Essay on Utilizing Lean Six Sigma in a Healthcare Setting

The year 2001 was a turning point for the healthcare system from an extended period of silence over medical errors with the release of to Err is Human, a report by the Institute of Medicine(IOM). This report broke the silence by providing shocking statistics on medical errors and their costs to the US healthcare system. For example, the report mentioned that over 98,000 died as a result of medical errors annually, with apparently 58% of the errors being much preventable. Over the next years from 2000, research on how to curb or reduce medical errors and associated cost followed, but with little success. It is because a later study by McFadden, et al. (2015) would reveal that an approximated 400,000 medical errors occur annually, costing America about $17 billion. So, what could probably be the hurdle toward meeting research goals on reducing a number of medical errors is wrong philosophy and methodology to achieve efficiency in healthcare settings. It is where lean management and lean production as a technique comes in.

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As research turns more on improving patient safety, it is fortunate that lean production is gaining focus as a way to make this remarkable turnaround for the many interested healthcare organizations (Lorden, et al., 2014). Lean production, which is linked mostly to the manufacturing industry, aims to eliminate waste in plant operations and improve on value adding activities (Arthur, 2013). In the end, the value available to the customer is greatly improved, and it is the dream of every business: leveraging value out of business processes and operations. It is also true that the applicability of lean in the healthcare settings has been questioned in the past. There are varying views on why it is may be specifically hard to apply lean production in the context of healthcare facilities. Safe and effective care is the aim of every healthcare professional who are accorded the privilege of autonomous decision-making (Bhamu & Sangwan, 2014). However, some argue this autonomous capability may be limited by standardization of processes and reduction of waste as suggested by a lean management approach (Graban, 2011). Another group of researchers reports on complaints from the nursing fraternity over time required to train healthcare workers on lean production and related activities. Resistance to change is also a widely cited drawback for the implementation of lean in healthcare settings. Apparently, this resistance comes from healthcare employees who do not want to change how they perform their duties and equally from managers who do not want to give up control to front-line workers. These reasons and more warrant a clarification on how exactly lean production could be applied in a healthcare setting effectively by incorporating related factors and principles of six sigma and goal specificity.

Lean management or production focuses primarily on the elimination of waste, a goal which a healthcare organization must surpass to realize value for its customers (DelliFraine, et al., 2013). For this to be achieved, healthcare managers must endeavor to link lean to patient responsiveness, and for this, two critical factors come into play; Six Sigma and goal specificity. Fortunately, healthcare organizations implement lean, Six Sigma and goal-setting, and unfortunately, they do so in disassociation. Each of the principles is applied in isolation of the other because of lack of understanding of the possible relationship among them. This is the focus of this paper, to examine and expound on the association between lean management, Six Sigma, and goal specificity, and how the three can work together to improve patient safety among other deliverables in a healthcare setting.

History of Lean Six Sigma

A bit of history of Lean Production and Six Sigma would be essential to establish the foundation for leveraging each of these in theory and application in practice. The roots of lean production can be traced to 1947 with Eiji Toyoda's tour of the United States and Taiichi Ohno's crowning of the lean production concept. During this time, Ford Motors had managed a great feat with approximately 7,000 cars a day from its manufacturing facilities. Toyoda could not imagine this against his company's, Toyota Motors Corporation, 13-year record of 2,685 cars (Bhamu & Sangwan, 2014). It was quite a challenge, not on the approach and methodology used, but how much this 1950s - 1980s giant managed. Toyota was not impressed by the idea of mass production applied to Ford and other auto firms in the US, particularly about the high level of waste it resulted in. Instead, during this tour, he noticed something with US supermarkets, where shelves were filled only when emptied by buyers. According to Mcfadden et al. (2015), it was the birth of the idea of lean production, which initially became known as Toyota Production System(TPS). In this system, the focus was on eliminating all wastes from processes and engaging only in those activities that added value to the final product. Thus, production shifted from mass production (that was even much harder to implement in Japan due to demographic, environmental and cultural differences) to lean production that focused on meeting customer quality needs using minimal resources (Bhamu & Sangwan, 2014). Today, Toyota remains a global leader in the automotive industry with substantial revenue and improving performance across all key markets courtesy of lean production or, as it is commonly known to Toyota employees, Just-In-Time(JIT) or Kanban System.

Six Sigma, on the other hand, is an implementation of a continuous improvement approach to ensure organization-wide improvement. First implemented in 1987 by Motorola, Six Sigma is widely applied across industries, with higher Six Sigma always meaning higher performance. A 3 Sigma Process, for instance, produce approximately 6.7% of defects in every million opportunities while Six Sigma does give only 3.4 defects per a million opportunities (McFadden, et al., 2015).

