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RUAS-UAS JMC 11 Vol. 03, Issue 02

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: [email protected]

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

smarter than to work harder and shifted the concept of employee-centric approach to employee-efficiency [1]. Healthcare industry faces the challenge of increasing its workload and demand at faster rate with minimal to zero errors to achieve patient satisfaction and improvement in overall revenue generation. Among several other methodologies, Lean and Six Sigma concepts are most commonly used methodology [2]. A

Hospital, Boston to improve wait time in phlebotomy department applying lean method resulted in decreased wait times from 14-17 minutes to 4-5 minutes. This improvement was achieved initially by assessing the performance of the laboratory staffs, mapping each steps of the laboratory workflow starting from patient arrival until report is dispatched. Then the work station was re-designed, non-value added steps were eliminated to finally achieve the desired result [3]. 1.1. Healthcare Organization

Quality of care provided in a health care sector is efficient or not is a debated topic all over the world [4]. Healthcare is one such sector where quality and quantity go hand in hand as it deals with people and outcome of their care. The present healthcare system needs to fulfill the criteria of rendering quality care and uplifting health with minimal cost. Quality management and lean healthcare focuses on both the work efficiency

benefit from expanding its current interpretation of structure to include broader perspectives on Organizational attributes as primary determinants of

Management science, Operations research and process engineering are directed at organizations and processes. Much of health services quality improvement implementations can be characterized as solution-driven with identification of research finding and working towards rapid diffusion [6].

2. PURPOSE OF THE STUDY The motivation to write this paper is on the personal experience during the Hospital departmental postings and observation made on the several forms of wastes at every step of the process be it resources, manpower or time of both employees and patient and their attenders. This made to dwell into various articles on managing wastes in hospital to improve work efficiency and quality in health care industry by using some methodologies. This quest motivated to write a paper that sheds light healthcare sector using various quality improvement tools in different department to reduce error and provide quality care with efficiency. 3. OBJECTIVES The objectives of the study are:

Importance of Quality Management in Healthcare Organization

Lean Six-Sigma Concept in Healthcare Organization

Incorporation of Lean in Healthcare Organization

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4. METHODOLOGY A systematic review study was carried out to prepare this article. Around 40 related articles were reviewed from websites such as EBSCO, Goggle scholar, PubMed Central between February 2016 and May 2016. Among them 21 articles were selected, analyzed to write this paper. 4.1. Quality Management in Healthcare Organization

first introduced into the business world by Armand Total Quality

Control - -

Joseph Juran and W. Edwards Deming [7]. The perception of TQM in any organization always focus on providing services of higher quality to enhance customer orientation, continual improvement and employee engagement along with management commitment and leadership [8]. The demand of quality in health care is a major issue as it need to define quality as desired by customer perception and satisfaction with respect to the quality of care received. Five broad attributes have been identified for understanding quality namely Reliability, Assurance,

author reviewed the 15 selected literature review and arrived at the conclusion of identifying eight important TQM practices : top-management commitment (or leadership), teamwork and participation, process management, customer focus and satisfaction, resource management, organizational behavior and culture, continuous improvem From the review it was concluded that the implementation of the above practices are vital for TQM success in healthcare organizations resulting performance improvement , patient expressing being satisfied, improvement in quality care rendered and minimal operational costs [10]. Hence, TQM as a corporate strategy can create an organization that inextricably links every employee, department and

achieving total quality in every aspect of services [11].

4.2. Lean Six Sigma Concepts

Lean comprises of tools and methodologies those results in identifying and eliminating all kind of wastes, adding value to the product and/or services as expected by the customers [12]. The Toyota car company was the first organization to approach Lean and implement it in its production department with the vision to accomplish: a continuous improvement in the system consisting of ordered inventory management, reduction in waste and quality improvement techniques. Lean exercises a continuous learning cycle that is stimulated by the experts in the processes of health care, whether it is the patients and/or families, healthcare staffs and other supportive staff [13]. Six Sigma was originally introduced by Motorola Company in the year 1987 with a concept of company-wide QI (Quality Improvement).

Six Sigma is described by its approach of customer- oriented, based on the critical analysis of the quantitative data it emphasis on decision making capability and importance on cost reduction. Six Sigma comprises of five phases Define, Measure, Analyze, Improve, and Control (DMAIC) this methodology can be appliedto solve aproblem [14,15]. Lean and Six 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 than concentrating only on its technique and effectiveness for improved efficiency in processes and product quality [15]. Lean is an approach that tends to be qualitative, while six sigma tend to be quantitative.

