Lean Six Sigma
The president of the Society of Hospital Medicine identifies attributes of industrial engineers that make for a better hospitalist and where to acquire tools and skills to succeed in a multifaceted role.
Researchers applied lean and Six Sigma methodologies to improve OR efficiency. Multidisciplinary teams addressed minimizing volume variation; streamlining the preoperative process; reducing non-operative time; eliminating redundant information; and promoting employee engagement.
This is a summary presentation of one year results from a project at Mayo Clinic in Florida aimed at improving the operational performance of a hospital's operating rooms by assessing and managing variability. The changes resulted in a 5 percent increase in OR utilization and net revenue and a 27 percent reduction in overtime. These data were also published in the June 2013 Journal of The American College of Surgeons.
This online article describes capacity improvement at the University of Pittsburgh Medical Center (UPMC) catheterization lab.
Dr. David Belson describes various operations improvement methods used by management engineers in healthcare in this paper prepared for the California Healthcare Foundation.
and the need to meet scheduled, emergent, and urgent patient needs.
What began as an MBA class project at Purdue University's Krannert School of Management ended up with participants applying factory management techniques that hold promise for improving medical clinic productivity and quality. The research was supported by the Regenstrief Center for Healthcare Engineering at Purdue's Discovery Park. The improvements improved the capacity of the clinic by 37 percent with no additional resources.
This article in the Harvard Business Review describes how one emergency department went from the sixth to the 99th percentile in patient satisfaction using a lean framework to eliminate waste.
Joanie Ching, RN MN, Administrative Director of Quality and Safety, blogs about how Virginia Mason Hospital in Seattle is abandoning batch administration of medications to improve patient safety. By going to just-in-time medication administration, nursing workload has been leveled, medication errors have been reduced, and nurses are better able to respond to patient needs.
Editor's note: Workload leveling and smaller batch size, like many other "Lean tools", are industrial engineering concepts that have been well understood for many decades. It appears that a Lean approach has helped Virginia Mason to discover the benefits in this novel.
There are two keys to successful cost-cutting in healthcare: the first - necessary but not sufficient - is to apply proven tools and tactics from industrial engineering, lean, Six Sigma, and business process reengineering; the second is to align the initiative with the organization's mission and culture and engage clinical and administrative staff across the organization to collaborate in the process. This post from the HBR Blog Network describes how Banner Health, one of the nation's largest health systems, did it.
Mark Graban and co-author Joseph Swartz just released the new book, The Executive Guide to Healthcare Kaizen. The book is a companion book to Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements. The new book is an introduction to kaizen principles and an overview of the leadership behaviors and mindsets required to create a culture of continuous improvement. It also includes more than 200 full color images, more than 100 real kaizen examples from various health systems around the world, and an introduction by Gary Kaplan, M.D., the CEO of Virginia Mason Medical Center.
This presentation from the Healthcare Systems Process Improvement Conference 2013 highlights the reduction in mortality rate at Mayo Clinic, in Rochester, Minn., as the result of learning from every death. A multidisciplinary, mixed method approach to mortality review was developed to learn as much as possible about system improvements that could save lives. This rich data source is a critical component of effective our DMAIC initiatives for mortality rate reduction.
The article describes the application of lean methods to improve OR turnover times. Key to the approach is differentiating turnover requirements by surgical specialty and developing standard work in a job breakdown structure for individual roles in the process. This approach can be applied to other healthcare processes where consistent performance is necessary for safe patient care and improving cycle times.
"What we're finding is that hospital administrators either learn lean Six Sigma, or they go out and hire people who know lean Six Sigma in order to apply their experience to a hospital setting," Dr. Gholston said. "The goal of the new course would be to train existing administrators and nursing staff to interpret data and implement process changes that improve efficiencies and boost patient satisfaction."
Management systems focused on standardization strategies like lean result in better health outcomes and lower mortality rates, according to a new JAMA report based on a study from the Oregon Health and Science University.
A lean look at hospital readmissions
Physicians at Denver Health provide a presentation on reducing readmissions using a lean approach. Denver Health has been applying lean methods to clinical and nonclinical improvement for more than seven years and is nationally recognized for performance in patient safety and outcomes among large teaching institutions.