Literature Review

In the preceding, it remains unclear how lean and Six Sigma are related. Also, the relationship between lean production and goal specificity remain obscure. This section reviews past studies examining these relationships with an attempt to examine relations and their applicability in practice. This will help to provide a better understanding of how lean production, Six Sigma, and additionally goal specificity can be implemented together to improve patient safety, for instance, in a healthcare system.

Relationship Between Lean and Six Sigma

It is clearly from the foregoing sections that lean production originated from Japan with Toyota Production System, and first implemented in the US. The first implementation of Six Sigma was in the US where it was conceived by Motorola in 1987. Beyond this, there are more similarities between the two process improvement initiates emanating from the manufacturing industry. For instance, according to Bhamu & Sangwan (2014), both initiatives involve the use of data and analytical tools and application of logical problem-solving strategies to improve the quality of output in a system. Moreover, the initiatives have since found broad applicability beyond the manufacturing sector into service and public sectors.

Differences remain and are critical in understanding how, when and why each initiative should be adopted in a system or organization. To begin with, lean makes use of the quantitative approach to optimize process flow while Six Sigma utilizes advanced statistical methods to, first, identify process variations and second, to eliminate these with the aim of improving quality (Easton & Rosenzweig, 2012). In a healthcare setting, for instance, Six Sigma allows the use of highly structured methodologies such as DMAIC (Define, Measure, Analyze, Improve and Control) in care facilities' acquisition, dissemination, and use of knowledge in a talent pool to improve patient outcome. The difference in methodologies could also be attributed to the fact that lean and Six Sigma tackle different problem types. Evans & Lindsay (2014) indicate that while lean production is associated with management of more visible processes and operations including material flow, safety, and inventory, Six Sigma helps in the management of less visible processes, an example of process variations mentioned earlier. Furthermore, Six Sigma focuses on keeping processes precise, accurate, and effective as lean pay close attention to speed and efficiency of these processes. Additionally, lean can be said to enable support and facilitation through self-directed teams of employees while Six Sigma assumes the active role of selection of project champions by financial goals and business strategy (Bhamu & Sangwan, 2014). All in all, both initiatives help in internal production process management for quality output with cost and process efficiency.

Relationship Between Lean and Goal Specificity

Goal-setting is a priority undertaking for all organizations. It forms the core of any business strategy (Field, et al., 2014). Not all goal-setting approaches guarantee success. Goal specificity is an important aspect of this exercise and refers to the extent to which a goal has been properly and clearly defined, articulated, and even well understood by the workforce (McFadden, et al., 2015). Goal specificity brings the advantage of greater focus and participation by employees while also enhancing their self-discipline and job satisfaction. Research consistently shows that clear goal definition and prioritization directly improves job performance across industries. With this basic understanding of goal specificity from the goal-setting theory of management, it is clear that goal specificity adds value to the implementation of lean management and Six Sigma by establishing a foundation for these initiatives.

However, linking of goal specificity to either lean or Six Sigma is still at infancy regarding coverage in research. These researches that date back to early 2000s show that, in the manufacturing sector, clear articulation of Six Sigma goals into the continuous improvement initiative helps to improve the performance of firms in this industry. For this, Linderman, Schroeder, and Choo (as quoted in McFadden, et al., 2015) reported that project teams must consistently apply tools and methods associated with Six Sigma. Otherwise, the positive correlation with performance may not be realized. McFadden, et al. (2015) make it clear that successful implementation of Six Sigma in the healthcare setting relies on the clear definition of goals, thus goal specificity. The current body of research do not provide sufficient evidence on how the programs described impact in the goal-setting initiatives of various hospital units. The most recent goal setting related program for hospital units is certainly CUSP that Peter Pronovost developed in 2001 (McFadden, 2015). This program has eight steps in total, of which goal setting and evidence-based practice are part. This goal setting initiative has been adopted by many hospitals in the US specifically for the ICUs where it has dynamically revolutionized care delivery, enhancing patient safety. However, it remains unclear how this is linked to lean management, because at the moment, implementation is done independently of each other.

Application of Lean Six Sigma in Healthcare

As mentioned earlier on, according to the report by IOM, To Err is Human, prompted a rigorous research on best practices to gradually reduce and eventually eliminate medical errors from healthcare settings. Adding to the healthcare reforms that now put emphasis on the need to improve the quality of care and patient safety while reducing cost, pressure...