Overview

This chapter is intended for health care managers, executives and Lean Six Sigma sponsors and project leaders who are interested in learning how to eliminate waste without jeopardizing quality in health care. There is a focus on the human side, often neglected but necessary for making changes that not only last, but show respect for the workers involved. It is time to put the heart back into Lean Six Sigma.

The economy is forcing changes in health care because the system cannot sustain the rise in costs that have occurred in the past. Currently at 16% of GDP, the Congressional Budget Office is predicting this percentage will nearly double over the next 25 years – to 31% of GDP. Despite the prevailing belief that health care in the United States is the best in the world, studies show major quality deficits and startling differences in outcomes.1 Clearly, this is a wake-up call that health care systems need to eliminate waste while improving quality – a situation that is a perfect fit for Lean Six Sigma methodologies.

We present the practical strategic and methodological framework through two case examples: one in the clinical setting and one in the hospital. These examples are typical in health care, and the improvements were successful and duplicable.

This chapter will help you to:

• Learn basic rules in laying a foundation for improvement in a health care organization.
• Understand how Lean and Six Sigma work best together.
• Realize the people-side of process improvement is as important as the tools.
• Consider projects in your health care organization with ideas from the case studies presented.

Seven Basic Rules to Implement before Starting Lean Six Sigma

1. It’s got to start at the top.

Not only does it have to start at the top with buy-in, but senior executives must have ongoing involvement in the process to deliver consistent,repeated, and obvious support for the project, and make it clear to everyone in the organization that the changes are part of the new way forward. This gives the implementers the “air support” from above to make those difficult choices and changes, and it works to change the mindsets of those who don’t buy in immediately. Often, consultants will make a presentation that demonstrates how applying Lean and Six Sigma
can reduce costs by at least 30% and improve service delivery time by even more. There are many examples of this in the literature from top
companies that have started Lean Six Sigma programs: GM, Lockheed- Martin and Stanford University Hospital, to name a few. This might be enough for executives to get on board, but participation and support from the physicians is critical and more challenging. You must be ready and able to demonstrate how improvement projects will benefit both doctors and patients.

2. Hire consultants that begin by teaching Change Management.

It is impossible to make the changes necessary for lasting improvement when employees are stuck in the mindset of “this is the way we’ve always done it.” Even if you are able to convince them to try a new process, it won’t be sustainable. They will think of a thousand ways to impede it without a proper Change Management education component. It’s like teaching an adult to swim the breast stroke when all they ever knew was how to dog paddle: In times of crisis, the person will revert to what they know best, even if they know they won’t survive long.

3. Hire consultants with expertise in both Lean and Six Sigma.

Lean is a continuous improvement methodology designed to eliminate waste from a process in order to increase process speed and improve quality. Six Sigma is a continuous improvement methodology using data and statistical analysis tools with a focus on reducing defects and variation. Lean, by itself, cannot bring a process under statistical control. On the other hand, Six Sigma does not provide the tools for analyzing process flow and delay times at each activity in the process. Lean will focus on velocity in the process, separating value-added from non-value-added work while getting to the root causes of non-value-added work.2 Six Sigma will show how to recognize opportunities and eliminate defects with an emphasis on quality and Voice of the Customer (See Chapter 16 on VOC). Six Sigma has better statistical tools to help datadriven decision making and a framework for effective problem solving. Marrying these two methodologies provides the speed of Lean with the systematic analytical abilities offered by Six Sigma. This produces better solutions. It’s a one-two punch strategy for reducing process problems and identifying viable solutions.

4. Hand-pick your first group of employees to train in the process.

“Look for those informal leaders in your company. They might not be the directors or managers – although you need them involved too – but look for the people that employees admire and respect most. These are the people that others want to follow; they are the Pied Pipers of the group that will validate your efforts and form the foundation for long-term change throughout the organization. Change is difficult for many people, but if they see a colleague they believe in embracing it, they are far more likely to get on board.

5. Go for the low-hanging fruit first.

You need a few success stories early on in the process to inspire employees and management. Managers and directors have a sense of processes that they know need improvement, either because they have had customers complain, they have lost market share, or other
departments have noticed the waste. As the saying goes, success breeds success. When you have early success stories, get those stories out to
everyone in the organization. Use all of your various communication methods to make sure everyone hears about it.

6. Decide on a process to use for choosing which projects to take on, how many, and in what order.

Your consultant should help with this task. Six Sigma Black Belts can expertly identify and prioritize projects that will maximize value. Ask the consultant to assist with a “readiness scan” of the organization so that you can identify any potential roadblocks that might impede progress and take preventative steps to avoid them.3 As you put your process into action, be realistic about how many projects you can take on in a single year. Don’t hammer away at just one department. Don’t burn out your best people. When big changes are made, people will always need some time to adjust and recover before taking on another project.

7. Make the commitment to terminal process improvement.

Some people in the organization may see this process as the latest management craze and assume that if they sit and do nothing, it will go away in a year. Don’t let that happen; eliminating waste and improving process functions are not fads. The truth is that any business that wants to stay in business for the next decade must continually look at processes, ways to improve those processes, and methods to eliminate waste.

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