What we didn't know we didn't know - and what you can learn from it: BJC HealthCare transformation journey
This presentation at the 2012 Healthcare Systems Process Improvement Conference describes the first part of a lean Six Sigma journey at BJC HealthCare. The author provides a candid discussion of the difficulty of change in a large organization and provides important lessons for anyone undertaking a similar challenge.
Application of lean Six Sigma in healthcare, improvement of nursing shift directors - a graduate-level-directed project experience
In this graduate-level-directed project, the workload of nursing shift directors (NSD) has been analyzed. The purpose of this study is to create a baseline metric of the existing process; collect operational data and analyze ways to improve the work efficiency by eliminating the non-value-added tasks from the daily workload; automate some of the tasks performed by NSD; and monitor and provide control methodologies for sustainability.
Science of improvement, how to improve - Institute for Healthcare Improvement
IHI offers a comprehensive healthcare improvement framework through an interactive website based on Plan-Do-Study-Act.
This self-study article from Healthcare Purchasing News provides an overview of hospital sterile processing with a lean perspective, provides evaluation criteria to identify improvement opportunities, and includes a self-test for comprehension of key aspects of sterile processing.
This presentation at the 2012 Healthcare Systems Improvement Conference, provides a basic description of several lean tools and statistical methods for continuous improvement in healthcare.
In this presentation at the SHS Healthcare Systems Improvement Conference 2012, the author describes a comprehensive lean design approach that includes the rapid testing of ideas and the embedding of lean principles into process and workspace design in the shortest time possible.
A hospital was losing more than $100,000 annually in write-offs due to inaccurate documentation of patient information during registration and scheduling. This presentation from the 2012 SHS Conference describes one hospital's journey to improve revenue cycle performance using lean Six Sigma. As a result of the project more than half of the errors initially identified by the team were eliminated.
A 291-bed children's hospital implements a process redesign initiative using the Design for Lean Six Sigma methodology to prepare for the electronic health record. The presentation describes the infrastructure, project plans, methodology and results to date.
In this presentation at the 2012 Healthcare Systems Process Improvement Conference, the authors describe how hoshin planning [strategy deployment] was implemented from the corporate executive suite to associates and physicians across an entire integrated healthcare system. The process has assured alignment of goals from top-to-bottom, taken unaligned goals off the plate, and promoted critical discussion between organizational levels on strategies and tactics to achieve well-defined goals.
Bill Santamour of Hospitals and Health Network describes how Columbus Regional Hospital in Indiana has worked more than 100 projects and saved the hospital more than 18 million dollars over the last several years through the application of a Lean Six Sigma program.
An online article in American Nurse Today, describes how Lehigh Valley Health Network (LVHN) in eastern Pennsylvania, is working to implement Lean. LVHN calls their approach the "System for Partners in Performance Improvement (SPPI)". The goal of the organization is to discover more efficient ways to provide health care by using lean tools and concepts that reduce waste and repetition. The article provides a detailed description of the five-day rapid improvement event process in use at LVHN.
In this presentation at the 2011 SHS Conference, Jonathan Flanders describes how a 400 bed hospital reduced average LOS for Hospitalist patients by 1.0 day using lean concepts applied at the service-line level. The presentation is a comprehensive case study for the application of lean and six sigma tools. The use of multi-level value stream mapping applied to an inpatient care unit will be of particular benefit for readers struggling in this area.
Undergraduates Joshua Wimble, Kristine DeSotto, Casey Krawic and Zachary Theoharidis at WPI completed a project as part of their graduate requirements resulting in a reduction of missing medications at the West Roxbury campus of the VA Hospital.
This paper presented at the 2011 SHS conference by Sandra Garrett, Clemson University, and Ashley Benedict, Purdue University; describes a human factors perspective of information flows based on the increasing complexity in healthcare. The presenters introduce a novel model for addressing this complexity and demonstrate application of the model with a case study in an outpatient prescribing process.
A recent feature in Binghamton's Watson Review describes ongoing healthcare improvement research at the Watson Institute for Systems Excellence (WISE). Ongoing healthcare research at WISE includes research in ED throughput and supply chain. WISE researchers collaborate with a number of hospital systems including Vitua, Mayo, and Wilson and Binghamton General Hospitals.Thirteen research assistants in the WISE program have recently been placed in healthcare organizations.
