Lean Six Sigma

CMS: Healthcare spending rises only modestly

Healthcare spending rose 3.6 percent, or $2.9 trillion, from 2012 to 2013, marking the lowest growth rate since the federal government began tracking healthcare expenditures in 1960.

How to get your improvement projects approved

Want to get your improvement project approved? Better read this first!

"Empowering staff can't be just lip service": Interview with Dr. Greg Jacobson

The more cumbersome it is for someone to engage in improvement work, the less likely they are to do so. I think that the key is: People need to feel empowered, but it can't be just lip service. It has to go that extra step, where people recognize and see that they are empowered.

Making process improvement 'stick'

Process improvements have become a main goal at hospitals, particularly as demands for greater efficiency in care delivery rise alongside care costs and pressures to improve outcomes. Hospitals can facilitate these improvements by first explaining to staff why the changes are necessary, then encouraging leaders to champion the improvements by tying their evaluations to the outcome, as well as ensuring staff and leaders have the skills necessary to achieve those goals.

White House: New PCAST report says 'systems engineering' can improve healthcare

On May 29, the President's Council of Advisors on Science and Technology (PCAST) released a report to President Barack Obama that identifies a comprehensive set of recommendations, including the implementation of systems engineering, to address cost and quality challenges in healthcare.

Hospitalists as industrial engineers

The president of the Society of Hospital Medicine identifies attributes of industrial engineers that make for a better hospitalist and where to acquire tools and skills to succeed in a multifaceted role.

Use of lean and Six Sigma methodology to improve operating room efficiency in a high-volume tertiary-care academic medical center

Researchers applied lean and Six Sigma methodologies to improve OR efficiency. Multidisciplinary teams addressed minimizing volume variation; streamlining the preoperative process; reducing non-operative time; eliminating redundant information; and promoting employee engagement.

Re-engineering the operating room using variability methodology to improve healthcare value

This is a summary presentation of one year results from a project at Mayo Clinic in Florida aimed at improving the operational performance of a hospital's operating rooms by assessing and managing variability. The changes resulted in a 5 percent increase in OR utilization and net revenue and a 27 percent reduction in overtime. These data were also published in the June 2013 Journal of The American College of Surgeons.

Increasing cath lab capacity through Six Sigma - iSixSigma

This online article describes capacity improvement at the University of Pittsburgh Medical Center (UPMC) catheterization lab.

Operations Improvement Methods: Choosing a Path for Hospitals and Clinics

Dr. David Belson describes various operations improvement methods used by management engineers in healthcare in this paper prepared for the California Healthcare Foundation.
and the need to meet scheduled, emergent, and urgent patient needs.

Professors use industrial lean methods to re-engineer clinic

What began as an MBA class project at Purdue University's Krannert School of Management ended up with participants applying factory management techniques that hold promise for improving medical clinic productivity and quality. The research was supported by the Regenstrief Center for Healthcare Engineering at Purdue's Discovery Park. The improvements improved the capacity of the clinic by 37 percent with no additional resources.

How we revolutionized our Emergency Department

This article in the Harvard Business Review describes how one emergency department went from the sixth to the 99th percentile in patient satisfaction using a lean framework to eliminate waste.

Can lean tools help crack the medication safety code?

Joanie Ching, RN MN, Administrative Director of Quality and Safety, blogs about how Virginia Mason Hospital in Seattle is abandoning batch administration of medications to improve patient safety. By going to just-in-time medication administration, nursing workload has been leveled, medication errors have been reduced, and nurses are better able to respond to patient needs.

Editor's note: Workload leveling and smaller batch size, like many other "Lean tools", are industrial engineering concepts that have been well understood for many decades. It appears that a Lean approach has helped Virginia Mason to discover the benefits in this novel. 

Organizing for systemwide improvement - Cutting costs without cutting corners: Lessons from Banner Health

There are two keys to successful cost-cutting in healthcare: the first - necessary but not sufficient - is to apply proven tools and tactics from industrial engineering, lean, Six Sigma, and business process reengineering; the second is to align the initiative with the organization's mission and culture and engage clinical and administrative staff across the organization to collaborate in the process. This post from the HBR Blog Network describes how Banner Health, one of the nation's largest health systems, did it.

