Six Sigma And Lean In Helthcare - Research Paper Example

? SIX SIGMA AND LEAN IN HELTHCARE Research Paper on the use of Six Sigma and Lean in Healthcare Number Department Grade Tutor’s Name 3rd December, 2011 Research Paper on the use of ‘Six Sigma and Lean in Healthcare’ ABSTRACT This study seeks to evaluate the uses of six sigma and lean in the healthcare sector. The healthcare as any other service operation requires strategic management measures to improve the quality of process output and remain competitive, as well as, be cost efficient. This research undertaken in the healthcare sector will analyze and evaluate the viability of the Six Sigma and Lean as discussed. This will be availed by critically looking at the methodologies, and present examples illustrating the working of the principles of Six Sigma and Lean thinking combined. Six Sigma and Lean Systems (SS/L) are extremely popular tools for the improving quality. Therefore, they provide the managers of Healthcare with the opportunity to improve the quality of healthcare on the basis of using sound methodologies and data. Cost increase control in the healthcare, improving the quality, and the provision of better Healthcare are some of the main benefits of this approach. However, these two quality improvement tools are not clear to many whether they are capable of improving the quality of healthcare. Thus, this research paper clearly illustrates how effective these tools can be and what can be corrected to improve further. This will go an extra mile in helping the health care sector, to render high quality services and achieve considerable accolades, as far as, Healthcare services are concerned. Key words: Healthcare, quality improvement, cost reduction, service delivery management, innovation, medical care INTRODUCTION In the recent past, medical care has become exceedingly expensive to an extent that many are not in apposition to access healthcare particularly in the underdeveloped and some of the developing world. Considerable amount of cost increase can be attributed to the out dated technology, and an aging population, which is inevitable due to the advancement of technology and modern demographic developments, which are beyond control. On top of that, operational inefficiency also contributes to the Healthcare cost increase, and this has to do with the healthcare professionals. Inefficiency in this research study is of much essence as it can be measured and necessary changes implemented to improve on the quality. This will lead to affordable Healthcare services and of better quality to a considerable percentage of the entire global population. Some inefficiency encountered in the process of operation can be connected to the delivery of services in the medical sector. Other inefficiencies arise as a result of logistical, administrative and healthcare delivery system operations, of which both can be extremely beneficial to the systematic process of innovation. The paper seeks to evaluate the importance of the Six Sigma and Lean approaches in the healthcare sector. Looking critically at the industrial sector, in the past century, it deployed massive machinery and innovation approaches to increase their level of operational approaches and hence achieve high levels of efficiency in operation systems (Jones, Roos, & Womack, 1990). On evaluating the history of economy, the efficiencies in the industry, were obtained from the collective effect of a substantial number of incremental improvements (Rosenberg, 1982). Six Sigma and Lean Thinking are two processes of an innovative approach that have gained much popularity in the industrial sector (Robinson, 1990). They both availed a systematic approach that facilitated process geared towards increasing the magnitude of innovations. According to Ohno (1988), Lean Thinking emerged in the automobile industry of Japan after the World War II, though it can be traced to the earlier days of the Ford Motor Company (Ford and Crowther, 1926). Six Sigma was originally brought to be by Motorola, and culminated to the synthesis of a sequence of life long developments in quality improvement (QI) (Box and Bisgaard, 1987; Garvin, 1988; Snee, 2004) and was built on a number of other approaches like the ‘Juran’s Trilogy (Juran, 1989). On looking at the two concepts: the Six Sigma and Lean Thinking, it is clear that they have gone through parallel developments in the recent years. Thus, the idea of incorporating the two approaches in improving service delivery and improving efficiency, while dropping on cost in the healthcare sector is of crucial essence. The two approaches are now being used to a large extent in the administration and service delivery areas, though their approaches have its roots to the manufacturing sector (Snee and Hoerl, 2004). Consequent developments have seen the synthesis of the two approaches taken to enhance their strategic channels of problem solving (Hoel, 2004). This research paper seeks to explore the integration of the two approaches in the Healthcare. Lean Thinking The propagation of Lean thinking was discussed by the work of Womack, Jones, and Roos (1990). Lean stands for a fundamental break with the tradition of Western manufacturing. Lean is an integrated structure of principles, tools, practices, and techniques