, will show who is responsible at each step. A fishbone diagram will organize causes, and the team will test the most likely ones with data before accepting them. For example, if the team suspects that cardiology clinic slots are full, it will measure the next available new-patient and post-discharge slots for four weeks.

Interviews with eight patients who missed follow-up will add their view, such as transportation problems or confusion about which clinician to see. Their accounts matter because the hospital's records show only whether a visit happened, not why it did not. A patient who skipped a visit because the clinic was forty minutes away by bus needs a different remedy from one who did not know the appointment existed. The team will ask each patient the same four questions and record answers in their own words, then sort them alongside the chart findings so that the two sources can confirm or challenge each other.

Improve

Improvements will be chosen only after analysis, but the plan anticipates several candidates: scheduling the appointment before the patient leaves, reserving post-discharge slots in cardiology and primary care clinics, a phone call within 48 hours to confirm the appointment and transportation, and telehealth visits for patients who cannot travel. Each change will be tested with plan-do-study-act cycles on one unit before spreading. Comparing transition programs across many trials, Van Spall and colleagues found that several kinds of intervention, including disease management clinics and nurse home visits, were associated with fewer readmissions (Van Spall et al., 2017), which supports testing more than one option.

Control

Gains will be held through a control plan. The defect rate will move from a run chart to a statistical process control chart, reviewed monthly by the unit managers, with a response rule for any special-cause signal. The appointment-before-discharge step will be built into the discharge checklist so it does not depend on memory. Ownership will move from the project team to the case management department at month nine, with the quality department reporting the outcome measure, readmissions, quarterly to the board.

Table 2

DMAIC Timeline and Deliverables

Each phase ends with a deliverable the sponsor signs before the next begins.

Conclusion

This plan narrows Cobalt Ridge's readmission problem to one defect that can be counted every month and improved by the hospital: no heart failure follow-up within seven days for patients sent home without services. DMAIC gives the project a disciplined path from definition to control, and the outcome that matters, fewer readmissions, is tracked alongside.

References

DelliFraine, J. L., Langabeer, J. R., & Nembhard, I. M. (2010). Assessing the evidence of Six Sigma and Lean in the health care industry. Quality Management in Health Care, 19(3), 211-225. https://doi.org/10.1097/QMH.0b013e3181eb140e

Hernandez, A. F., Greiner, M. A., Fonarow, G. C., Hammill, B. G., Heidenreich, P. A., Yancy, C. W., Peterson, E. D., & Curtis, L. H. (2010). Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure. JAMA, 303(17), 1716-1722. https://doi.org/10.1001/jama.2010.533

Van Spall, H. G. C., Rahman, T., Mytton, O., Ramasundarahettige, C., Ibrahim, Q., Kabali, C., Coppens, M., Haynes, R. B., & Connolly, S. (2017). Comparative effectiveness of transitional care services in patients discharged from the hospital with heart failure: A systematic review and network meta-analysis. European Journal of Heart Failure, 19(11), 1427-1443. https://doi.org/10.1002/ejhf.765