Which process improvement tool can have the most powerful effect in healthcare and why?

Reply 1

Healthcare is an industry that every individual has interacted with at one point or another. The Centers for Disease Control and Prevention (CDC) estimated that approximately 83.4% of adults had a visit with a healthcare professional or physician between 2019 and 2020 (Centers for Disease Control and Prevention, 2022). Although process and quality are top concerns of healthcare professionals, there are many improvement tools at their disposal including Six Sigma, Lean, and Lean Six Sigma. Six Sigma is a popular process improvement tool used throughout the healthcare field. Six Sigma was originally developed by Motorola in 1986 as a method to identify and eliminate defects while potentially reducing variation in production processes (Kam et al., 2021). Six Sigma methodology utilizes a team-based approach by focusing on the define-measure-analyze-improve-control (DMAIC) cycle (McLaughlin et al., 2022). The ‘define’ of DMAIC is responsible for discovering issues of a process (Kam et al., 2021). The ‘measure’ portion of DMAIC is necessary for breaking down and exploring a process (Kam et al., 2021). ‘Analyze’ is responsible for the data analysis and the identification of underlying causes (McLaughlin et al., 2022). The ‘Improve’ phase is responsible for identification, evaluation, and implementation of solutions (McLaughin et al., 2022). Finally, the ‘control’ phase is responsible for maintaining solutions and monitoring ongoing processes (Kam et al., 2021). Sigma Six methodologies in healthcare could improve care and patient satisfaction while reducing unnecessary costs associated with redundant testing.

Although Six Sigma is a leading approach to process improvement in healthcare, Lean methodologies are often incorporated. Lean was introduced by Toyota to improve productivity in the automobile industry by reducing overall waste (Grassi et al., 2020). The methodology is considered both a management philosophy and strategy for improvement (McLaughlin et al., 2022). Lean methodologies are often incorporated with Six Sigma in the healthcare industry creating the hybrid Lean Six Sigma (LSS). LSS is often regarded as the best of both Six Sigma and Lean methodologies as Six Sigma is focused on process improvement while Lean is focused on waste elimination (Dempsey et al., 2021). LSS seeks the ‘root cause’ of a problem in a process while eliminating unnecessary waste using real-time observations and data collection (Dempsey et al., 2021).

LSS could be considered one of the most powerful tools in healthcare process improvement due the effectiveness of the methodologies that create it. Dempsey et al. (2021) conducted a pilot study on the review process for accessing a Basic Life Support (BLS) training program. Pre- and post-team-based interventions using LSS methodologies were used in the redesigning process (Dempsey et al., 2021). The creation of a hybrid BLS class delivery method resulted in a 50% increase in volume of BLS classes and significant time savings for staff, instructors, and customers (Dempsey et al., 2021). LSS can also reduce hospital wait times, improve access to medical treatment, and reduce healthcare costs due to the elimination of unnecessary costs. Patient satisfaction is at the root of process improvement in healthcare as taking care of the patient is the top priority of any healthcare professional. The Bible touches on taking care of others in Galatians 6:2 which states, “carry each other’s burdens and so you will fulfill the law of Christ” (New International Version, 1978/2011). Healthcare involves caring for patients and bearing their burdens as Christ does; improvements in healthcare only make the job less stressful.

Centers for Disease Control and Prevention. (2022). Ambulatory care use and physician office visits.  (Links to an external site.)“>https://www.cdc.gov/nchs/fastats/physician-visits.htm (Links to an external site.)

Dempsey, A., Robinson, C., Moffatt, N., Hennessy, T., Bradshaw, A., Teeling, S. P., Ward, M., & McNamara, M. (2021). Lean six sigma redesign of a process for healthcare mandatory education in basic life Support—A pilot study. International Journal of Environmental Research and Public Health, 18(21), 11653.  (Links to an external site.)“>https://doi.org/10.3390/ijerph182111653 (Links to an external site.)

Grassi, M. O., Furino, C., Recchimurzo, N., De Vitis, F., Sborgia, G., Sborgia, L., Meleleo, A., Molfetta, T., Piepoli, M., Locatelli, P., Boscia, F., & Alessio, G. (2020). Implementation of Lean healthcare methodology in designing an Intravitreal Injection Center: First Italian experience. International ophthalmology 40(10), 2607-2615.  (Links to an external site.)“>https://doi.org/10.1007/s10792-020-01441-1 (Links to an external site.)

Kam, A. W., Collins, S., Park, T., Mihail, M., Stanaway, F. F., Lewis, N. L., Polya, D., Fraser-Bell, S., Roberts, T. V., & Smith, J. E. H. (2021). Using lean six sigma techniques to improve efficiency in outpatient ophthalmology clinics. BMC Health Services Research, 21(1), 38-38.  (Links to an external site.)“>https://doi.org/10.1186/s12913-020-06034- (Links to an external site.)

McLaughlin, D. B., Olson, J. R., & Sharma, L. (2022). Healthcare Operations Management (4th ed.). Health Administration Press.