aimed at reducing waste, coordination the flow of work while at the same moment managing variability in production flows of services (Pospisil, 2011). Lean boasts its distinction between value and the non-value added activities with the value added activities contributing extensively to what a customer wants from a service (George, 2003). With all the other activities, they are termed as non-value added. Lean has its primary analytical tool in the concept of value stream map, encompassing an extended process flowchart with information about speed, continuity of flow, and work in progress. This tool highlights non value added steps and bottle necks finding its use in guiding quality identification (QI) activities (CPHIMS, Elyse and PMP, 2009). With the value stream map, it avails a holistic picture of the complete chain in any organization. Other highly useful tools for of Lean include Visual Process management, Kitting and Setup Time/ Changeover Reduction which also blend well with the Six Sigma efforts in healthcare. Figure 1: Business Process Management; the chart above illustrates Lean Value Stream Mapping as applied in the registry project at the Good Samaritan Hospital in Los Angeles. Methodology for implementing Lean may well be described by use of the 5S’s. It is a process for work area or data clean up consisting of five basic concepts. These concepts are highlighted in the representation below. Sort incorporating arranging and prioritizing; Simplify involving the prevention of problems from occurring; Sweep involving clean up; Standardize incorporating clear definition of tasks to be undertaken, lastly is Sustain, which entails ensuring that the habits are in place. Six-Sigma Six-Sigma was initially a concept for company wide quality identification introduced by Motorola in 1987. Further progression work was done by General Electric in the 1990’s. The program is customer driven approach and emphasis on the process of decision making with a basis on carefully analyzing on the quantitative data and cost reduction as the priority (Bisgaard and Freiesleben, 2004). This approach is deployed by carrying out improvement projects with the selection of the projects being based on the conversion of the company’s strategies into operational goals (Pyzdek, 2004). Six –Sigma’s approach is like the appropriate medical practice used since the time of Hippocrates where relevant information is collectively followed by careful diagnosis (Anthony et al, 2007). With a thorough diagnosis having been made, treatment follows by first being proposed and then implemented. In the long run, check ups are put in place to evaluate the viability and effectiveness of the treatment. For this approach to be effective and operationalize the problem solving strategy, the approach of Six-Sigma deploys five phases incorporating, defines, measure, analyze, improve and control (DMAIC) (Brexler, 2005). These are rigorously followed in the occurrence of a problem of any magnitude. In the define phase, drafting of a charter is effected which includes; a cost benefit analysis. This is followed by evaluation of the cost benefit analysis, if it qualifies to meet the threshold of the company, then the charter is accepted and follows the DMAIC procedure. Whenever we get to measure phase, assembling of baseline data and the diagnosis is initiated. The problem gets transformed to quantifiable terms using the critical to quality (CTQ) characteristics (Breyfogle, 2003). The analysis phase progressively continues the diagnosis and entails identification of possible causal relationships between inputs and the CTQs. When the diagnosis comes to a conclusion, the assigned team continues with the improving phase. They suggest a solution to the problem under observation (Breyfogle, 2003). The team then designs and implements process changes or adjustments to improve the performance of the critical to quality (CTQ). To the end of the process is the control phase, which ensures control systems are developed to enhance improvements maintained, and the new, improved process can be handed over to the daily operations staff. Every single entity in the five DMAIC phases involves a detailed series of plans that assist project leaders through the execution of quality improvement (QI) projects (De Koning and De Mast, 2006). In order to obtain a successful launch, and deployment of Six Sigma, an organizational infrastructure is created. An excellent example is a deployment plan for strategically relevant projects that ensure streamlining of project goals with the long term organizational objects. On the same note, Six Sigma uses a stage gate approach to the project management whereby projects are supervised carefully by experts and appropriate actions taken if a project fails to meet the specified completion dates (Breyfogle, 2003). Six-Sigma is known for its complexity, and this is perceived as a weakness. Whenever, ordinaly problems are to be solved, rigorous adherence to the approach of Six Sigma problem solving process is considered inefficient (George 2003). Further the Six Sigma does not resort to standard solutions to common problems same as lean. Finally, the danger of undermining any process, while failing to take into account the entire value chain is ever