Healthcare Blog

20 years ago, Lean Six Sigma applications seemed only to be reserved for manufacturing companies. The methodology became synonymous with manufacturing and industries that found themselves outside of that realm found it impractical and useless to adopt lean and agile methodologies. 

However, over the years lean applications have stretched far beyond what the initial founders thought was possible. Today lean six sigma methodologies, tools, and practices are being adopted in many industries, but why? In recent decades there has been a shift to producing products and services not only in the fastest way possible but also in the most efficient way possible. Every industry has its own set of reasons why that is important. For manufacturing and production, it’s because they need to deliver higher quality products at faster rates than their competitors. For agriculture, it’s because they need to use inputs and resources wisely to avoid waste. 

One notable industry that has significantly increased its exposure to lean six sigma ideas and philosophies is healthcare. Healthcare, like all industries adopting lean six sigma ideas, has its own set of reasons for adopting the methodology.

Why Lean Six Sigma in Healthcare?

Healthcare’s adoption of lean six sigma has been so resilient that the Virginia Mason Institute embarked on its own mission to define Lean Six Sigma implementation standards and procedures for healthcare, which any hospital or clinic can adopt, and is known as the Virginia Mason Health System. 

There are three reasons why the healthcare industry has rushed to adopt lean six sigma. One reason is to reduce errors. Today, medical errors are the third leading cause of death in the United States. This statistic alone has alarmed healthcare experts and has prompted them to look for solutions.

Healthcare has also struggled with customer satisfaction. Recall the last time you went to the doctor and had to sit in a waiting room or the last time you had to wait for results, or for a consultation. These long waiting periods lead to a decrease in satisfaction, but since people need their healthcare, rarely do people complain. People also do not have the easy choice of “shopping” around for a healthcare provider and primary care physician, which means a customer does not have substitutes and is forced to conform to the needs of their healthcare provider rather than the other way around.  

The final reason for the growing need for lean six sigma in the healthcare space is workplace culture. The healthcare system has long been known to have fragmented and in some cases toxic work environments, where nurses are incentivized to stay quiet when an abnormality arises due to fear of being reprimanded. Doctors have been known to be difficult to work with, and an environment where fear guides a nurse can result in further issues which fall on the patient. 

Places that have done it right

Today we will present a well-known implementation project which many point to as a success story of lean six sigma in the healthcare industry. This project and case study was presented by Kim C. van Leeuwen and Ronald J.M and was issued by the Taylor and Francis Group. The case study follows the lean six sigma implementation at the Reinier de Graaf Health Group in Delft, Netherlands. 

The health group had to navigate difficult and policy imposed by the dutch ministry of welfare and health which placed severe budget cuts on hospitals across the nation. In addition to that, the hospital was receiving negative feedback from patients. Complaints were pouring in regarding poor health care management and an increase in health care delivery. So, the health group reacted quickly and decided to implement a not-so-obvious solution…. Lean Six Sigma.

The Define Phase

The health group first had to define what the problem was and where they were going to focus their efforts. After conversing and brainstorming the problem and scope the group decided on their objective, which would be to discover factors that influenced the length of stay for orthopedic patients undergoing total hip surgery. One of the many actions during the definition phase is to define a CTQ or a Critical to Quality metric which they identified as the length of stay for total hip surgery patients. Their job now is to shorten the length of time the patients stay in the hospital. 

The Measure Phase

The measure phase is critical. After the define phase, the health group has a focus but they need to identify what they can impact. So in this phase, the team created a cause-and-effect matrix. This matrix would map all potential factors that could influence the amount of time a pertinent stays at the hospital. They provided a table with the description of each factor:

The Analyze Phase

In the analysis phase, the team’s job was to quantify the exact amount of time that a patient spends at the hospital. To do that the team created a control chart that physically maps the length of stay at the hospital per patient. The results were the following: 

Based on this simple graph, the team was able to extract some valuable information. The first was that there were two clear outliers who managed to stay in the hospital for more than 10 days. After further investigation though, those two patients were very old and came in with other preexisting conditions and complications. 

The most profound finding from this investigation was the difference in the doctors who were performing the surgery. The group found that depending on the doctor performing the surgery the patient was subject to stay in the hospital within a range of 5 days to 8.4 days. This significant range in the surgical procedure conducted by each doctor exposed an opportunity to improve. 

The Improvement Phase

The improvement phase can prove to be a very fun activity. In this phase, the team brainstormed and implemented the improvement ideas that the team generated. One of the many factors that influenced the time of stay was the admission date. Many patients had to wait additional days if they were admitted on a day when surgeries were not to be performed. One idea was to introduce a “joint care program in which a group of patients is operated on the same day” rather than scheduling each patient individually causing an increase in the length of stay. Other improvements were made in the way the wounds were treated and the procedures each doctor take to perform the surgery. 

The Control Phase

During this phase, the team has to think of ways to sustain the changes they made. One important deliverable at this stage was to create and design a control panel that would monitor the several indicators that reveal the length of stay of each admitted patient. The control goal was to maintain an average length of stay of fewer than 5 days. The chart also included the scheduled day of discharge which “forced medical and nursing staff to take action if the discharge date was near”.  


In the end, the health group saw substantial improvement in its operations. In 2009, one year after the implementation, the average length of stay was equal to 5.1 days which was 0.5 days lower than the prior year. The improvements performed had several impacts one of which was the need for fewer personnel. Altogether the project was estimated to have a financial impact of around $110,000 annually. 

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