HealthAugust 11, 2017

Lean six sigma for healthcare quality improvement

With documented successes in business and industrial settings, Lean Six Sigma is making its mark in healthcare, too.

Lean Six Sigma is an approach to quality improvement that blends two separate, already well-established methodologies: Lean and Six Sigma. At its essence, Lean, which originated in the 1950s at Toyota Motor Corp. of Japan, targets efficiency. Six Sigma, which began at Motorola in the 1980s, zeroes in on consistency.

With documented successes in business and industrial settings, Lean Six Sigma is making its mark in healthcare, too. In just one example, researchers employing a Lean Six Sigma approach successfully reduced ICU length of stay for patients with prolonged mechanical ventilation by 24% (from 29 days to 22 days). Costs per patient dropped 27% (from $66,335 to $48,370).

“We implemented a clinical redesign intervention based on Lean Six Sigma principles,” researchers explained in the Journal for Healthcare Quality. “We identified eight distinct processes in preparing patients with prolonged mechanical ventilation for post-acute care. Our clinical redesign included reengineering daily patient care rounds to reduce variation and waste in these processes.”

Nursing informatics

In hospitals, nursing informatics professionals play a role in many efforts to improve quality and function. They develop systems to boost efficiency, replace paper-based processes with electronic ones, improve the speed and effectiveness of drug dispensing, lab testing and other services, and make sure hospital beds are open and ready when and where they need to be.

Lean Six Sigma can assist nursing informatics and other healthcare professionals in their quality improvement efforts.

Lean six sigma problem-solving

Lean Six Sigma features five steps to address a problem: define, measure, analyze, improve and control (DMAIC).

In an article in American Nurse Today, Armi S. Earlam, DNP, MPA, BSN, RN, CWOCN, wrote how her hospital decreased hospital-acquired pressure ulcers 60% in a year using Lean Six Sigma and its DMAIC method of problem-solving.

  • First, the problem was defined: certified wound, ostomy and continence nurses (CWOCNs) noticed a hospital-wide increase in pressure ulcers.
  • The CWOCNs then developed a success measure: a 20% decrease in pressure ulcers over 12 months.
  • An analysis of the problem showed the importance of staff education on pressure ulcer prevention, monthly skin champion meetings, and better availability of chair pads and specialty beds for pressure ulcer prevention.
  • Solutions to improve the situation and process were numerous and included a mandatory class on pressure ulcer prevention, monthly skin champion meetings, frequent email updates on pressure ulcer rates for each unit, special placement of chair pads within each unit, and relocation of specialty beds to make them easily accessible by each department.
  • The hospital sustains improvement control through continued pressure ulcer initiatives.


The effort paid off. Not only was the hospital’s 60% drop triple what it had aimed for, but the following year, pressure ulcers dipped an additional 30%.

“The Lean Six Sigma methodology provides a structured approach in eliminating causes of common problems encountered in the healthcare setting,” Dr. Earlam reflected. “It also fosters teamwork and involvement of the different departments and disciplines in the healthcare facility. It helps improve process flow, eliminate waste, decrease process variation, and overall it helps improve outcomes, which will ultimately improve patient care.”

Is your organization utilizing any Lean Six Sigma principles? How is it working thus far?  Leave us a comment. 

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