present. However, Six-Sigma offers a structured, analytic and logically viable approach to problem solving, as well as a strong organizational framework for its deployment (Hoerl, 2004). Six-Sigma and Lean Thinking The Two key Lean tools are strategic principles proving to work exceptionally well in hospitals and are Value Stream Mapping that visualizes the process-flow, patient-flow, information-flow and relevant throughout data one document and 5S’s; which is a process simplification and process cleanup tool (Brexler, Caldwell, and Gillem, 2005). Lean and Sigma applications in healthcare require a detailed understanding of how the apparatus and methodologies translate to the people emergency processes of taking care of patients. On the application, the possibilities of outstanding achievement are excellent. When we talk of Lean and Six Sigma, we refer to the elimination of the non-value-added activities and waste while saving money and time for the former (Agency for Health Care Research and Quality, 2010). While, Lean-Six-Sigma entails increasing the satisfaction of patients and at the same time reducing errors by improving on the process of service delivery. This is particularly crucial in the undertakings of the healthcare organizations as they will improve on service delivery while reducing on the cost of operation. Strategic measures of blending the best elements of Six Sigma and Lean are approaches that are highly effective in the increasing of productivity and optimizing of performance in the healthcare (Brexler, Caldwell, and Gillem, 2005). Due to the special nature of services rendered in the healthcare field; involving giving of patient-care and the composite environment within any healthcare group, this calls for specific measures to ensure that near excellent success is achieved in the saving life process and health improvement. Waste and inefficiency can move stealthily into virtually any process; the concept of lean terminology and variation in Six Sigma language is applicable to the Health care systems and services (Brexler, Caldwell, and Gillem, 2005). Just like, these principles have been used elsewhere in the manufacturing and service delivery; this can be translated into the healthcare environment by taking any enhancement approach into the particular realm of patient care. It only calls for understanding, awareness, and familiarity relative to the unique needs within the Healthcare environment. Once translation has taken place, and necessary techniques put in places which address the human or cultural aspects involved, this eventually leads to improvement in the healthcare with acceleration of sustenance ensured (Agency for Health Care Research and Quality, 2010). A thriving Lean Six Sigma project delivers an efficient procedure by helping to categorize and eliminate the vital work, which is of low value in meeting the fundamentals that are vital to the eminence of the customer. In the healthcare sector, the customer in this context may refer to the patient, family, physician administrator, nurse or even any other stakeholder in the process of health care service delivery. In order to come up with the right project structure and scope; understanding every individuals’ requirement is key in this context. Intertwined approaches of Lean-Six Sigma for healthcare arise which integrates the strategic measure in the improvement of service delivery and cost reduction. The approaches are four and are as highlighted below; Strategic deployment approach where the top officials attach themselves to the strategic-plan by group of quality, outlay reduction, patient protection, approval of the medics and the patients. An organizational, cultural change approach that targets improving the status quo. A statistical calculation approach relating to categorization of costs as quality and the usage of statistical concepts in providing proof of the problem and control of improvement efforts. A project management approach, which provides the organization with tools and frameworks to facilitate the implementation like DMAIC, project management and a hundred day rapid change response teams (CPHIMS, Elyse and PMP, 2009). Looking at the case studies of Nebraska Medical Center, Black Belt Matt Pospisil; they utilized the principles of Lean-Six-Sigma methodology and was able to realize an achievement of a twenty minute reduction in Patient “Time to Bed after Bed assignment.” On the same note, through the process of Value Stream Mapping, Pospisil identified and removed the non-value additional work connected with faxing the patient review sheet to the receiving section; on the same note, it simplified, combined and eliminated some other forms, approvals, phone calls and extra pages (Pospisil, 2011). This results to significant benefits like the one realized in Nebraska medical Center using a similar project. In this case, an additional capacity of patients were recorded which culminated into an increase in annual revenue (Agency for Health Care Research and Quality 2010). Lean complements Six-Sigma, and changes the management through the provision of effective and efficient method of analyzing large, more complex processes, in some cases increasing the frequency to the traditional approach of Six-Sigma (Snee, 2004). On the collaboration, of Lean