Quality Management Methods

In healthcare systems, Six Sigma Process is a technique of reducing defect rates by using process improvement, product development and statistical methods. In healthcare, Six Sigma Process aims to identify the patient’s needs and addresses the types of variation in processes and in meeting these needs. A Lean Process is a concept that involves improving the process flow by eliminating waste. In healthcare, Lean Process ensures that the treatment service is delivered to the right patient and at the right time while minimizing waste and being flexible to change. 

Similarities between Six Sigma and Lean Methods

Six Sigma and Lean philosophies and concepts are built on total quality management. Six Sigma and Lean Methods produce improvements more quickly with positive effects to the bottom line. Tapping (2009) says that Six Sigma and Lean Methods are more appropriately accompanied with very user-friendly guides, allowing for greater ease of implementation. The key principle of Lean and Six Sigma Methods is the importance of stripping out process waste and cost of quality in all its forms. Lean and Six Sigma Methods provide resources, coaching and training in methods of process waste identification and flow improvement techniques (Hoerl & Gardner, 2010).

The advantages of both Six Sigma and Lean Methods in healthcare can be argued, based on organizational culture, needs and personal experience. Hoerl and Gardner (2010) noted that many healthcare organizations have successfully implemented Six Sigma and improved its quality. Both, Lean and Six Sigma Methods effectively minimize process variation and can work very well together or independent of each other (Hoerl & Gardner, 2010). Both, Lean and Six Sigma Methods are beneficial to healthcare. The benefits include improvement in clinical outcomes, care process, increased throughput, reduced waiting times and medication errors. 

Lean and Six Sigma Methods experience greater success than TQM, because they ensure improved clinical outcomes, customer satisfaction, reduced cycle and lead times. Both approaches of quality improvement are essential, because they are enable to reduce production and overhead cost, besides ensuring safer work environments, especially for nurses and other physicians (Dahlgaard & Per-Olaf, 2007).   

Differences between Six Sigma and Lean Methods

Although, Six Sigma and Lean Methods have many similarities, there are major differences that make each unique. Tapping (2009) says that Six Sigma and Lean Methods are both very effective means to improve quality, but have different approaches to get the job done. While Six Sigma Method takes longer duration to complete project, Lean Method takes relatively short duration for eliminating waste (Hoerl & Gardner, 2010). On the other hand, Six Sigma Method requires extensive training for individuals to attain certifications, while Lean Method takes less extensive training for learning, implementation and maintenance.

With Six Sigma Method, healthcare projects are more narrowly focused and are highly recommended to have a direct correlation to strategic priorities and bottom line results. Hoerl and Gardner (2010) say that the application of Six Sigma Method in healthcare system is proven more difficult than the application of Lean Method. This is because it is often difficult to directly correlate a clinical process with a bottom line result and obtain the data, required to continuously monitor for clinical process improvements through an empowered staff (Nold, 2011). Lean Method, on the other hand, has successfully and quickly been implemented in all areas of healthcare system, but also in bottom line and strategic implications, while engaging the staff.

Quality improvements, made while utilizing Lean concepts, positively impact all areas of healthcare system, including safety, patient/customer satisfaction, employee satisfaction and clinical outcomes. Tapping (2009) says that, while using Lean Method, patients are more satisfied with the decreased wait times, reduction of duplicate documentation and fewer errors. The elimination of waste impacts the bottom line results in hospitals by decreasing the number of required resources to complete the same amount of work such as attending to one patient (Nold, 2011).

Unique Contributions to Quality of Six Sigma and Lean Methods

Six Sigma Method futures in healthcare system are far from bleak. Feng and Antony (2010) say that on the basis that consumers become better informed, healthcare system providers must commit to achieve excellence in every aspect of the care delivered. Hoerl and Gardner (2010) argues that the use if Six Sigma Method brings fundamental strategies, which allow other healthcare organizations to be built on prior success, sharing information and knowledge to ascertain all patients’ safety and deliver a healthcare experience, defined by excellence.

