LEAN AND SIX SIGMA IN

HEALTH CARE
(QUALITY INITIATIVE TO ACHIVE WORLD CLASS
EXCELLENCE)

2/19/2011
VADAMALAYAN INSTITUTE OF PARAMEDICAL SCIENCES
R.GAYATHRI, B.Sc., M.B.A., PGDHRM, & M.PRIYA, M.B.A FIRST YEAR
 LEAN AND SIX SIGMA IN HEALTH CARE

(QUALITY INITIATIVE TO ACHIVE WORLD CLASS EXCELLENCE)

INTRODUCTION:

Quality, though recognizable to one and all, is one of the most imperative issues that
all sectors have focused on in the last 20-30 years. As markets become much more
competitive, quality has become a key ingredient for victory in today’s business.

With Lean and Six Sigma, hospitals embark on with the accent of the client to capture
the anticipation of patients, family members, physicians, and other stake holders.

LEAN SIX SIGMA

ELIMINATING DOING THINGS

NON-VALUE RIGHT AT FIRST
ADDED
 Quality is a comparative term and it is expression of patient who is receiving the
actual service. Lean gives organizations the tools to drive out waste so that all work adds
value and serve patient’s need. Six Sigma is an perfection methodology which uses a well
thought-out approach to drive business improvement. Six Sigma methodologies afford the
modus operandi to perk up the capability and trim down the flaws in any practice.

SOME QUALITY TOOLS USED TO IMPLEMENT SIX SIGMA AND LEAN:

• Reducing waiting time - Triaging patient

• Eliminating non value added procedures – cost-cutting
• Pareto chart – decreasing nosocomial infection
• Standardizing the process – process flow diagrams for each department
• Quality assurance – Professional Review
• Why- Why diagrams – Reluctance of staff nurse to work in ICU
• Cause and effect diagram – Poor ICU Services

TRIAGING PATIENT:

LONGER WAITING TIME IN EMERGECY DEPARTMENT

USING LEAN PRINCIPLE

TRIAGING PATIENTS – BY TRIAGE TEAM

RED YELLOW GREEN BLACK

 GIVING
TREATMENT

NOT
REQUIRES
LIFE NOT
IMMEDIATE THREATENING EMERGENCY
MEDICAL BUT REQUIRES
ATTENTION ATTENTION

ELIMINATING NON VALUE ADDED ACTIVITIES:

OUT PATIENT DEPARTMENT – In some hospitals where they they want to train
their CRRI’s to collect history, do physical assessment, ask for laboratory diagnosis, and
make preliminary diagnosis. Here what happens these beginners at their learning period they
would like to be in safer side. They almost get complete history, wasting patient time, go for
all-embracing physical assessment, solicit for all related laboratory diagnosis like urine
routines, blood routines, x rays etc, most of the times which results in unnecessary things.
These not only devastate the money and time of the client but the precious productivity of the
hospital.

There are thousands of populace who are not able to access even indispensable health
care due to various dispropositions. Here it is sagacious for us as health care professionals to
cut down preventable procedures so that we can deliver our service some other who are
really in need.

Here we can make these CRRI’s to practice with the senior doctors, so that they can
observe what are appropriate things to be carried out to save cost and money for both the
parties. It also helps the hospital to fabricate a good image among community and enhance
its promotion through WOM communication

ELIMINATING NOSOCOMIAL INFECTION:

CHECK SHEET, HISTOGRM AND PARETO CHARTS:

Check sheets are simple tool used to keep a record of the number and type of defects/
nonconformities over a specified period of time or within a certain batch.
Histogram is a variation of a bar chart in which data values are grouped together and put
into different classes. This grouping allows you see how frequently data in each class occur
in the data set. It’s just a pictorial representation of data collected through check sheets.

