Need of Lean Six Sigma and Quality Management

in Healthcare Organization-A Review Paper

Shweta Naik R.1*, Khyathi G.V.1, Lokesh A.C.1
1Faculty of Management and Commerce, M.S. Ramaiah University of Applied Sciences, Bengaluru 560054
*Contact Author E-mail: [Link]@[Link]
Abstract

Healthcare organization, due to its complex nature needs to adapt to changing needs and regulations. To sustain in the
competitive, technology-driven health care industry where customer demands are changing rapidly, hospitals need to
incorporate theories and philosophy of quality and excellence. The core idea of this article is to understand the
importance of implementing Lean Six Sigma methodologies in healthcare settingsand the possible benefits to both the
patient and healthcare providers. The outcome of this paper is based on the various literature reviews and case studiesthat
provide information on improvements achieved from using Lean Six-Sigma and other quality methodologies. The
healthcare industry has to re-examine the entire workflow facilities and infrastructure design to provide the accepted level
of quality and value-added services to the customers, along with improved efficiency of the employees by applying quality
improvement methodologies.

Keywords: Lean Six Sigma, Quality Methodology, Efficiency, Healthcare Industry

1. INTRODUCTION Management science, Operations research and process

engineering are directed at organizations and processes.
Much of health services quality improvement
smarter than to work harder and shifted the concept of implementations can be characterized as solution-driven
employee-centric approach to employee-efficiency [1]. with identification of research finding and working
Healthcare industry faces the challenge of increasing its towards rapid diffusion [6].
workload and demand at faster rate with minimal to
zero errors to achieve patient satisfaction and
improvement in overall revenue generation. Among 2. PURPOSE OF THE STUDY
several other methodologies, Lean and Six Sigma
concepts are most commonly used methodology [2]. A
The motivation to write this paper is on the personal
Hospital, Boston to improve wait time in phlebotomy experience during the Hospital departmental postings
department applying lean method resulted in decreased and observation made on the several forms of wastes at
wait times from 14-17 minutes to 4-5 minutes. This every step of the process be it resources, manpower or
improvement was achieved initially by assessing the time of both employees and patient and their attenders.
performance of the laboratory staffs, mapping each This made to dwell into various articles on managing
steps of the laboratory workflow starting from patient wastes in hospital to improve work efficiency and
arrival until report is dispatched. Then the work station quality in health care industry by using some
was re-designed, non-value added steps were eliminated methodologies. This quest motivated to write a paper
to finally achieve the desired result [3]. that sheds light healthcare sector using various quality
improvement tools in different department to reduce
1.1. Healthcare Organization error and provide quality care with efficiency.

Quality of care provided in a health care sector is

efficient or not is a debated topic all over the world [4]. 3. OBJECTIVES
Healthcare is one such sector where quality and
quantity go hand in hand as it deals with people and The objectives of the study are:
outcome of their care. The present healthcare system
Importance of Quality Management in
needs to fulfill the criteria of rendering quality care and
Healthcare Organization
uplifting health with minimal cost. Quality management
Lean Six-Sigma Concept in Healthcare
and lean healthcare focuses on both the work efficiency
Organization
benefit from expanding its current interpretation of Incorporation of Lean in Healthcare
structure to include broader perspectives on Organization
Organizational attributes as primary determinants of