A multidisciplinary group at Presbyterian Healthcare Services teamed together to meet the Joint Commission National Patient Safety Goal and to reduce the central line infection rate to less than 1 per 1000 patient days. The team used a Lean Sigma improvement methodology to identify a number of countermeasures including checklists, education, defined observer, and a standardized central line kit. Over the first six months of the project the central line infection rate was reduced to .22 infections per 1,000 patient days.
Students at Worcester Polytechnic Institute and in coordination with UMass' Center for Innovation and Transformational Change examined how lean tools can eliminate non-value added work, improve resource management, and create lean flow at the UMass Memorial Hospital. After implementing a number of changes, the team saw a reduction in patient throughput time, elimination of defects in the chart tracking process, and a decrease in stocked inventory.
A team at Kadlec Regional Medical Center in Richland, Wash., took a lean approach to improving the availability and reliability of anesthesia related equipment in the OR. The team included physicians, staff, and external consultants. The article describes the background of total productive maintenance and how it was applied by a multidisciplinary team including physicians, OR staff, and clinical engineering. View related photos
In this Ezine article author Gerald Leone describes how lean tools and principles were successfully applied in preparation for a Joint Commission Survey.
In an article recently published in the Journal of Industrial Engineering and Management, the authors concluded that while IE students working in hospitals focused on technical approaches to improvement, mastery and application of softer skills may be more beneficial.
Pharmacy leaders at Elkhart General Hospital, in Elkhart, Ind., applied a number of lean concepts resulting in lower operational costs and improved patient care.
In a case study on the AHRQ website, the 340-bed Forbes Regional Campus of Western Pennsylvania Hospital developed a number of strategies to reduce delays in patient admission and discharge resulting in improved patient flow. The improvements were made during a weeklong kaizen blitz.
In an article previously published in Industrial Engineer magazine, industrial engineering researchers at Clemson University assisted Cannon Memorial Hospital in Pickens, S.C., in a number of hospital-wide and service specific improvements resulting in increased efficiency.
STLtoday.com recently featured efforts at Barnes-Jewish Hospital in St. Louis to provide improved patient-centered-care using a number of lean management principles. A number of examples of process improvement in the OR and peri-operative services are discussed.
A recent article in AORN Management Connections by Carina Stanton describes how three healthcare organizations are implementing lean.
The authors provide a description of improvements in blood transfusion processing by applying Lean concepts at 14 different laboratories in three different countries. Average savings per site was over $190,000 excluding savings associated with improved inventory management.
Cancer Treatment Centers of America has recently adopted the A3 as a Lean tool to help empower stakeholders in improving key processes. This article provides a case study of how stakeholders are coached through the A3 to improve the patient and family service experience.
In this presentation at a past SHS Conference, Lynne Linder and Brian Pfister describe the importance of using the right project selection methodology using a failed DMAIC case study with lessons learned.
In March 2009, the Roudebush VA Medical Center initiated a series of Rapid Process Improvement Workshops (RPIWs) to organize and redesign supply and equipment areas within inpatient units.
Management Engineering: What is it?
Replenishment of IV fluids and medications can be more methodical than repeated visual inspections.
One hospital details improvements to their medical equipment retrieval, cleaning, and distribution process.
Using Lean Six Sigma tools, a hospital redesigns and implements new ICU protocols for patients on mechanical ventilation. The article details how the initial sustainability effort failed, but was brought back into long-run control.
Physician and Nursing roles and responsibilities within a PICU are redefined using lean tools to decrease LOS while increasing outcomes.
Using examples from several clinical lab redesigns, the sequence of steps utilized during a lean improvement effort are described.
Methods of measuring work done by skilled labor are discussed.
When applying value stream mapping, don't forget that sometimes patients will need to be grouped just like part families - and each of those may need a unique VSM.
A CT scan department has its demand smoothed.
5S theory and implementations are discussed
Lean tools are used to redesign processes throughout a hospital.
Discussion of applications of lean within the OR.
Workers at a substance abuse clinic use the Toyota Production System to continuously refine their treatment for each patient.
Future advances in medical devices and informatics within health care IT are described in this article.
System-level quality and effectiveness programs are implemented using Six Sigma at a children's hospital in Washington DC.
Improvement projects in surgery, nursing, and the ED are discussed. The process of moving a hospital towards adoption of Lean Six Sigma is also described.