 SHS member and healthcare improvement author releases new book

Mark Graban and co-author Joseph Swartz just released the new book, The Executive Guide to Healthcare Kaizen. The book is a companion book to Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements. The new book is an introduction to kaizen principles and an overview of the leadership behaviors and mindsets required to create a culture of continuous improvement. It also includes more than 200 full color images, more than 100 real kaizen examples from various health systems around the world, and an introduction by Gary Kaplan, M.D., the CEO of Virginia Mason Medical Center.

Learning from every death: Six Sigma approach to mortality rate reduction

This presentation from the Healthcare Systems Process Improvement Conference 2013 highlights the reduction in mortality rate at Mayo Clinic, in Rochester, Minn., as the result of learning from every death. A multidisciplinary, mixed method approach to mortality review was developed to learn as much as possible about system improvements that could save lives. This rich data source is a critical component of effective our DMAIC initiatives for mortality rate reduction.

Using lean methods to improve OR turnover times

The article describes the application of lean methods to improve OR turnover times. Key to the approach is differentiating turnover requirements by surgical specialty and developing standard work in a job breakdown structure for individual roles in the process. This approach can be applied to other healthcare processes where consistent performance is necessary for safe patient care and improving cycle times.

Nursing, engineering blend to seek greater healthcare efficiency

"What we're finding is that hospital administrators either learn lean Six Sigma, or they go out and hire people who know lean Six Sigma in order to apply their experience to a hospital setting," Dr. Gholston said. "The goal of the new course would be to train existing administrators and nursing staff to interpret data and implement process changes that improve efficiencies and boost patient satisfaction."

JAMA - Lean management systems could actually save lives 

Management systems focused on standardization strategies like lean result in better health outcomes and lower mortality rates, according to a new JAMA report based on a study from the Oregon Health and Science University.

A lean look at hospital readmissions

Physicians at Denver Health provide a presentation on reducing readmissions using a lean approach. Denver Health has been applying lean methods to clinical and nonclinical improvement for more than seven years and is nationally recognized for performance in patient safety and outcomes among large teaching institutions.

What we didn't know we didn't know - and what you can learn from it: BJC HealthCare transformation journey

This presentation at the 2012 Healthcare Systems Process Improvement Conference describes the first part of a lean Six Sigma journey at BJC HealthCare. The author provides a candid discussion of the difficulty of change in a large organization and provides important lessons for anyone undertaking a similar challenge. 

Application of lean Six Sigma in healthcare, improvement of nursing shift directors - a graduate-level-directed project experience 

In this graduate-level-directed project, the workload of nursing shift directors (NSD) has been analyzed. The purpose of this study is to create a baseline metric of the existing process; collect operational data and analyze ways to improve the work efficiency by eliminating the non-value-added tasks from the daily workload; automate some of the tasks performed by NSD; and monitor and provide control methodologies for sustainability.

Science of improvement, how to improve - Institute for Healthcare Improvement

IHI offers a comprehensive healthcare improvement framework through an interactive website based on Plan-Do-Study-Act.  

Achieving LEAN sterile processing 

This self-study article from Healthcare Purchasing News provides an overview of hospital sterile processing with a lean perspective, provides evaluation criteria to identify improvement opportunities, and includes a self-test for comprehension of key aspects of sterile processing.

The role of continuous improvement in healthcare

This presentation at the 2012 Healthcare Systems Improvement Conference, provides a basic description of several lean tools and statistical methods for continuous improvement in healthcare.

Using 3P in lean healthcare facility design    

In this presentation at the SHS Healthcare Systems Improvement Conference 2012, the author describes a comprehensive lean design approach that includes the rapid testing of ideas and the embedding of lean principles into process and workspace design in the shortest time possible.

Eliminating write-offs: Using lean to reduce outpatient claim denials   

A hospital was losing more than $100,000 annually in write-offs due to inaccurate documentation of patient information during registration and scheduling. This presentation from the 2012 SHS Conference describes one hospital's journey to improve revenue cycle performance using lean Six Sigma. As a result of the project more than half of the errors initially identified by the team were eliminated.