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4. METHODOLOGY Six Sigma is described by its approach of customer-
oriented, based on the critical analysis of the
A systematic review study was carried out to prepare quantitative data it emphasis on decision making
this article. Around 40 related articles were reviewed capability and importance on cost reduction. Six Sigma
from websites such as EBSCO, Goggle scholar, comprises of five phases Define, Measure, Analyze,
PubMed Central between February 2016 and May 2016. Improve, and Control (DMAIC) this methodology can
Among them 21 articles were selected, analyzed to be appliedto solve aproblem [14,15]. Lean and Six
write this paper. Sigma methodologies have strongly integrated strengths
that are useful for developing innovations
systematically in healthcare service [14]. Lean Six
Sigma reflects its effects on human resources, rather
4.1. Quality Management in Healthcare than concentrating only on its technique and
effectiveness for improved efficiency in processes and
Organization product quality [15]. Lean is an approach that tends to
be qualitative, while six sigma tend to be quantitative.
first introduced into the business world by Armand
Total Quality 4.3. Incorporation of Lean in Healthcare
Control -
-
Joseph Juran and W. Edwards Deming [7]. The following the exploration of the Toyota model. Lean is
perception of TQM in any organization always focus on a versatile concept that requires organizations to exert
providing services of higher quality to enhance effort along several dimensions simultaneously. Joseph
customer orientation, continual improvement and Juran linked manufacturing industry to healthcare
employee engagement along with management advising to implement principles and philosophy of lean
commitment and leadership [8]. The demand of quality and management for value creation through elimination
in health care is a major issue as it need to define
quality as desired by customer perception and management philosophy to develop a hospital culture
satisfaction with respect to the quality of care received. characterized by increased patient and other stakeholder
Five broad attributes have been identified for satisfaction through continuous improvements, in which
understanding quality namely Reliability, Assurance, all employees (managers, physicians, nurses, laboratory
people, technicians, office people etc.) actively
author reviewed the 15 selected literature review and participate in identifying and reducing non-value added
arrived at the conclusion of identifying eight important This applies to both the operative
TQM practices : top-management commitment (or level and managerial levelin the organization[4]. The
leadership), teamwork and participation, process lean in healthcare involvesspecial practices, and hence
management, customer focus and satisfaction, resource Lean approaches need not to belargely articulated
management, organizational behavior and culture, indicating that the process is particularly or exclusively
continuous improvem Lean. Lean methodologies needuniformity so that
From the review it was concluded that the continuous improvement cycles results to better and
implementation of the above practices are vital for desired outcomes as well as for improved patient
TQM success in healthcare organizations resulting experience or efficiency gains [17]. Lean
performance improvement , patient expressing being implementation always expects to overcome traditional
satisfied, improvement in quality care rendered and mindsets of health care providers and administration
minimal operational costs [10]. Hence, TQM as a and accepting that lean thinking is not just about
corporate strategy can create an organization that reducing waste, but also intensifying efficiency, with
inextricably links every employee, department and patient care as the core concept[18]. Application of
Lean Six-Sigma methodology in Catheter laboratory to
achieving total quality in every aspect of services [11]. improve workflow efficiency. In the cath lab, initial
assessment was done and gathered data was analyzed
before implementing lean tools such as 5S, Change
4.2. Lean Six Sigma Concepts
management, heijunka,pull, mistake proofing, single
piece flow, Just-in-Time, layout change. These
Lean comprises of tools and methodologies those implementations resulted in improved patient flow,
results in identifying and eliminating all kind of wastes, better cath lab utilization both in the form of manpower
adding value to the product and/or services as expected and other resources, thus improving work efficiency
by the customers [12]. The Toyota car company was the and patient satisfaction [19]. The Red Cross Hospital,
first organization to approach Lean and implement it in Beverwijk, Netherland adopted Lean Six-Sigma in 2002
its production department with the vision to resulting in tremendous improvement in various section
accomplish: a continuous improvement in the system of the hospital such as reducing length of hospital stay
consisting of ordered inventory management, reduction for COPD(Chronic Obstructive Pulmonary Disease),
in waste and quality improvement techniques. Lean reduced invoice errors at purchase department, reduced
exercises a continuous learning cycle that is stimulated time taken to prepare intravenous medication, revising
by the experts in the processes of health care, whether it
is the patients and/or families, healthcare staffs and antibiotics. Implementation of Lean Six-Sigma in
other supportive staff [13]. Six Sigma was originally Healthcare industry proves to be a strong tool that helps
introduced by Motorola Company in the year 1987 with in service innovations reducing unnecessary waste and
a concept of company-wide QI (Quality Improvement). time consumption [14].

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5. DISCUSSION 7. CONCLUSION

These article emphases on the importance of adopting

in manufacturing industry to efficiently deliver the lean six sigma in a healthcare industry to improve the
products and services in a much better, faster way with quality services and its positive impact on both
low cost; now it is adopted even by healthcare services. customer and the healthcare providers. Implementing
Healthcare industry is a complex sector and sustaining Lean Six-Sigma in certain healthcare areas such as
the implemented methodologies requires lots of efforts Operation Theater and its benefits derived are to be
from all the stakeholders involved in the service either researched. In recent years, lean six sigma is widely
directly or indirectly. Quality issue in healthcare is accepted as it improves revenue being generated by the
always the topic of concern and incorporating theories business and service excellence. Though challenging to
such as six sigma and lean provides additional benefits implement the methodology in the all department
to improve the existing services and facilities as it is simultaneously, undertaking a project of one unit for
proved successful in manufacturing industries too process improvement is advisable with eventual
[12,14]. But, it takes greater effort to understand what incorporation of the same overall to attain the planned
vision and mission of quality assurance.
Lean and six sigma benefits by waste reduction and
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