100-Day SWAT Team FAQs (Frequently Asked Questions )

  

Questions frequently asked in our ACHE and onsite training regarding the 100-Day SWAT Teammethod include:

1. How do we know that a 100-Day SWAT Team is suitable for our organization?

Introducing additional management work into an organization is always a tough decision and false starts result when the timing isn't right. The short answer is that if the organization possess one or more of the following conditions, the 100-Day SWAT Team makes sense: Patient satisfaction, patient safety, and/or cost goals remain unachieved; the organization has a history of successful implementation of new methods every year or so; the organization has a culture of trying new things; and/or senior leaders are willing to make necessary changes in priorities, training, and other requirements to make the 100-Day SWAT Team process successful.

2. Does it matter if we haven't initiated Six Sigma?

No. The 100-Day SWAT Team is one of 4 methods in the Six Sigma suite. It is a self-contained process and doesn't require advanced knowledge or application of Six Sigma. In fact, only 1 of the 4 methods, DMAIC(Define-Measure-Analys-Improve-Control), requires advanced knowledge. all that is needed is covered in the Workout kick-off. Further, starting with apprenticeship in the 100-Day SWAT Team is the best way to begin the journey into Six Sigma. Note: Often, organizations start with the more complex DMAIC projects, sending Black Belts off to training.etc. and fall short of their goals because DMAIC is so complex.

3. How do you select a process for a 100-Day SWAT Team?

Each project should be large enough to produce quality and cost recovery that justifies the intensity of a 100-Day SWAT Team. It must also be small enough to be manageable. We suggest starting with one or more of the six listed above because they are the highest leverage opportunities, but other processes are suitable, like Imaging, Surgery & Anesthesia, Critical Care. One the clinical side, even a single DRG like DRG 209, Hip Replacement, often contains at least $500,000 cost recovery potential.

4. How does a 100-Day SWAT Team differ from PICOs, GE's Workout, or other rapid execution methods?

The 100-Day SWAT Team method is the most recent innovation in a rapidly growing suite of improvement tools being introduced into healthcare. PICOs, created by GM and introduced by IHI, was a great pilot for increasing speed of execution. We found, however, that results were spotty, predominantly because of a lack of sophistication. GE's Workout method improved upon PICOs by adding needed discipline of execution. While more effective than PICOs, it lacks the provision of pre-tested solution sets, leaving creativity up to managers, who quickly ran out of ideas, resulting in less than stellar results. The 100-Day SWAT Team solves these two problems by nesting inside the Workout process training of managers in Tom Nolan's 70 idealized design techniques, HCAB and other reputable solution sets to jump start execution.

5. We've tried PICOs and, worse still, reengineering, with no results, and we've had comparative benchmarks with no real progress in over two years. Why will a 100-Day SWAT Team be different?

• There is never 100% confidence that a new method will work. The first prerequisite is presence of strong organizational will to achieve quantum improvement. If you lack confidence in managers' will to execute, we recommend beginning the process with a Belief System Transformation session to build buy-in and organizational will. Launching anything new without the organizational will to excel will produce little if any sustainable results. (To download a free Belief System Transformation Workshop agenda and faciliator's guide, go to www.chipcaldwellassoc.com/resources and scroll down to Free Downloads.

• PICOs, along with Lean Thinking and GE's Workout, upon which the 100-Day SWAT Team method is adapted, adds several critical features not present in older methods. PICOs and GE's Workout driver speed, but possesses little engineering sophistication. The 100-Day SWAT Team introduces Tom Nolan's 70 idealized design techniques, HCAB, and other solution sets, as part of each Kick-off giving managers a jump start on executable ideas.

• The 100-Day SWAT Team is the most disciplined of methods currently available. Managers during the Kick-off create the plan to execute and report their progress using accountability-based tools that requires proof of not only changes executed, but also the strategic results those changes have produced to date.

6. What if we do not have goals based on external comparative benchmarks?

Comparative benchmarks simply add a level of clarity about what goals are possible. In the absence of external benchmarks, stretch goals can still be created, but with less certainty. If the organization is committed to acquire external benchmarks, the cost of these services continues to drop. Our partner, HMC offers an online service that is as effective as the most expensive alternatives and requires only 4-6 weeks to complete the benchmarking normalization process, significantly faster than other services. Organizations can save significantly by switching to this service, freeing up resources for 100-Day SWAT Team funding.

7. How many apprentices should we commit to learning & applying 100-Day SWAT Teams after you have concluded the 2-3 100-Day SWAT Team apprenticing process?

Building capacity for sustained quality and productivity improvement remains among the most important roles of senior leadership and yet is often the one delegated to others. Improvement capacity depends on two factors - the number of 100-Day SWAT Team facilitators and the number of projects managers can deploy. Increasing this capacity increases the rate of strategic results achievable by the organization. As a rule of thumb, every manager should be executing one 100-Day SWAT Team at all times. More than one usually results in a manager's inability to execute effectively. Therefore, if each manager, in groups of 8 - 16, participates in a 100-Day SWAT Team report-out session, two to four 100-Day SWAT Team facilitators can sustain the effort.

8. If we bring this advanced method into the organization, what happens to our FOCUS-PDCA and other improvement methods?

The short answer is the 100-Day SWAT Team method complements and adds effectiveness to the organization's suite of improvement methods, but is not a replacement. There are four methods in the Six Sigma suite of tools, one of which is FOCUS-PDCA. Most organizations are yet to introduce the more statistically-oriented DMAIC method, leaving three - FOCUS-PDCA, 100-Day SWAT Team, and manager projects. Therefore, the issue becomes capacity as addressed above.

9. How does cost recovery occur?

• Cost recovery is a relatively new concept in healthcare. Costs can be affinitized into one or three types:
  • Process cost, that is, the cost to execute a process (like an ED visit, 24-hour care, hip replacement). Process cost, on average, consumes 67% of the total cost of a process;
  • Cost of Quality (COQ) - the cost to assure quality standards are met. The most common form of COQ is inspection. Some departments, like case management, spend over 75% of their time inspecting. Quality professionals recognize that inspection isn't an assurance of high quality, it is a surrender to poor quality. A six sigma process requires no inspection, thereby freeing up inspector time for productive tasks. COQ consumes about 13% of total process cost.
  • Cost of Poor Quality (COPQ) - not all inspection catches all potential mistakes. When mistakes slip through, rework results and the process must be repeated. This costs additional resources unnecessarily. Some COPQ, albeit only about 4%, results in harm to patients, creating an Adverse Event (AE). AE COPQ is substantial, not to mention the harm. COPQ consumes about 20% of total process cost.
• Cost recovery occurs during a 100-Day SWAT Team, and other methods in the Six Sigma suite, by identifying COQ and COPQ, and reducing the occurrence of the root cause, thereby, reducing the need for inspection. E.g. one organization reduced 11 FTEs of 21 FTEs by reducing the need to inspect MCO claims from 93% of claims to 30% claims. Another organization, in reducing medication errors, reduced added length of stay due to AEs and $248,000 of FTE inspectors. The 100-Day SWAT Team contains several tools, like the Waste Walk, to identify and remedy these issues. However, cost recovery is still new to healthcare and much work remains to gain skill in this critical competency.

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