New International Version Bible. (2011). The NIV Bible.  (Links to an external site.)“>https://www.thenivbible.com (Links to an external site.)(Original work publishe

reply 2

Discussion Thread: Lean Six Sigma and Health Care Improvement

The increasing importance of cost control, risk management, performance improvement management, as well as, increasing efficiency and efficacy of operational workflows requires a solid set of project management skills. By applying project management systems, the organization can strategically plan, organize, and execute tasks and workflows that may redesign and/or realign the operational workflows that aim to improve patient care, reduce costs, and improve the patient’s satisfaction and experience. Operations management requires that health care systems and organizations continuously seek out ways to improve. Where there are activities that have the ability to evolve or change, the ability to improve also lives. Those opportunities abound in hospitals. As these improvement projects continue to become more complex, the roles and responsibilities of project management come to the forefront (Langabeer & Helton, 2021). Project Management is not a new idea for industries across the world, and the health care industry, and the participants within the industry. Of the many methodologies utilized for improving efficiency, reducing cost, or improving quality, Lean Six Sigma (LSS) has been utilized in health care.

While both Lean and Six Sigma systems have the same goals, eliminate waste, and create the most efficient system possible, the methods by which each identify root cause of waste is different. Lean views waste as the byproduct of unnecessary steps in a process; Six Sigma’s view is that waste is the result of variation in the process. Lean Six Sigma at its core is an integrated methodology that utilizes lean’s approach to identify and remove waste, and then relies on Six Sigma apparatuses to reduce variation within the process. Lean, unlike Six Sigma, does not require advanced statistics, costly training, or expensive platforms or systems. Also, lean values can be applied in regular stages on the journey of continuous improvement. Each episode of care and the resulting patient interactions represent opportunities to encourage value and cut waste.

The never-ending pressures to increase access, increase patient visit volumes, and reduce costs are constant within health care. Lum et.al., (2019), experienced a significant reduction in duration and variability while being able to increase patient visits. The authors noted, “As demands on healthcare resources continue to increase in the future, Lean Six Sigma techniques may play an increasingly important role in improving the delivery of healthcare services” (p. 9). From human resources, information technology, nursing, imaging systems, workflows/processes, to the actual design of a physician office, health care projects encompass the entire aspect of delivery of patient care. PMO personnel are the subject matter experts in ensuring the successful planning, implementing, and executing a project.

Health care project management involves more than the typical planning and managing a new build or upgrading of existing structures. Change management inside the health care environment is a balancing act that involves often involve managing multiple projects with different stakeholders (Gordon & Pollack, 2018). Underestimating the need or ability of this resource could lead to failure and failing to provide the highest quality care in an efficient and effective manner has the potential to be disastrous to the long-term viability of the organization.

The successes, and failures, can be felt from the top of the organization down to the bottom. Changes that result in a reduction of inefficiencies and waste can be felt on the organization’s “bottom line” and with the quality of life for staff. All of these improvements will result in a more engaged and productive workforce, which will only seek to improve revenue producing activities. Inefficiencies, whether from redundancies or waste, are a burden on a system. In the context of health care, workflows that are impeded are capable of negative impacts to the safety and success of patient-care delivery (Blijleven et al., 2017). One of the juxtapositions that project management face is solving one issue only to have to address another. As project management decreases inefficiencies and promotes a more effective and efficient care model, increases in patient wait times and decreasing patient satisfaction start to come into light.

While researching this week’s work, the verses from Luke 14:28-30 came to mind. Luke 14:28-30 states,

For which of you, desiring to build a tower, does not first sit down and count the cost, whether he has enough to complete it? Otherwise, when he has laid a foundation and is not able to finish, all who see it begin to mock him, saying, ‘This man began to build and was not able to finish.’ (Holy Bible, English Standard Version, 2001, Luke 14:28-30).

This verse reminds that when health care organizations take on projects, the administrators need to be mindful of the foundation on which the project is being built upon, the costs of the project, and whether or not the organization has the required resources necessary to undertake the project and see it through to completion and to do so in a manner that provides quality output.

References

Blijleven, V., Koelemeijer, K., & Jaspers, M. (2017). Identifying and eliminating inefficiencies in information system usage: A lean perspective. International Journal of Medical Informatics (Shannon, Ireland), 107, 40-47.  (Links to an external site.)“>https://10.1016/j.ijmedinf.2017.08.005 (Links to an external site.)

English Standard Version Bible. (2001). ESV Online.  (Links to an external site.)“>https://esv.literalword.com/ (Links to an external site.)

Gordon, A., & Pollack, J. (2018). Managing healthcare integration. Project Management Journal, 49(5), 5-21.  (Links to an external site.)“>https://10.1177/8756972818785321 (Links to an external site.)

Langabeer, J. R. I., & Helton, J. (2021). Health care operations management. Jones & Bartlett Learning.

Lum, B., Png, H. M., Yap, H. L., Tan, C., Sun, B., & Law, Y. H. (2019). Streamlining workflows and redesigning job roles in the theatre sterile surgical unit. BMJ Open Quality, 8(3), e000583.  (Links to an external site.)“>https://10.1136/bmjoq-2018-000583 (Links to an external site.)