Thinking and Six-Sigma approaches, a hybrid approach is achieved and combines the methodologies of the two and they become highly effective in problem solving. This concept has been enhanced by the power curves below. Sigma is particularly strong in defining, measure and analyzing but may not be very clear in demonstrating the sustainable and recurring solutions for Improve and Control (Pospisil, 2011). On the other hand, Lean tends to be truly effective in Defining, Improve and control. Whereas Six-Sigma is data determined; Lean is a visual and hands-on lending; it to faster process solutions. Fig 2: Six Sigma Lean Power curves. Six Sigma and Lean in Healthcare Lean Six-Sigma has found its way in the healthcare sector (Glasgow, 2011). Improving levels satisfaction to the customer is a critical issue in the healthcare organizations’ long term success. In order to improve patient satisfaction, the providers of healthcare ought to focus on strategies geared towards the improvement of quality. On the same note, healthcare professional has an obligation of demonstrating attributes consistent with the organizational culture (Agency for Health Care Research and Quality 2010). The following attributes for quality healthcare system are highlighted below. They include; safety, effectiveness, being patient centered, efficient, timely and equitable. On close monitoring the attributes, it is a crucial element of any organization’s philosophy and ought to be an essential part in the initiative of quality improvement (Hoerl, 2004). By means of adopting the six-sigma concept, a cultural change in the healthcare organization is crucial, and will lead to sustainable bottom line results being realized. This calls for the committed and supportive top management officials who are bound to select quality strategies that tie projects to organization imperatives (Glasgow, 2011). From the emergency room to the boardroom in the healthcare sector, Six Sigma could be used in the reduction of variability and ensure error minimization, enhance better processes, improve the care to patients while ensuring greater satisfaction rates to the patient, and arrive at acquiring happier, and more productive enthusiastic employees. In order to achieve the above goals, the strategy of DMAIC (Define, Measure, Analyze, Improve, and Control) ought to be implemented. DMAIC involves a five step improvement cycle aimed at continuously reducing errors. It entails identifying the problems thus, defining the project to be studied, followed by clarifying the scope of the project and lastly defining the targeted goals (Garvin, 1988). In Healthcare, the approach of Lean Six-Sigma has a specific aspect in the sense that there is a fundamental pattern to identify the next step. In every venture, there are always places where wastes will always exist (CPHIMS, Elyse and PMP, 2009). The crucial key outcome of the Lean-Six-Sigma in the healthcare sector entails the organization to be proactive and purposeful rather than the reactive and un-prioritized. A clear example is the using of Lean Six Sigma at the Morton Plant Hospital in Clearwater which improved the satisfaction of patients by fifty per cent, reduced emergency department volume of service by twenty one per cent and more than four million US dollars in cost of quality. On using Lean principles, process improvements leads to reduction in the risk of infection and enhances the production and satisfaction of the staff (De Koning, and De Mast, 2006). After the Lean principles are virtually applied, they increase the output of the staff which leads to a high level of customer satisfaction and this in turn gives the staff a sense of utter satisfaction. This is in the sense that they feel they have realized their so much cherished desire by enhancing their potential. Six Sigma on being applied leads to better adherence to evidence based protocols and fewer infections for surgery patients (Bisgaard, & Freieselben, 2004). On the same note, it inspires the redesigning of workflow which in turn enhances manageable access to care and increase patient satisfaction. Lean and Six Sigma principles on implementation in the healthcare sector can significantly improve operational performance, lower down costs and increase on returns, and improve on the quality of services delivered and develop a culture to ensure lasting results that are viable for a considerable duration (AHRQ Healthcare, January, 2010). On evaluating the Stanford Hospital and Clinics, on the pioneering work on Lean Six-Sigma (George, 2006), the following had been identified by the top management officers. Projects undertaken were not necessarily of strategic relevance. The projects did not have a significant business case. There was no systematic project tracking system that could be used in monitoring purposes. There was no formal method for project management and control to be followed. There were many projects which were not completed and thus brought a lot of distraction. When the hospital applied the approach of Six-Sigma towards the end of 2001, the management found out that the methodology provided solutions to many of the problems at that time. The initial implementation of Six-Sigma at the Red Cross Hospital is explained in details, in the literature (Van den