Electronic Health Record Implementation: Design for Lean Six Sigma

A 291-bed children's hospital implements a process redesign initiative using the Design for Lean Six Sigma methodology to prepare for the electronic health record. The presentation describes the infrastructure, project plans, methodology and results to date.

Lean Strategy Deployment: Hoshin Planning to Align Efforts of 13k Healthcare Staff 

In this presentation at the 2012 Healthcare Systems Process Improvement Conference, the authors describe how hoshin planning [strategy deployment] was implemented from the corporate executive suite to associates and physicians across an entire integrated healthcare system. The process has assured alignment of goals from top-to-bottom, taken unaligned goals off the plate, and promoted critical discussion between organizational levels on strategies and tactics to achieve well-defined goals.

A hospital blends lean and Six Sigma to improve quality, save big bucks

Bill Santamour of Hospitals and Health Network describes how Columbus Regional Hospital in Indiana has worked more than 100 projects and saved the hospital more than 18 million dollars over the last several years through the application of a Lean Six Sigma program.

Lehigh Valley Health Network nurses go lean

An online article in American Nurse Today, describes how Lehigh Valley Health Network (LVHN) in eastern Pennsylvania, is working to implement Lean. LVHN calls their approach the "System for Partners in Performance Improvement (SPPI)". The goal of the organization is to discover more efficient ways to provide health care by using lean tools and concepts that reduce waste and repetition. The article provides a detailed description of the five-day rapid improvement event process in use at LVHN.

Reducing length of stay using service line lean concepts 

In this presentation at the 2011 SHS Conference, Jonathan Flanders describes how a 400 bed hospital reduced average LOS for Hospitalist patients by 1.0 day using lean concepts applied at the service-line level. The presentation is a comprehensive case study for the application of lean and six sigma tools. The use of multi-level value stream mapping applied to an inpatient care unit will be of particular benefit for readers struggling in this area.

Undergraduates at Worcester Polytechnic Institute reduce missing medications at VA Hospital

Undergraduates Joshua Wimble, Kristine DeSotto, Casey Krawic and Zachary Theoharidis at WPI completed a project as part of their graduate requirements resulting in a reduction of missing medications at the West Roxbury campus of the VA Hospital.

A human factors perspective of information flow in healthcare

This paper presented at the 2011 SHS conference by Sandra Garrett, Clemson University, and Ashley Benedict, Purdue University; describes a human factors perspective of information flows based on the increasing complexity in healthcare. The presenters introduce a novel model for addressing this complexity and demonstrate application of the model with a case study in an outpatient prescribing process.

Industrial and systems engineers cure some of healthcare's ills - Watson Institute for Systems Excellence at Binghamton University

A recent feature in Binghamton's Watson Review describes ongoing healthcare improvement research at the Watson Institute for Systems Excellence (WISE). Ongoing healthcare research at WISE includes research in ED throughput and supply chain. WISE researchers collaborate with a number of hospital systems including Vitua, Mayo, and Wilson and Binghamton General Hospitals.Thirteen research assistants in the WISE program have recently been placed in healthcare organizations. 

Central line infection reduction using Lean Sigma at Presbyterian Healthcare Services, Albuquerque, N.M.

A multidisciplinary group at Presbyterian Healthcare Services teamed together to meet the Joint Commission National Patient Safety Goal and to reduce the central line infection rate to less than 1 per 1000 patient days. The team used a Lean Sigma improvement methodology to identify a number of countermeasures including checklists, education, defined observer, and a standardized central line kit. Over the first six months of the project the central line infection rate was reduced to .22 infections per 1,000 patient days.

Undergraduates in action - Utilizing lean techniques for improved patient and information flow, UMass Memorial Hospital

Students at Worcester Polytechnic Institute and in coordination with UMass' Center for Innovation and Transformational Change examined how lean tools can eliminate non-value added work, improve resource management, and create lean flow at the UMass Memorial Hospital. After implementing a number of changes, the team saw a reduction in patient throughput time, elimination of defects in the chart tracking process, and a decrease in stocked inventory.

