The Optimizing of Urgent Stroke and the Vascular Interventions: A Lean Six Sigma Project

We are delighted to have Dr. Camilo Gomez joining us today to share the details of a Lean Six Sigma project he developed for optimizing urgent stroke endovascular interventions.

Dr. Gomez is a vascular and interventional neurologist who graduated from the Pemba program in 2006. He currently practices at the University of Missouri Medical Centre. 

Stay tuned to learn how Dr. Gomez approached this innovative Lean Six Sigma project at the University of Missouri Medical Center.

The Pemba MBA Program

Dr. Gomez highly recommends the Pemba program, especially for mid-career professionals and those in managerial roles. He praises the program for its medical-focused curriculum, which applies business principles directly to healthcare settings, believing that all department chairs in universities should undergo similar training to enhance their leadership capabilities.

Transition to Private Practice

In 2003, Dr. Gomez left his role as Stroke Center Director at the University of Alabama, Birmingham. He then joined the business world and established a private practice group, prompting him to write a business plan and secure a loan before joining the MBA program.

Realization of Business Knowledge Necessity

As the CEO of his new private practice, Dr. Gomez saw the need for business knowledge to communicate, negotiate, and manage effectively. A chance meeting with an old friend solidified his decision to enroll in the MBA program.

Return to Academia

In 2016, Dr. Gomez returned to the academic world to focus on education, research, and high-end practice. His MBA experience helped him streamline his roles and focus on quality care and operational excellence.

Influence of MBA in Academic Role

Dr. Gomez found his MBA knowledge invaluable in academic settings, especially when dealing with hospital administrators. 

Optimizing Endovascular Interventions

Dr. Gomez is deeply involved in enhancing healthcare processes at the University of Missouri, particularly in stroke care. He actively leads initiatives that streamline operational workflows, improve patient outcomes, and integrate Lean Six Sigma methodologies for continuous process improvement. His work underscores the importance of data-driven decision-making, interdisciplinary collaboration, and innovation in healthcare delivery.

Challenges and Quality Metrics

Dr. Gomez finds the current quality metrics for stroke centers inadequate. He emphasizes the need for more sophisticated analysis and better metrics, drawing on principles like Lean Six Sigma to improve processes and outcomes.

Breakdown of Interventions and Categories

He explains the complexity of various interventions, highlighting the need to categorize them to ensure accurate performance assessment. He proposes developing and publishing a categorization grid to enhance understanding and measurement of intervention quality.

Anesthesia Team Readiness

Dr. Gomez explains the importance of having an anesthesia team ready to receive patients immediately. That includes starting the intubation process before other team members arrive to ensure continuous patient care without any delays.

Expedited Transport

Dr. Gomez emphasizes the need for quick patient transport from the CT table to the angiography table without unnecessary stops, aiming to reduce wasted time and improve efficiency in stroke treatment processes.

Value Stream Mapping and Parallel Processing

Dr. Gomez explains how he uses value stream mapping to identify and eliminate inefficiencies, allowing for parallel processing, where different team members perform tasks simultaneously rather than sequentially.

Challenges and Adaptations Due to COVID-19

The COVID-19 pandemic caused a shortage of contrast agents critical for CT angiograms. The team had to adapt by using MRI techniques instead, despite them being more time-consuming and complex.

Data Collection and Analysis

From May 2022, they collected data under the new process and compared it with baseline data. Although the change in intravenous thrombolysis rates was statistically significant, it did not considerably impact the overall outcomes.

Control Process and Variability

Despite establishing a control process, the variability during the contrast shortage period was significant, highlighting the impact of resource shortages on workflow and outcomes, necessitating careful consideration in future planning.

Importance of Sub-Interval Analysis

While overall door-to-puncture time did not improve significantly, targeted sub-intervals showed measurable improvements, indicating the importance of analyzing specific workflow segments independently.

Advocacy for Lean Six Sigma

Dr. Gomez advocates for applying Lean Six Sigma methodologies to improve processes continuously. He encourages getting certified in Lean Six Sigma and involving as many team members as possible to enhance system efficiency and patient care quality.

Organizational Support and Investment

Dr. Gomez highlights the need for better recruitment, retention, and investment in critical team members. He suggests viewing these costs as investments rather than expenses to enhance system efficiency and patient outcomes.

Conclusion and Final Thoughts

Dr. Gomez encourages listeners to embrace Lean Six Sigma principles for continuous improvement. He highlights the importance of investing in systemized data analysis and involving multidisciplinary teams to achieve and sustain high-quality care in stroke treatment.

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