Lean Six Sigma is thriving in healthcare, a distinct change from two decades ago, when the performance improvement methodologies were first introduced to the industry.
When Marti Beltz, a healthcare instructor with the American Society for Quality in Milwaukee, started applying Lean Six Sigma to healthcare fifteen years years ago, she says there were no books, no conferences and even no curriculum dedicated to the field. Now, there are dozens.
"Five years ago, my work was only in clinical units," Beltz said. "Now, I work in support services--revenue cycle and supply chain at hospitals--as well as medical schools, rural clinics, public health departments, rehab facilities, outpatient surgery centers, primary care and dental practices."
Organizations that have made the most progress talk in big terms about a shift from what they're doing to how they think.
The typical Lean Six Sigma healthcare project involves the standardization of processes, making sure work is done the best way every time with the fewest number of steps, Beltz said. "It increases the quality of care by reducing the errors that come with variation and waste."
Lean, which began in auto manufacturing in the 1990s, started transforming healthcare in the early 2000s. But applying manufacturing quality improvements to the healthcare environment requires a learning curve. Beltz said that, unlike manufacturing, "healthcare does not have a long history of applying statistical rigor to measure the effectiveness of operations." Yet she expects that to change, as hospital leaders "accept that processes are processes, regardless of context."
Mark Graban, author of Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement, says Lean offers an alternative to cost reduction through staff layoffs.
"Lean is different than cost cutting in the sense that Lean views cost as better safety and patient flow," he said. "If you reduce your lab time, you can release your patient faster, which improves your payment."
Healthcare leaders who embrace Lean as a management system from top to bottom can change their culture. "Organizations that have made the most progress talk in big terms about a shift from what they're doing to how they think," said Graban, who noted that mid-sized hospitals of 250 to 300 beds enjoy more Lean success than their large, academic counterparts because they're "smaller ships to turn."
According to Beltz, Lean Six Sigma can reap a 20 percent to 50 percent return on investment for hospitals. Graban agrees. He said streamlining processes that reduce central line infections "can have a huge effect on the bottom line. If you do a couple of more cases in the operating room or reduce length of stay by half a day, it can have a multi-million-dollar impact. You can reduce costs while improving quality."
Lean Six Sigma complements quality improvement efforts, such as the National Malcolm Baldrige National Quality Award. Graban said state-level Baldrige programs tell hospitals what to do, not how to do it, while Lean tells you how to meet the criteria of Baldrige.
Beltz recommends integrating Lean into a hospital-wide strategy for maximum effectiveness. She said chief financial officers (CFOs) should forge partnerships with chief medical officers to maximize quality improvements.
Ultimately, CFOs should look at the broader potential of Lean and the connection between patients, safety, satisfaction and how it flows through the organization. "The quickest way to get employees eyes to glaze over is to talk about costs," said Graban. "But when you engage and ask how to reduce wait times, harm to employees, and scores for HCAHPs [Hospital Consumer Assessment of Healthcare Providers and Systems], then people want to participate."