Background Increasing the value of health care delivery is a national priority, and providers face growing pressure to reduce cost while improving quality Ample opportunity exists to increase efficiency and quality simultaneously through the application of systems engineering science Objective We examined the hypothesis that Lean-based reorganization of laboratory process flow would improve laboratory turnaround times (TAT) and reduce waste in the system Methods This study was a prospective, before-after analysis of laboratory process improvement in a teaching hospital emergency department (ED) The intervention included a reorganization of laboratory sample flow based in systems engineering science and Lean methodologies, with no additional resources The primary outcome was the median TAT from sample collection to result for 6 tests previously performed in an ED kiosk Results After the intervention, median laboratory TAT decreased across most tests The greatest decreases were found in "reflex tests" performed after an initial screening test: troponin T TAT was reduced by 33 minutes (86 to 53 minutes; 99% confidence interval, 30-35 minutes) and urine sedimentation TAT by 88 minutes (117 to 29 minutes; 99% confidence interval, 87-90 minutes) In addition, troponin I TAT was reduced by 12 minutes, urinalysis by 9 minutes, and urine human chorionic gonadotropin by 10 minutes Microbiology rapid testing TAT, a "control," did not change Conclusions In this study, Lean-based reorganization of laboratory process flow significantly increased process efficiency Broader application of systems engineering science might further improve health care quality and capacity while reducing waste and cost

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Applying Lean methodologies reduces ED laboratory turnaround times

This article presents a process improvement study applied at a local paper manufacturing company based on customized Lean Six Sigma methodologies. More specifically, the DMAIC (Define, Measure, Analyze, Improve, and Control) project management methodology and various lean tools are utilized to streamline processes and enhance productivity. Two performance measures namely production rate and Overall Equipment Effectiveness (OEE) are employed to evaluate the performance of the cutting and the printing machines before and after the DMAIC cycle. Obtained results indicate that the production rate increment for printing machines by 5% and for the cutting machines by 10%. Moreover, the OEE for the printing and cutting machines has increased by 21.6% and 48.45% respectively

An Application of Customized Lean Six Sigma to Enhance Productivity at a Paper Manufacturing Company

This article presents a quality improvement study applied at a yarn manufacturing company based on six sigma methodologies. More specifically, the DMAIC (Define, Measure, Analyze, Improve, and Control) project management-methodology & various tools are utilized to streamline processes & enhance productivity. Defects rate of textile product in the yarn manufacturing process is so important in industry point of view. It plays a very important rate for the improvement of yield & financial conditions of any company. Actually defects rate causes a direct effect on the profit margin of the product & decrease the quality cost during the manufacturing of the product. By checking & inspection of defects of product at different point in production where more defects are likely to happen. A thousand defects opportunities create in the final package of yarn. That's why it is decided to do work & implement DMAIC methodology in winding departments where the final package of yarn is make. Organizations look for ways to improve their production and management processes in order to remain competitive in the market. This calls for ways to reduce production cost, enhance productivity and improve product quality. Therefore, organizations must utilize all the available resources efficiently and effectively in order to cater their customers with high quality products at a low price. For these reasons, researchers all over the world proposed several improvement strategies and tools to satisfy organization's needs. Such initiatives include Total Quality Management, Quality Awards, Total Preventive Maintenance (TPM), Lean and Six Sigma. The lean concept, which was initially referred to as the Toyota Production system, concentrates on the flow of the entire processes rather than on the optimization of individual operations (13). Womack (2002)

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An Application of DMAIC Methodology for Increasing the Yarn Quality in Textile Industry