Applications of industrial engineering tools to healthcare are discussed.
A methodology for standardized evaluation of the financial impact of operational and patient care improvements is discussed.
An ED lean project is discussed, highlighting some advantages that undergraduates can bring when partnered with professionals in the field.
Detailed description of a lean project to improve TAT in the CT Scan department.
In a for-profit ambulatory surgical center, the current scheduling method often results in cases starting later than the initial plan. The presentation describes an implementation of clustering as well as multiple simulations of different possibilities.
The surgical admitting process is targeted with a lean event. Current and future state is described, the process of improvement is shown, and results are discussed.
Three successful lean projects are discussed in detail. The ED, Radiology, and HR departments all show significant improvement.
Three successful lean projects are discussed in detail. Specimen Labeling, Surgery and Endoscopy Pre-Op, and Inpatient Nursing Crash Cart projects all demonstrate significant improvement.
Results of a hospital-wide specimen labeling lean project is discussed.
A lean event focused on patient flow out of the ED was conducted, and results are discussed
All processes in an ED are redesigned, with multiple outcomes showing improvement.
A 100,000 annual visit hospital ED is redesigned using lean principles. Wait times decrease and pt satisfaction and revenue increases. Simulation shows further viability of new processes. This presentation is made by a MD who became a lean coach.
This is an overview of several lean redesign projects in the ED with overall solutions discussed and analyzed.
ED throughput process improvement projects are discussed. The presenter is a MD. Several changes are shown with great results.
Billing error reduction as a Lean Six Sigma project
A Lean Six Sigma project focusing on ICU throughput times is completed. Lessons learned and successes are shared.
Observation of production processes is a key part of process improvement.
A discussion of the importance of metric and measurement accuracy during execution of improvement projects.
A lean project is done at a cardiac clinic. Problem is to reduce wait time for an appt and cycle time of the appointment. Results are discussed.
A hospital undertakes a systemic improvement of their OR suite. The process and final results are detailed.
A Premier consultant discusses lessons learned from performing many Lean ED projects during her career.
Emergent Care was redesigned to decrease wait time significantly.
Methods of confronting and smoothing the variability of patient flow are discussed.
A lean project generated proposals for rescheduling the providers' workload. During testing of the proposals, daily departmental volume was completed significantly earlier in the day.
4 lean projects were performed - pharmacy, lab, outpatient clinic, and telemetry unit. Each project was meticulously documented in the presentation. Pre- and post- metrics are included, as well as a discussion of sustainability.
Task analysis of an RN's shift on a med/surg unit is performed, using spaghetti maps and other lean tools. Integration of a new medicine delivery system is studied to examine how RN efficiency is affected.
Lean projects at Kaiser Permanente are detailed and discussed. The report is a system-level presentation showing many departmental improvements.
Lean improvements within the radiology suite and laboratory workspace yield notable improvements. Project benefits are discussed.
A system-wide rollout of 5S was performed. Results as well as lessons learned are discussed.
5S implementation strategies at multiple systems of varying sizes are presented and contrasted.
Two supply cost projects are described, analyzed, and discussed.
Lean principles are utilized during analysis and transformation of a HIM department. Results and lessons learned are discussed.
Lab collection and processing techniques are examined and improved. Results are discussed.
The authors present a tool for introducing lean across a system. Results from selected projects are discussed.
System-wide implementation of Lean Six Sigma has resulted in many successes. This presentation discusses the rationale for their overall strategy.
The IHI Bundle was implemented; metric changes are documented and discussed. Several nursing practices were also changed.
ED charge capture is a constant problem for hospitals. This presentation covers one system-wide approach to increasing the capture rate.
A pull system is implemented within a surgical suite, saving on inventory cost. Other accomplishments and lessons learned are discussed.
Any organization implementing lean six sigma will experience both success and failure. This presentation describes some of the "growing pains" of one system, as well as a methodical demonstration of the lean tools utilized in their improvement efforts.
Motivation is made for performing lean improvements within the lab.
Payment denials were decreased, resulting in a cost savings of $1.6 million annually. This project steps through the list of improvements made.
Turnarounds and first case starts are improved using a variety of lean techniques. Sustainability, achievement of buy-in and metric details are also discussed.
Lean improvement projects are performed within the supplies delivery function of a surgical services suite.