Pareto Diagram is a combined bar chart and line diagram based on cumulative
percentages. 80% improvement in quality or performance can reasonably be expected by

eliminating 20% of the causes of unacceptable quality or performance. A graphical

representation ranking discontinuities from the most to least significant. Used to help
brainstorm what discontinuities, if worked upon first, would be the most likely to produce the
greatest improvement in quality.

Let us try these tools to measure the nosocomial i.e., hospital acquired infection rate
in an hospital. Assumption – Total inspected case 500

SL TYPE OF TALLY TOTAL NO. OF

INFECTION INFECTIONS INSPECTED
NO
IN A MONTH

1. A //// // 7

2. B /// 3

3. C //// //// // 12

4. D //// //// //// // 17

5. E //// 5

Grant Total 44

Arranging the collected data in descending order

SL TYPE OF INFECTION TOTAL NO. OF INFECTIONS

INSPECTED IN A MONTH
NO

1. D 17

2. C 12

3. A 7
 4. E 5

5. B 3

Histogram – Graphical Representation of above data

TYPE
INFEC

Constructing Pareto Chart

TYPE OF SUB TOTAL PERCENTAGE OF PERCENTAGE OF

INFECTION INFECTION INFECTION PER
(n)
PATIENT

D 17 3.4 38.64

C 12 2.4 27.27

A 7 1.4 15.91

E 5 1 11.36

B 3 0.6 6.82

44 8.8 100

80
 20% cause 80% effect

Blue color shows 20% of the cause i.e D, C, A is the reason for
remaining 80% of the effect. So the health care workers can concentrate on eliminating
nosocomial infection of type D, C, ans A, one can abolish the jeopardy of nosocomial
infection which increases patient length of stay in hospital,so that they can improve service
quality.constructed.

PROCESS FLOW DIAGRAM:

Process flow diagrams can be unit wise so that the process flow
becomes consistent and it will be effortless for fresh enterents to follow without any
haziness. Employees can assertively take autonomous decisions because they are following
the standard procedures knowing their justification.

Here i have erected process flow diagrams in an ICU unit of a

hospital to stay away from superfluous wastage of time in taking decision concerning what
next.

QUALITY ASSURANCE – PROFESSIONAL REVIEW:

Quality assurance is achieving through an ongoing valuation of patient care which

would declare the hospital that all that was done for the patient was done to validate
diagnosis, treatment, and outcome and to pinpoint the inadequacies in medical care for
renovation for the future cases.
Retrospective Professional Review:

We have to form a team compraising heaads of clinical heads, pathologist, radiologist and
hospital adminstrators. The main objective of the team is to scrutinize all fatal case medical
records.

SL TYPE OF REVIEW PURPOSE

NO
1. Radiographic review To justify the radiological
assessments done
2. Tissue review To justify surgeries done
3. Chart review To assess the completeness
of medical records
4. Death review To validate the untoward
outcome

The professional review helps to assess professional competence of health care providers and
to make recommendations for future policy planning
 W hy
WHY WHY DIAGRAMS: In a d e q u a t e R e c ru it i n g a d e q u a t e
s ta ff s ta ff
This can be used to draw the possible solution for any quality problems. Here I have tried to

Heavy
find out the possible solution to overcome reluctant staffs to work in Intensive care units

w o r k lo a d
W hy
U n p re d ic t a b le O n C a l l n u rs e s
CAUSE AND EFFECT DIAGRAM: W hy re q u i re m e n t s
R e lu c t a n c e
This type of diagrams are also called as fish bone diagram which is used to identify the
tpossible
o w ocauses
rk in IC U
for any adverse effect which affect hospital service quality. Here I have used
this diagram to identify causes W h y ICU services.
for poor

W hy
L ack o f T r a in in g p r o g ra m s
H ig h ra t e T ra i n i n g
o f in f e c t io n

P r o p e r Is o la t i o n
P oo r f o r p a t i e n t w it h
Is o la t i o n I n fe c tiv e d i s e a s e s
W hy