Why Lean Sigma Alone Won't Get Us Where We Need To Go

Tuesday, March 24, 2015

Imagine you are getting ready to start a project to reduce ADEs, avoid unnecessary ED visits or any number of process improvement efforts. What methodology should you use? A Kaizen or Lean rapid improvement event? Six-Sigma or a DMAIC project (define, measure, analyze, improve, control)? The theory of constraints (TOC)? Process re-engineering? Something else?

What if you are taking on a bigger project such as ED throughput or hospital-wide falls, which method should you use? Hospitals and clinics have been investing in process improvement methods like those listed above (and many more) for a long time. Yet, for the most part, our processes remain broken. Lots of tools, projects and events without much lasting improvement — so what gives?

At Purdue Healthcare Advisors, we believe part of the problem has been too much focus on tools and too little focus on managing processes over time. Tools fall in and out of fashion, leaving organizations with a fragmented approach to process improvement. Process management and innovation on the other hand involve balancing cost and risk against meeting patient and staff requirements over time.

Process Innovation DiagramManaging a process over time happens in four basic steps:

  1. See the Process. Map or make visible your value stream or process, and be sure to include an understanding of what is needed to make the improvements. All the methods listed above start with mapping the current state. The symbols and tools you use are not important. The key is to use cross-functional teams, make a visual representation of the current state, and get clear on how value should be delivered.
  2. Continuous Improvement. Use PDCA (plan-do-check-act) cycles to Lean your process out by removing waste and improving flow. This is low cost, low risk and is sufficient to solve many problems. It means running multiple rapid improvement events across the process or value stream. You can focus on specific targets such as hospital-acquired conditions (error reduction) or work more systemically and create Lean flow cells and daily improvement systems.
  3. Deep Dive. If you still have not reached your improvement goal, use Six-Sigma, discrete event simulation or advanced analytics to improve your process. This involves higher cost and risk but uses science versus team knowledge to get at the root cause. This more complex effort requires project management and advanced math or computer skills. Predictive analytics is especially popular now.
  4. Rethink. If a deep dive or two is not enough to reach the improvement goal, then you will need to re-engineer using new technologies and organizational enablers. This approach can include using Lean tools (2P and 3P), Six Sigma (DFSS or design for six-sigma) and human-centered design techniques (DT) all of which start with a blank slate rather than analyzing the current process. This is high-risk, breakthrough-oriented work. It produces a brand new process which takes you back to step one (1. See the Process) to begin the cycle again. Sometimes new enablers, such as electronic health records and accountable care organizations come along and we fail to rethink when implementing them. Because it lacks a process innovation capability, our re-engineering plan can result in more complex processes rather than the hoped for improvement.

While firmly established in other industries, we are just starting to learn Process Management and Innovation in healthcare. It goes beyond Lean and Six Sigma, and it could not come at a better time. Given the dual demands of healthcare transformation and managing margins, we must continuously improve and reinvent at the same time!

Mark Clare Mark Clare, MA, MS, LSSMBB, serves as principal advisor for strategic initiatives at Purdue Healthcare Advisors. In this role, he leads PHA’s performance improvement offerings including Lean Six Sigma for Healthcare training and certification, Lean leadership and strategy, rapid improvement events and solution delivery in re-admissions, HAC, patient flow and other high-impact areas. He is a published author, patented inventor, serves as adjunct faculty at Northwestern University, and has extensive administrative and consulting experience within the healthcare industry.

Writer: Mark Clare, 765-496-6945, mclare@purdue.edu

Tags: Process & Cost Improvement (Lean)

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