Total productive maintenance in the OR - A case study at Kadlec Regional Medical Center

A team at Kadlec Regional Medical Center in Richland, Wash., took a lean approach to improving the availability and reliability of anesthesia related equipment in the OR. The team included physicians, staff, and external consultants. The article describes the background of total productive maintenance and how it was applied by a multidisciplinary team including physicians, OR staff, and clinical engineering. View related photos 

How to ace your joint commission survey with lean

In this Ezine article author Gerald Leone describes how lean tools and principles were successfully applied in preparation for a Joint Commission Survey. 

Evaluation of industrial engineering students' competencies for process improvement in hospitals

In an article recently published in the Journal of Industrial Engineering and Management, the authors concluded that while IE students working in hospitals focused on technical approaches to improvement, mastery and application of softer skills may be more beneficial.

Indiana hospital pharmacy saves $1 million annually with lean improvements

Pharmacy leaders at Elkhart General Hospital, in Elkhart, Ind., applied a number of lean concepts resulting in lower operational costs and improved patient care.

Case study on patient flow improvement, streamlining admissions from the emergency department 

In a case study on the AHRQ website, the 340-bed Forbes Regional Campus of Western Pennsylvania Hospital developed a number of strategies to reduce delays in patient admission and discharge resulting in improved patient flow. The improvements were made during a weeklong kaizen blitz.

Helping a hospital shine

In an article previously published in Industrial Engineer magazine, industrial engineering researchers at Clemson University assisted Cannon Memorial Hospital in Pickens, S.C., in a number of hospital-wide and service specific improvements resulting in increased efficiency. 

Barnes-Jewish Hospital featured for process improvement efforts 

STLtoday.com recently featured efforts at Barnes-Jewish Hospital in St. Louis to provide improved patient-centered-care using a number of lean management principles. A number of examples of process improvement in the OR and peri-operative services are discussed.

The art of implementing Lean from AORN Management Connections

A recent article in AORN Management Connections by Carina Stanton describes how three healthcare organizations are implementing lean.

Using Lean to identify process improvement opportunities and improve effectiveness of blood transfusion

The authors provide a description of improvements in blood transfusion processing by applying Lean concepts at 14 different laboratories in three different countries. Average savings per site was over $190,000 excluding savings associated with improved inventory management.

The Influence of Empowerment - An A3 Performance ImprovementSM Success Story

Cancer Treatment Centers of America has recently adopted the A3 as a Lean tool to help empower stakeholders in improving key processes. This article provides a case study of how stakeholders are coached through the A3 to improve the patient and family service experience.

Successful Projects – Take the "guess work" out of choosing performance improvement methodology

In this presentation at a past SHS Conference, Lynne Linder and Brian Pfister describe the importance of using the right project selection methodology using a failed DMAIC case study with lessons learned.

5S Improvement Inpatient Supply Rooms at Richard L. Roudebush VA Medical Center, Indianapolis, Indiana

In March 2009, the Roudebush VA Medical Center initiated a series of Rapid Process Improvement Workshops (RPIWs) to organize and redesign supply and equipment areas within inpatient units.

Management Engineers

Management Engineering: What is it?

Using Material Pull to Improve a Pharmacy Process

Replenishment of IV fluids and medications can be more methodical than repeated visual inspections.

Improving Medical Equipment Availability at Barnes-Jewish Hospital

One hospital details improvements to their medical equipment retrieval, cleaning, and distribution process.

Sustaining VAP Bundle Compliance in the ICU: A Model of CQI

Using Lean Six Sigma tools, a hospital redesigns and implements new ICU protocols for patients on mechanical ventilation. The article details how the initial sustainability effort failed, but was brought back into long-run control.

Optimizing Caregiver Workflow in a PICU

Physician and Nursing roles and responsibilities within a PICU are redefined using lean tools to decrease LOS while increasing outcomes.

Beginning the Lean Improvement Journey in the Clinical Laboratory

Using examples from several clinical lab redesigns, the sequence of steps utilized during a lean improvement effort are described.

