Six Sigma and Lean for Healthcare Case Studies

Six Sigma and Lean for Mammography Center’s Patients and Profitability

The Problem: Appointments not available for weeks, registration delays, inconsistent patient procedure times, delays for follow-up procedures, fluctuating staff morale, mediocre patient satisfaction, physician complaints, delays in processing reports, missing films, and a perception that costs are out of control. Do any of these sound familiar?

A community hospital decided to enhance patient experience and increase staff morale.

The Solution: They implemented a program to pursue “enterprise excellence” through Six Sigma methodologies.

  • In order to ensure the root causes to delays and rework were addressed, a multigenerational project plan with three major components was developed: stabilize, optimize, and innovate.
  • By including staff and process owners in the process, they are empowered to think differently about what they do and how they do it. A team that works collaboratively to identify problems and develop solutions can only be a positive force for any organization.

The Results:

  • Average time from calling for an appointment to the actual appointment went from 13 weeks to 3 weeks.
  • Patient’s arrival in the center to the finished diagnostic component went from 8 weeks to a single appointment.


Faster Lab Results Using Six Sigma and Lean

The Problem: A not-for-profit community medical center needed to deliver blood test results to doctors earlier in the workday.

The Solution: A Six Sigma/Lean project was initiated to deliver blood test results to doctors by 6 a.m. for critical care patients and by 7 a.m. for all other patients.

The Results: Within about six weeks, the project team implemented a new process whereby the percentage delivered by 7 a.m. increased from 68% to 98%.

Because daily measurement is necessary, maintaining results remains an ongoing effort. The laboratory process project team made progress quickly using Six Sigma and Lean, but holding the gains requires effort from the entire medical center staff every day.

Hospital Network’s Collective Effort Improves Health of Patients and Finances

The Problem: With $130 million in revenue lost to Medicare services each year, this large not-for-profit healthcare system needed to revamp its approach to care.

The Solution: Key officials convened to analyze existing practices and explore how they could be improved. The project: to better serve patients while meeting its financial challenges.

A Six Sigma approach best addressed the quality and costs of Medicare service, as it drives customer satisfaction and bottom-line results by reducing variation and waste. Six Sigma reviews can occur anywhere in the hospital environment where variation and waste have the potential to exist, and every employee is involved. Even inefficiencies at the custodial level can have a negative impact on overhead costs.

The Results:

  • Two years after tackling the Medicare issue, annual losses in the overall system have dropped from $130 million to $68 million, an overall improvement of almost 48% (ranging from 10% to 83% improvement).
  • Several hospitals in the system have gone two years without any patients contracting pneumonia and it’s been more than a year-and-a-half since any patients contracted an inline infection.

These successes have a positive impact on patient health, patient satisfaction, hospital quality ratings, and hospital costs, which in turn have a positive impact on Medicare reimbursements.

Toyota Production System/Just-in-Time for a Hospital

The Problem: To create the “hospital of the future”: serving the right patient, the right care, at the right time, in the right way, all the time (similar to just-in-time production).

The Solution: In 2001, this university medical center first applied principles of the Toyota Production System (TPS), the model for Lean, on a few beds in the surgical unit. Since the initial application on this “learning line,” the hospital has systematized the concepts into an approach to “redesign broken processes.” The approach emphasizes the plan, do, check, act (PDCA) cycle so central to TPS.

The Results: A group called the "Core Team” tracks the progress in improvement projects. The improvement methodology is being used to speed patient meal deliveries, eliminate wasted steps and paperwork from emergency room procedures, redesign nurses’ stations, improve the setup of operating rooms, and mistake proof the distribution of medicine in oncology units, among other projects.

  • Turnaround: Small tissue samples are processed, sent to a pathologist for analysis, and the results returned the same day, instead of 1 or 2 days.
  • Quality: Mistakes are discovered immediately.
  • Inventory: Stock levels were reduced by to 50% to 60%; overstocking and rush orders due to stockouts were virtually eliminated.
  • Productivity: The lab is doing the same amount of work even though attrition and transfers have decreased staff by 28%. Time needed to order inventory was cut from 8 hours weekly to minutes daily.

Hospital’s Process Changes Inspire New Workplace Culture

The Problem: Overcrowding in its emergency department (ED) indicated to one hospital that it had to change how its staff worked together and approached problems. Since earlier hospital-wide improvement efforts were generally unsuccessful, the department had developed a culture that was not only resistant, but reacted negatively to change.

The Solution: The staff began using data to drive decisions related to process changes. Positive results from the changes inspired a new workplace culture at the hospital.

  • Baseline data and value stream maps were established to determine where to focus efforts to improve patient flow and reduce length of stay—two things that would help the overcrowded ED and the frustrated staff.
  • Everybody had to learn to work together as one team for the same purpose: improving patient care.

The Results: As the workplace culture in emergency services changed and improved, so did the level of patient care.

  • The average patient walkout rate was cut by almost half, from 7% to 3.9%, during the last six months of 2007.
  • Patient satisfaction scores jumped to the 89th percentile after consistently being in the 60th percentile.

The department’s work culture continues to change, as do its leaders through constant training, planning sessions, and focus on continuous improvement.

Hospital's Six Sigma and Lean Efforts Help Patients and Bottom Line

The Problem: Pharmacy sales at a hospital in India were lower than benchmarks, despite increased outpatient flow.

The Solution: A team used DMAIC and Lean tools to tackle the problem. The resulting sustainable improvements reduced wait times, improved cycle time efficiency, and increased patient flow into the pharmacy.

The Results:

  • Cycle time efficiency increased from 10.2% to 25.3%. Compared with no patients experiencing a total buying time of 12 minutes or less before the project, the improvement efforts resulted in as many as 88.9% of patients experiencing a total buying time of 12 minutes or less.
  • Average buying time decreased from 21.10 minutes to 9.26 minutes.
  • As the word spread, patient flow into the pharmacy increased by 23%.

The advantage of Six Sigma in a smaller setting, such as a hospital, is that the project's links to organizational strategy can be short, direct, and strong. Such was the case with this project, which was initiated directly from the strategic dashboard top management uses to run the hospital.

This case study proves once again that Six Sigma methods can be successfully applied across countries and cultures irrespective of industry or sector. Best of all, it shows how a problem that was identified at the business level was actually solved at the customer level, resulting not only in benefits for customers, but also as a windfall for business.