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Lean or Lean Six Sigma:  What are hospitals choosing for process improvement?

Tuesday, January 30 2018

You want to implement some type of process improvement at your hospital, but what kind and what’s the commitment? A survey of hospitals on Lean healthcare adoption by the American Hospital Association and the University of Berkeley found that you are not alone in wanting to explore the kind of process improvement that the manufacturing industry has relied on for decades.

Of the hospitals that responded as engaged in process-improvement transformation (N=821), about 60% were using some form of Lean, but only 11% of that group was using the combined Lean Six Sigma as their primary approach. This does not surprise Purdue Healthcare Advisors Senior Advisor for Lean Healthcare Jack Fenton, BBM, LSSGB, LGC, who has observed that, without Six Sigma, the Lean approach can be an “easier lift” for organizations with little or no continuous improvement experience. 

Because Lean and Six Sigma generally differ in their focus (Lean focusing on waste that comes from unnecessary steps in the process that do not add value; Six Sigma a deeper statistical analysis focusing on minimizing variability in a process), the Lean Six Sigma combined approach tends to be more statistics/data driven and may require more project-based work.

Both approaches, however, can require a significant time commitment from the organization depending on the scope of the work. “Lean as a stand-alone begins to embed problem solving methodologies at various levels within the hospital (executive, mid-level managers and front-line staff) through activities such as strategic planning, value stream work, rapid improvement events, and daily improvement,” said Fenton. “Once learned, these tools are pretty straight forward.”

Fenton says organizations must decide how best to set the pace for Lean implementation in order to ensure sustained results.

“We have a hospital client that is focusing Lean efforts almost exclusively on its emergency department, and will use the results of a value stream analysis to produce a Lean work plan for the next 10 months,” said Fenton. “On the other hand, we are working with a critical access hospital that has started with two Lean value streams (medical/surgical and supply chain) that will require a greater investment of time, but have the potential for increased results.”

He says Lean Six Sigma may benefit organizations after they removed their low-hanging fruit with a multi-year Lean effort. Once a hospital has matured in its Lean journey, Six Sigma can be brought in to further enhance the improvement work.


The 2017 online survey of 4,500 non-federal, short-term, acute-care medical and surgical hospitals in the United States, including pediatric general and medical hospitals, was conducted by the University of Berkeley’s Center for Lean Engagement and Research in Healthcare (CLEAR) School of Public Health and the American Hospital Association with results reported in the presentation entitled “Adoption and Implementation of Lean Philosophy, Practices and Tools in U.S. Hospitals.

Writer: Jeanine Parsch, 765-337-7047,

Tags: Process & Cost Improvement (LEAN)

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