Work Measurement in Skilled Labor Environments

Methods of measuring work done by skilled labor are discussed.

Value Stream Mapping Got You Down? The Problem May Not Be You

When applying value stream mapping, don't forget that sometimes patients will need to be grouped just like part families - and each of those may need a unique VSM.

In by 9 Out by 6 - Level Loading

A CT scan department has its demand smoothed.

Time-release fix: 5S is the little big secret for improving healthcare

5S theory and implementations are discussed

Helping a Hospital Shine

Lean tools are used to redesign processes throughout a hospital.

Paging Dr. Toyota

Discussion of applications of lean within the OR.

Root Causes

Workers at a substance abuse clinic use the Toyota Production System to continuously refine their treatment for each patient.

A Life-Saving Role

Future advances in medical devices and informatics within health care IT are described in this article.

Lollipops for Excellence

System-level quality and effectiveness programs are implemented using Six Sigma at a children's hospital in Washington DC.

Attacking Waste and Variation Hospital-Wide: A Comprehensive Lean Sigma Deployment

Improvement projects in surgery, nursing, and the ED are discussed.  The process of moving a hospital towards adoption of Lean Six Sigma is also described.

Patient Safety with Six Sigma, Lean, or Theory of Constraints 

Applications of industrial engineering tools to healthcare are discussed.

Development and Implementation of a Healthcare-Based Economic Evaluation Methodology

A methodology for standardized evaluation of the financial impact of operational and patient care improvements is discussed.

Utilizing Industrial Engineering Student Teams to Benefit Management Engineering Efforts

An ED lean project is discussed, highlighting some advantages that undergraduates can bring when partnered with professionals in the field.

In by 9 out by 6 - Load Leveling

Detailed description of a lean project to improve TAT in the CT Scan department.

Improved Scheduling in a for Profit Surgical Center

In a for-profit ambulatory surgical center, the current scheduling method often results in cases starting later than the initial plan.  The presentation describes an implementation of clustering as well as multiple simulations of different possibilities.

Building Lean From the Ground Up

The surgical admitting process is targeted with a lean event.  Current and future state is described, the process of improvement is shown, and results are discussed.

In the Quest for Performance Excellence: Deployment of Lean Manufacturing Principles in Healthcare Delivery Processes

Three successful lean projects are discussed in detail.  The ED, Radiology, and HR departments all show significant improvement.

Using Lean Methodology to Improve Patient Safety and Clinical Quality

Three successful lean projects are discussed in detail.  Specimen Labeling, Surgery and Endoscopy Pre-Op, and Inpatient Nursing Crash Cart projects all demonstrate significant improvement.

Reaching New Levels of Patient Safety Through Improved Specimen Labeling

Results of a hospital-wide specimen labeling lean project is discussed.

Improving Patient Flow from the ED to a Nursing Unit

A lean event focused on patient flow out of the ED was conducted, and results are discussed

Enhancing Performance Excellence: Total Emergency Services Redesign

All processes in an ED are redesigned, with multiple outcomes showing improvement.

The Journey Toward a Lean ED

A 100,000 annual visit hospital ED is redesigned using lean principles. Wait times decrease and pt satisfaction and revenue increases.  Simulation shows further viability of new processes.  This presentation is made by a MD who became a lean coach.

Applying Redesign Principles to Design ED and Hospital Patient Flow Processes

This is an overview of several lean redesign projects in the ED with overall solutions discussed and analyzed.

A Revolution in ED Patient Throughput Management

ED throughput process improvement projects are discussed.  The presenter is a MD.  Several changes are shown with great results.

Using Six Sigma Principles to Reduce Billing Errors

Billing error reduction as a Lean Six Sigma project

Using Six Sigma to Improve ICU Patient Flow

A Lean Six Sigma project focusing on ICU throughput times is completed.  Lessons learned and successes are shared.

Power of Observation for Lean Six Sigma Initiatives in Health Care

Observation of production processes is a key part of process improvement.

Key Performance Indicators: Relevant Metrics that Sell Results and Drive Ongoing Improvement

A discussion of the importance of metric and measurement accuracy during execution of improvement projects.

