Lean Six Sigma in Healthcare

May-June 2010 | Source: Quality India (A QCI Publication)
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In its effort to find out if lean and Six Sigma can coexist in organisations, the Quality Council of India has started the National Demonstration Project in 10 hospitals in southern and western India. The move is aimed to achieve improved patient satisfaction and upgrade the reputation of the hospitals.

There is an ongoing debate in some organisations regarding the difference between Lean and Six Sigma, and whether they are mutually exclusive. Toyota, in particular, is credited with making Lean a well known approach as embodied in the Toyota Production System (TPS).

While Lean is about eliminating wastes, reducing process time, and creating better flow, Six Sigma is a business strategy and philosophy built around the concept that companies can gain a competitive edge by reducing defects in their industrial and commercial processes.

Both Six Sigma and Lean focus heavily on satisfying customers. Six Sigma makes customers the primary driver for action in a “war on variation” and identifies opportunities that promise a large, fairly immediate, financial reward. Lean considers customer inputs and conducts a “war on waste”. Both Six Sigma and Lean empower people to create process stability and a culture of continuous improvement.

Should Six Sigma and Lean coexist in any organisation? The answer to this question is self-evident: Yes. Lean approach should precede and coexist with the application of Six Sigma methods. Why? Put simply, Lean provides stability and repeatability in many basic processes. Once stability has taken hold, much of the variation due to human processes goes away. The data collected to support Six Sigma activities thereby becomes much more reliable and accurate.

Lean solutions
If major problems fall into the following categories:

  • There seems to be a lot of waste
  • There is a need to minimise inventories and redundancies
  • There is a need to improve work flow
  • There is a need to speed up processes
  • There are human mistake

If so, then LEAN TOOLS should be utilised to:

  • Eliminate wastes
  • Simplify processes
  • Increase speeds
  • Improve flows
  • Minimise inventories
  • Mistake proof processes.

Six Sigma Solutions
However, if organisational challenges exhibit the following attributes:

  • There are quality issues
  • There is excessive variation
  • There are complex problems
  • There are challenging root cause identifications
  • There are numerous technical considerations.

such cases, SIX SIGMA TOOLS should be utilised to:

  • Minimise variation
  • Apply scientific problem solving
  • Utilise robust project chartering
  • Focus on quality issues
  • Employ technical methodologies.

Lean Six Sigma Solutions
Most organisations have a combination of both sets of issues. Placing Lean and Six Sigma in the middle of this continuum reflects a more holistic and synergistic approach. Lean Six Sigma is a relatively new paradigm providing broader selection approaches. If the only tool in a company is a thermometer, then all problems start to look like a fever!!

An increasing number of organisations (manufacturing, service hospitals, insurance, etc) have been unifying their efforts into a Lean Six Sigma approach. The mechanisms of these combinations vary widely. The most effective approaches include management direction and involvement, a cadre of trained specialists, the use of teamwork, the use of project management, team member training, the humane treatment of people, an understandable problem solving methodology, and application of appropriate tools.

Lean Six Sigma in Healthcare
The Lean Six Sigma approach for “war on waste” and “war on variation” in a hospital context, will focus initially on non-clinical processes. Non-clinical processes have an abundance of waste and variation. This results in a bottom-line erosion, of a very significant magnitude.

Examples of non-clinical processes are: admission, check-out, billing, purchasing, maintenance, ambulance, laundry, meals, recruitment, training, etc.

The objective of the National Demonstration Project is to introduce Lean Six Sigma in 10 hospitals. The expected gains resulting from process effectiveness are improved patient satisfaction and hospital reputation. In addition, the expected gains resulting from process efficiency are process speed and cost reduction.

Implementation of the NDP:

  1. The implementation of the NDP on LSS in healthcare is planned in two. phases:
    1. LSS training for selected hospitals
    2. Facilitation for identifying and executing LSS improvement projects in the selected hospitals
  2. From all the NABH accredited hospitals that had given their consent to be a part of the NDP on LSS in healthcare, QCI shortlisted 10 hospitals in western and southern India. These hospitals include:
    • P D Hinduja National Hospital and Medical Research Centre, Mumbai.
    • Sterling Hospital, Ahmedabad
    • Godrej Memorial Hospital, Mumbai
    • L H Hiranandani Hospital, Mumbai
    • Narayana Hrudayalaya, Bangalore
    • Columbia Asia, Bangalore
    • Amrita Institute of Medical Sciences, Kochi
    • Nethradhama Eye Hospital, Bangalore
    • Manipal Hospital, Bangalore
    • GKNM Hospital, Coimbatore.

The project is expected to be completed by end of August 2010. This will lead to development of framework and toolkit, which will then be promoted widely in the health industry, to reap all-round benefit for all stakeholders.

CREDITS: Quality Council of India
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