The widespread gap between evidence and practice for clinical and preventive services argues for a deeper understanding of effective quality improvement (QI) and system change. Using implementation and system redesign sciences, we have developed and used an effective strategy to enable robust implementation of QI initiatives, including clinical practice bundles, within a health care setting. Our program, which applies Lean and systems engineering methodologies, is specifically designed to exploit the five characteristics of effective innovations, as outlined by Berwick. This strategy has been applied in over 21 hospitals (six hospital systems) throughout the State of Indiana and is currently being used as part of the Radically Reducing methicillinresistant Staphylococcus aureus (MRSA) initiative funded by the Agency for Healthcare Research and Quality (AHRQ). The benefits of the process redesign activities are detailed at the business level through a business case analysis. Additionally, benefits at the personal level are quantified through workflow analysis (prior to and following the interventions). The intervention strategy is integrated into the current quality framework for each organization to ensure compatibility with existing organizational programs. Our staff engagement, training, and educational programs make systems engineering methodologies and principles readily accessible to frontline staff. Additionally, each project session requires immediate application of tools and techniques. This article will discuss our implementation strategy, provide examples of Lean and systems engineering tool applications, and provide an assessment of spread adoption and sustainability as a function of this implementation strategy.

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Implementation of Systems Redesign: Approaches to Spread and Sustain Adoption

The healthcare sector is promoting the use of process improvement approaches
resulting in several successful improvement projects. However, evidence,
based on literature, points out that in a significant number of cases, healthcare
organisations have failed to sustain the deployment of process improvement
tools for long-term continuous improvements. Lean Six Sigma, which
incorporates the speed and impact of Lean, with the quality and variation control
of Six Sigma, is considered to have a high impact. Nevertheless, to reap the full
benefits of LSS, it is necessary to develop a systematic approach to sustain
LSS in healthcare organisations. Organisations have been shown to approach
change from only three ways: functional, operational and ad hoc, neglecting a
holistic or systemic analysis. Hence, the literature has not provided a systemic
approach to change and improvement, which also includes the assessment of
readiness for change.
Therefore the objectives are to carry out an extensive literature review and
survey to identify the reasons for organisations failing to sustain Lean Six Sigma.
A list of factors critical for successfully sustaining Lean Six Sigma are identified
and analysed using the ISM methodology. With the view to support healthcare
professionals in integrating Lean Six Sigma in their organisation, this research
develops a new framework (SLSS) to shift focus away from short term and
towards long-term improvement. Furthermore, using a semi structured interview
approach experts validate the framework. The framework will allow
professionals to pay more attention on strategically important factors when
integrating Lean Six Sigma in their organisation.
The major outcome of this research is that the relationship between CSFs is
analysed providing a distinctive view on how to handle them. Common
approaches have focused on other aspects of research and were content with
having identified CSFs, which led to the misconception that all CSFs are equally
important. Hence, this research provides a more sophisticated view on this topic.
In addition, the SLSS framework was build to fill the gap between
implementation-focused and organisational culture focused frameworks. It can
be used in conjunction with the organisation's preferred implementation
framework in order to guarantee that the strategic component is covered.

Development of a sustainable Lean Six Sigma framework in healthcare sector

In January 2005, Indiana University, Purdue University at Indianapolis (IUPUI) and PurdueCalumet were invited to partner with the Alverno Clinical Labs in adapting Lean Six Sigma methodologies for use within healthcare. Our initial project focused on optimization of lab services for the emergency department at the Saint Margaret Mercy Hospitals in Hammond, IN. This project resulted in reduction of lab test report time to the emergency department from 75 minutes to less than 35 minutes. These results have been sustained from the initial implementation to present – over 14 months. Additionally, this project has been successfully implemented across two additional hospitals lab within the Alverno-Provena Clinical Labs system. This paper will describe the partnership between IUPUI faculty and Alverno Clinical Labs in application of Lean Six Sigma techniques to optimize hospital lab services for the emergency department. Additionally, this paper will discuss the strategies and methodologies used to sustain initial results following the initial implementation and the key characteristics of successful project migration to additional hospital labs.

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Lillie Brandford

Papers

Application of Lean Six Sigma techniques to optimize hospital laboratory Emergency Department Turnaround time across a multi-hospital system