Improve Outpatient Clinic Access and Service with Lean Six Sigma

A lean project is done at a cardiac clinic.  Problem is to reduce wait time for an appt and cycle time of the appointment.  Results are discussed.

Streamlining Your OR

A hospital undertakes a systemic improvement of their OR suite.  The process and final results are detailed.

Size Matters; How Big Does Your ED Need to Be?

A Premier consultant discusses lessons learned from performing many Lean ED projects during her career.

Applying SHS Conference Learnings Back at the Ranch

Emergent Care was redesigned to decrease wait time significantly.

Managing Variability in Patient Flow - Data, Process, Sustainability

Methods of confronting and smoothing the variability of patient flow are discussed.

Optimizing Cargiver Workflow in a New Pediatric Intensive Care Unit

A lean project generated proposals for rescheduling the providers' workload. During testing of the proposals, daily departmental volume was completed significantly earlier in the day.

Engaging Staff in Lean Improvements for Patient Care Settings

4 lean projects were performed - pharmacy, lab, outpatient clinic, and telemetry unit. Each project was meticulously documented in the presentation. Pre- and post- metrics are included, as well as a discussion of sustainability.

Medication Administration and the Complexity of Nursing Workflow

Task analysis of an RN's shift on a med/surg unit is performed, using spaghetti maps and other lean tools. Integration of a new medicine delivery system is studied to examine how RN efficiency is affected.

Our Lean Journey Continues and What A Year It's Been!

Lean projects at Kaiser Permanente are detailed and discussed. The report is a system-level presentation showing many departmental improvements.

Lean in the Laboratory and Radiology: A Patient Throughput Imperative

Lean improvements within the radiology suite and laboratory workspace yield notable improvements. Project benefits are discussed.

5S An Entire Hospital System in 5 Months

A system-wide rollout of 5S was performed. Results as well as lessons learned are discussed.

Health System Examples of Long Term 5S Success

5S implementation strategies at multiple systems of varying sizes are presented and contrasted.

A Better Way to Manage Supplies

Two supply cost projects are described, analyzed, and discussed.

Enhancing Hospital Health Information Management Using Industrial Engineering Tools

Lean principles are utilized during analysis and transformation of a HIM department. Results and lessons learned are discussed.

Delivering Faster Lab Turnaround Through Lean

Lab collection and processing techniques are examined and improved. Results are discussed.

Lean System for Managing© (LSFM), the Missing Change Management Tool Lean

The authors present a tool for introducing lean across a system. Results from selected projects are discussed.

5 Projects, 5 Hospitals: Using DMAIC for Rapid Quality Improvement

System-wide implementation of Lean Six Sigma has resulted in many successes. This presentation discusses the rationale for their overall strategy.

Sustaining VAP Bundle Compliance in the ICU: A Model of CQI

The IHI Bundle was implemented; metric changes are documented and discussed. Several nursing practices were also changed.

Capturing Supply Charges in the Emergency Department: How and Why?

ED charge capture is a constant problem for hospitals. This presentation covers one system-wide approach to increasing the capture rate.

Reducing Inventory Waste Through Material Pull

A pull system is implemented within a surgical suite, saving on inventory cost. Other accomplishments and lessons learned are discussed.

Lessons Learned Implementing Lean Sigma in Healthcare

Any organization implementing lean six sigma will experience both success and failure. This presentation describes some of the "growing pains" of one system, as well as a methodical demonstration of the lean tools utilized in their improvement efforts.

Beginning a Hospital Lean Improvement Journey in the Clinical Laboratory

Motivation is made for performing lean improvements within the lab.

A Six Sigma Approach to Denials Management

Payment denials were decreased, resulting in a cost savings of $1.6 million annually. This project steps through the list of improvements made.

Using Lean Techniques to Improve Turnaround Time and First Case Starts in the Operating Room

Turnarounds and first case starts are improved using a variety of lean techniques. Sustainability, achievement of buy-in and metric details are also discussed.

Improving Surgical Services Through Enhanced Ancillary Support

Lean improvement projects are performed within the supplies delivery function of a surgical services suite.