Heuvel, Does, and Bisgaard, 2005). The article well illustrates selected examples amid outlining the Six-Sigma’s management framework and lessons that are highly relevant in the learning context of healthcare. Major problems tackled include; shortening the chronic period of obstructive pulmonary disease patients, reduction of errors found in invoices from the temporary agencies, revision on the terms of payment, allowing children patients to sleep with their parents in the wards, reducing the number of patients in need of intravenous antibiotics, shortening the time taken to prepare intravenous medication, as well as a reduction on the number of mistakes found in the invoices. Frorm the above, it is clear that the approach in healthcare clearly tackles both medical and administrative problems (Anthony et al, 2007). It is imperative that, from this study, significant studies can be made by expanding the scope of application of Six Sigma and Lean in the healthcare sector and alleviates operational inefficiency and waste. CONCLUSION There is no reason why the healthcare sector cannot provide high quality services. The Six Sigma and Lean tool exists to achieve this aim, whether using Six Sigma or the Lean tools, it is imperative that service delivery is enhanced, cost operation reduced and effective work realized. Focus should be developed towards the quality improvement in our healthcare organizations while at the same time developing QI leaders. This will ensure steady and effective work towards the creation of a culture that seeks the provision of high quality health care. Eventually with quality service delivery and cost reduction most of the world population will being a position to access quality and affordable health care. The Six Sigma and Lean approaches are remarkably effective in the healthcare sector. REFERENCES Agency for Health Care Research and Quality, (2010). Six Sigma and Lean Healthcare Forms. Accessed on December 3, 2011, from; http://innovations.ahrq.gov/ Anthony, J., Sezen, B. and Tolga, M. (2007). An overview of Six Sigma Applications in Healthcare Industry. International Journal of Healthcare; Quality Assuarance. 20(4), 329-340 Emerald Group Publishing Limited. Bisgaard, S., & Freieselben, J. (2004). Six Sigma and the bottom line. QualityProgress, September, 37, 57-62. Box, G.E.P., & Bisgaard, S. (1987). The Scientific Concept of Quality Improvement. Quality Progress, June, 20, 54-61. Brexler, J., Caldwell, C. and Gillem, T. (2005). Lean Six Sigma for Healthcare: A Senior Leader Guide to Improving Cost and Throughput. (eBook) available on http://www.amazon.com/Lean-Six-Sigma-Healthcare-Improving- Throughput/ Breyfogle, F. W. (2003). Implementing Six Sigma-Smarter Solutions Using Statistical Methods (2nd ed.). New York: Willey. CPHIMS, Elyse and PMP, (2009). Deming’s 14 Points for Management. December 19, 2009. Retrieved December 3, 2011, from; http://www.anticlue.net/archives/ CPHIMS, Elyse and PMP, (2009). The Four Key Approaches of Healthcare Lean-Six-Sigma. July 1, 2009. Accessed on December 3, 2011, from; http://www.anticlue.net/archives/ CPHIMS, Elyse and PMP, (2009). Understanding Healthcare Lean Six Sigma’s Categories of Waste. July 5, 2009. Retrieved December 3, 2011, from; http://www.anticlue.net/archives/000942.htm De Koning, H., and De Mast, J. (2006). A Rational Reconstruction of Six-Sigma’s Breakthrough Cook-book. International Journal of Quality and Reliability Management, 23(5). Ford, H. & Crowther, S. (1926). Today and Tomorrow. Cambridge, MA: Productivity Press. Garvin, D. A. (1988). Managing Quality: The Strategic and Competitive Edge. New York: free Press. George, M. L. (2003). Lean Six Sigma for services. New York: McGraw-Hill. Glasgow, J. (2011). Introduction to Lean and Six Sigma Approaches to Quality Improvement. National Quality Measures Clearinghouse. Retrieved http://www.qualitymeasures.ahrq.gov/expert/expert-commentary.aspx?id=32943 Hoerl, R. W. (2004). One Perspective on the future of Six Sigma. International Journal of Six Sigma and Competitive Advantage, 1(1), 112-119. Jones, D. T., Roos, D. & Womack, J. P. (1990). The Machine that Changed the World: The Story of Lean Production. New York: Rawson Associates. Juran, J. M. (1989). Juran on Leadership for Quality. New York: Free Press. Onho, T. (1976). Toyota Prodction System. New York: Productivity Press. Pospisil, M., 2011. Lean Six Sigma in Healthcare. The Global Voice of Quality. Retrieved December 3, 2011, from; http://asq.org/healthcaresixsigma/ Pyzedek, T. (2004). Strategy deployment using balanced Scorecards. International Journal of Six Sigma and Competitive Advantage, 1(1), 21-28. Robinson, A. (1990). Modern Approaches to Manufacturing Improvement: The Shingo System. Cambridge, MA: Productivity Press. Rosenberg, N. (1982). Inside the Black Box: Technology and Economics. New York: Cambridge University Press. Snee, R. D. (2004). Six Sigma: The Evolution of 100 years of Business Improvement Methodology. International Journal of Six Sigma and Competitive Adavntage, 1(1), 4-20. Snee, R. D.& Hoerl, R. W. (2004). Six Sigma Beyond the Factory Floor. Upper Saddle River, NJ: Pearson Education. Van den Heuevel, J., does, R. J. M. and Bisgaard, S. (2005). Dutch hospital implements Sig Sigma. Six Sigma Forum Magazine, 4(2), 11-14. Read More