Lean Six Sigma in Healthcare

Juran Knowledge

In many countries, people are living longer while the birthrate is either stagnant or falling. In the U.S., the 2018 birthrate was down 2% on 2017, the fourth consecutive year of decline, according to the Centers for Disease Control and Prevention.

The U.S. Census Bureau reports that the population of citizens aged 65 and above increased by over 12 million between 2010 and 2018. It calculates that by 2030, for the first time in U.S. history, older people will outnumber minors.

Clearly, this has implications for the whole of society, and arguably most strongly for healthcare. A need to improve quality while reducing costs has driven many healthcare organizations to investigate, and implement, Lean practices.

Six Sigma aims to reduce errors and defects. Lean aims to eliminate waste. The two together are known as Lean Six Sigma.

In healthcare, they combine to enhance and improve the way organizations operate and so increase value for patients. Successful implementation requires commitment from the top down but, once established, everyone benefits – the employee, through enhanced job satisfaction; the organization, through better systems and lower costs; and the patient, through added value.

Key areas of waste in healthcare

The main types of waste in healthcare can be broken down as follows:

Transportation: involves considering the route typically taken through a facility by, for example, staff, patients, supplies, and equipment.

Inventory: excessive inventory in the form of, for example, equipment, medication, and surgical supplies means capital and storage space are tied up. Also, as medicine has a shelf-life, it may become unusable.

Motion: motion waste occurs when movement made by a worker does not add value for a patient – e.g. not having commonly used supplies to hand, or difficulties transferring a patient from a wheelchair to a bed.

Waiting: idle time is any time spent waiting by workers, patients, or equipment. Meetings should start on time; appointments should be scheduled; expensive equipment should be used to capacity.

Over-production: involves avoiding the concept of “too much.” That might be, for example, duplicating tests, over-extending hospital stays, or employing too many people.

Over-processing: covers duplication of work, or work that is unnecessary; e.g. entering the same information more than once, or carrying out needless tests.

Defects: includes those things that interfere with the provision of quality care and can have a cost attached, whether in terms of life, health, money, and/or reputation; e.g. misdiagnosis, medical errors, and incorrect record-keeping.

Skills: when waste is eliminated from other areas, workers are better able to innovate, train, and learn. Waste elsewhere leads to untapped potential in the workforce.

Lean in action

There are many examples of Lean principles benefitting healthcare organizations. Here, we focus on just three.

Lean principles reduced average emergency room waiting times by 31% across nine hospitals in northern Virginia. There was also a significant reduction in the number of people who walked out without seeing a medical professional.

A Lean initiative introduced by a dental practice in Florida had a dramatic impact on time. Patients saw a 79% reduction in the number of visits required and a 95% drop in the time taken to achieve full recovery. Clinicians saw an 82% increase of available time, resulting in a 35% increase in patients seen and the chance to see new patients. A 40% reduction in the requirement for treatment rooms and staff (the latter achieved through natural wastage) was achieved.

In Britain, Bolton Hospital’s pathology department tracked every step taken by blood samples on their journey from the patient, through various laboratories, and back. This identified waste and blockages. Following redesign of the process and the workspace, the journey was reduced from 309 steps to 57, and the distance staff had to walk each day was reduced by 80%. The time taken to process samples was cut from 24–30 hours to between two and three.

What next?

Lean is more widely used in other industries, but the potential for those principles to benefit healthcare is vast. The industry is, of necessity, undergoing a fundamental transformation and there are already many examples of how Lean has helped. Contact Juran to discuss how we can help you to apply lean principles in your organization.