How are Lean and Six Sigma techniques used in healthcare settings? The focus for Lean is to remove waste and improve process flow. In healthcare it has beean used quite a bit in the operating room and the emergency room. Admissions and discharge, and radiology are other areas where lean has been used. Lean is also relatively popular in purchasing and information systems.

Six Sigma is a very sophisticated tool, put together in a high level way to tackle complex problems, using a fair amount of statistics. The focus for Six Sigma is reducing variation within a process. For instance, you could focus a Six Sigma project on trying to figure out why the waiting time in the ER is 2 hours and then deploy Six Sigma techniques to reduce the time. Six Sigma is also popular in the ER and the operating room, as well as in radiology, purchasing and admissions.

What kind of financial investment is required for hospitals to initiate programs like Lean and Six Sigma?
We found that the median investment for hospitals in 2007 was $25,000 for Lean and about $96,000 for Six Sigma. It was quite a bit more for Six Sigma, which reflects that Lean tends to be easier to implement.

What are some quality tips you have for hospitals?
In order to succeed, you need to think of the organization in terms of a system, linked together with interacting parts, and in order to make the system better you have to bring in these kinds of tools to change your culture. You must have good communication strategies throughout your organization, and good training strategies. You must have a consistent message and a good way of communicating that message. It’s hard work and doesn’t happen overnight.

James Levett, MD, is  chief medical officer, The Physicians' Clinic of Iowa (Cedar Rapids), and chairman, American Society for Quality's healthcare division.