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Lean Method is fully focused on adding value to patients in healthcare organizations. The use of Lean approach provides a strict criterion for determining value (Dahlgaard & Per-Olaf, 2007). It is important to note that many of the improvements that come with Lean Method implementation also benefit virtually the entire healthcare workforce (Pulakanam, 2012). Employees are able to enjoy greater work efficiencies as well as the pleasure for greater responsiveness to patient needs. Lean approach among healthcare staff, such as physicians, ensure that they experience the greatest gains in efficiency and quality of caring for patients (Pulakanam, 2012).

The use of Six Sigma Method addresses quality during the delivery of healthcare by integrating patient care and safety improvements. It is important to note that quality in Six Sigma Method addressed through efficiencies and efficacy by checking that the right things are being done at the right cost. Pulakanam (2012) noted that Six Sigma Method is an operational approach to evidence, based medicine and risk management. The use of Six Sigma Method ensures that staff in healthcare facilities obtains the skills and knowledge, required to administer both the quality and healthcare cost (Pulakanam, 2012).

Patient Care Setting

Lean quality improvement process is widely applied in ambulatory care. Lean concepts and tools can be used in ambulatory care setting to deliver high-quality cost-effective care (Feng and Antony, 2010). Since the some of ambulatory care visits are for non-illness or non-injury conditions, such as routine check-ups and pregnancy examinations, Lean Process improvement can be used to create a standard process for following up on laboratory tests and X-rays to enhance patient satisfaction. Dahlgaard & Per-Olaf (2007) says that the implementation of Lean Process improvements in ambulatory care setting leads to fewer defects, safer care and high-quality evidence based care for patients every day.

Lean quality improvement in ambulatory care eliminates the sign-in sheet and allows registers to enter arrivals directly into the hospital management system (Dahlgaard and Per-Olaf, 2007). It helps hospitals to adopt a standard procedure for preparing charts before a patient’s arrival. Feng and Antony (2010) argues that the implementation of Lean Process improvement enables the hospital to establish a permanent location for frequently needed instruments and supplies within the examination room. Feng and Antony (2010) noted that Lean concepts are applied to clinics to improve flow, reduce errors and re-work, eliminate waste and add value to the patient clinic experience.  

Six Sigma quality improve process is used in emergency departments in healthcare settings. Wheeler, Wong and Shanley (2007) say that Six Sigma Methodology can be used to measure and improve both operational and service related performance. For example, in healthcare setting, Six Sigma Method has been used to improve the emergency department to bed wait times. In emergency departments it could also be used in PICU to improve events, such as unintended intubations, bloodstream infections or even the timeliness of transfers from the PICU to the ward (Wong & Shanley, 2007).

Optimizing patient services in emergency department requires a combination of well-trained and dedicated personnel, cutting edge technology and a thoughtful examination of workflow, processes and productivity. The implementation of Six Sigma Method in emergency care settings helps to reduce emergency room diversions, ensure fewer errors in operating rooms’ cart materials, reduces bloodstream infections in an ICU and ensures improved radiology turnaround time.  

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The Preferential Approach

Lean quality improvement approach is more appropriate for healthcare settings. This is because improving a healthcare system to make it leaner requires identifying and eliminating one or more waste categories, such as errors, excessive waiting, inventory inefficiency and unnecessary motion (Feng and Antony, 2010). The Lean approach should be implemented first in order eliminate waste, improve flow, reduce waits, decrease costs and eliminate errors.

Healthcare organizations often do not start with applying Six Sigma Method tools for process improvement, as the processes are filled with waste and a significant amount of inconsistency (Feng and Antony, 2010). In order to attain the greatest impact toward improving the process, Lean concepts are applied first, so as to eliminate waste and streamline processes and then to apply Six Sigma Method tools to reduce variation. While Lean quality improvement approach can be successful without statistics, Six Sigma Method relies heavily on statistical methods. In addition, Six Sigma approach is a sophisticated problem solving approach, which utilizes complex tools and it is more difficult to teach, understand and implement it.

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