4.3. Incorporation of Lean in Healthcare

following the exploration of the Toyota model. Lean is a versatile concept that requires organizations to exert effort along several dimensions simultaneously. Joseph Juran linked manufacturing industry to healthcare advising to implement principles and philosophy of lean and management for value creation through elimination

management philosophy to develop a hospital culture characterized by increased patient and other stakeholder satisfaction through continuous improvements, in which all employees (managers, physicians, nurses, laboratory people, technicians, office people etc.) actively participate in identifying and reducing non-value added

This applies to both the operative level and managerial levelin the organization[4]. The lean in healthcare involvesspecial practices, and hence Lean approaches need not to belargely articulated indicating that the process is particularly or exclusively Lean. Lean methodologies needuniformity so that continuous improvement cycles results to better and desired outcomes as well as for improved patient experience or efficiency gains [17]. Lean implementation always expects to overcome traditional mindsets of health care providers and administration and accepting that lean thinking is not just about reducing waste, but also intensifying efficiency, with patient care as the core concept[18]. Application of Lean Six-Sigma methodology in Catheter laboratory to improve workflow efficiency. In the cath lab, initial assessment was done and gathered data was analyzed before implementing lean tools such as 5S, Change management, heijunka,pull, mistake proofing, single piece flow, Just-in-Time, layout change. These implementations resulted in improved patient flow, better cath lab utilization both in the form of manpower and other resources, thus improving work efficiency and patient satisfaction [19]. The Red Cross Hospital, Beverwijk, Netherland adopted Lean Six-Sigma in 2002 resulting in tremendous improvement in various section of the hospital such as reducing length of hospital stay for COPD(Chronic Obstructive Pulmonary Disease), reduced invoice errors at purchase department, reduced time taken to prepare intravenous medication, revising

antibiotics. Implementation of Lean Six-Sigma in Healthcare industry proves to be a strong tool that helps in service innovations reducing unnecessary waste and time consumption [14].

RUAS-UAS JMC 13 Vol. 03, Issue 02

5. DISCUSSION

in manufacturing industry to efficiently deliver the products and services in a much better, faster way with low cost; now it is adopted even by healthcare services. Healthcare industry is a complex sector and sustaining the implemented methodologies requires lots of efforts from all the stakeholders involved in the service either directly or indirectly. Quality issue in healthcare is always the topic of concern and incorporating theories such as six sigma and lean provides additional benefits to improve the existing services and facilities as it is proved successful in manufacturing industries too [12,14]. But, it takes greater effort to understand what

Lean and six sigma benefits by waste reduction and zero or minimal defects, non-value added activities or motion in the existing process flow, and providing the quality services that not only increases the customer satisfaction but also increases the work efficiency. Improvement in turn-around time (TAT) of laboratory reports using six sigma methodology was implemented in Sakra World Hospital, Bangalore .The 8 months project aimed to achieve 5% TAT outlier, increase 36 tests per day and financial benefit. At the end of the project, hospital laboratory was able to achieve 4.6% TAT outlier, 76 tests per day and financial benefit improved from Rs. 3960-86,400/day to Rs. 8630- 1,82,400/day. To achieve the desired target, the team process mapped the work flow, identified the root cause and appropriate measures were implemented [20]. A study conducted in Nebraska Medical Center with implementation of Lean methodology in the hospital showed reduced unnecessary staff movement, laboratory specimen processing turn-around time reduced by 20% and average length of patient stay reduced from 6.29 daysto 5.72 days [12]. Better service quality can be achieved by careful streamlining the process and providing the services that adds value to end user and a satisfaction to staffs of doing efficient

The application of Lean Six Sigma in health care is still in its early stages. Appropriately implemented, Lean Six Sigma can produce benefits in terms of better Operational efficiency, cost-effectiveness and higher process

methodologies needs continuous monitoring and control measures with greater level of zeal from managers to commission the project until it achieve the expected success and scrutiny for sustainability.

6. LIMITATIONS OF THE STUDY The above paper solely concentrated on Lean Six- Sigma methodologies applied in Laboratory of healthcare sector. Though there are various department in healthcare industry where these methodologies can be implemented to eliminate non-value added times and activities. There is scope to do further research on applying these methodologies in healthcare field based on the various wastes being identified in the process of work flow and adopting appropriate tools to eliminate waste and achieve minimal defects with increased efficiency.

7. CONCLUSION

These article emphases on the importance of adopting lean six sigma in a healthcare industry to improve the quality services and its positive impact on both customer and the healthcare providers. Implementing Lean Six-Sigma in certain healthcare areas such as Operation Theater and its benefits derived are to be researched. In recent years, lean six sigma is widely accepted as it improves revenue being generated by the business and service excellence. Though challenging to implement the methodology in the all department simultaneously, undertaking a project of one unit for process improvement is advisable with eventual incorporation of the same overall to attain the planned vision and mission of quality assurance.

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