Dr. Apurva Jain writes about Lean Six Sigma (LSS) and its applications in healthcare systems to improve efficiency in hospitals, reduce the chances of errors, and improve patient satisfaction.

Botched-up cataract surgery; man sucked into MRI machine; surgery performed on the wrong organ; hospital declares live baby dead- such headlines often make news in the media. These errors in the field of medicine could clearly cross the line between life and death, fall outside of the Hippocratic Oath which promises to ‘Do No Harm’ and also cripple the quality of healthcare.

What is LSS?

Lean Six Sigma (LSS) is “a business process philosophy that focuses on the customer and increasing value and improving quality, safety and productivity.” Though initially when started in 1986, the concept was used only in the corporate world, today it finds extensive application in the field of healthcare.

The waste, the value, the error

Lean and six-sigma are two separate concepts. Lean is the process of identifying value-adding and non-value adding steps in the process and removing the non-value adding steps or waste, so that all work adds high value. Waste in healthcare can be extra patient waiting time, redundant data entries, increased movement of staff in search of resources or even causing errors by the healthcare provider leading to resurgeries. Six Sigma is the process of optimising averages by reducing variation as also reducing errors so that the final product is 99.9967 percent error-free. It is customer centric and a data-driven method which relies only on facts and figures.

DMAIC- Define, Measure, Analyse, Improve and Control

The process implies a disciplined, step-wise approach.

1. First, define stage includes what is the problem which is leading to customer dissatisfaction or needs to be solved.
2. Once the problem is clearly defined, identify the ways to measure the problem by enumerating the various parameters which quantify inefficiency, wastage and error. Relevant data is then collected by surveys, previous hospital records, interviewing of important stakeholders.
3. Analysis is an important step. Various six sigma techniques like process mapping, preparation of standard operating procedures, process breakdown, WHY method, fishbone diagram, input-output methods are to be used appropriately. It also uses the Pareto Effect which states that 80 percent of the effects come from changes in 20 percent of the causes.
4. The Improve and control phase involve removing redundant steps, replacing correct steps where necessary, monitoring them and making it permanent if proved to be successful.

Another useful methodology in LSS is known as Design for Six Sigma (DFSS) which is a process development rather than a process improvement model. It involves studying a process in another area or organisation and duplicating it as per local requirements.

Management principle in healthcare

Few of the many applications include reducing patient waiting time, reducing discharge time, customising of a health information management system, improvement in medical tourism or in telemedicine, reducing errors in the operation theatre, avoiding needle prick injuries, reducing errors in datda transfer by nursing staff during change of shifts and reduction in time period for reimbursement of insurance. Thus, it aims at improving efficiency and reducing time of process, thus increasing patient satisfaction, as also, removing waste and thus decreasing cost of production, benefitting the provider. Therefore, in spite of being patient centric, it creates a win-win situation for the healthcare provider as well as the user.

Bhat and Jnanesh [1] changed the turnaround time for health information department from 52 min to 39 min. Dr Kusuma M et al [2] was able to increase the number of cases in the operation theatre by 1 or 2 cases per day by applying the six-sigma model using a fishbone diagram for analysis. These being just a few instances of the application of this model in healthcare and hospital.

Scope ahead

Management and delivery of healthcare have now become two separate domains in hospitals and healthcare. Integration of such managerial principles in healthcare will help to increase the overall efficiency of hospitals, improve patient satisfaction and utilising resources to the fullest.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

Dr. Apurva Jain is a dentist and an aspiring public health professional. She can be reached at apujain94@gmail.com