Written by Jay Arthur and published by McGraw-Hill, this book is a welcomed addition to the long list of books covering the Lean Six Sigma methodology. Six Sigma has penetrated so many industries since it was originally conceived. Once relegated to the manufacturing line, Lean and Six Sigma methods have now greatly enhanced the operational workflow of many industries, including healthcare. MSI is so glad to see a book that discusses the benefits that Lean Six Sigma can bring to the healthcare industry. Let’s take a deep-dive into this book and she what it brings to the table.
Chapter 1, Simple Steps to a Faster Hospital
This book gets to the heart of Lean Six Sigma in Hospitals immediately by saying that the goal is to accelerate the patient’s experience. This is so true! One of the first paragraphs states: “One of the key principles of Lean thinking is to eliminate delays that consume up to 95 percent of the total cycle time (57 minutes per hour). If you’ve ever been a patient in a hospital emergency room (ER) or nursing unit bed, you know that there are lots of delays. Over the years, healthcare has made tremendous strides in reducing cycle time in various aspects of care. Outpatient surgeries are one example: Arrive in the morning, and leave in the afternoon. No bed required. But there is still lots of room for improvement.”
“Faster in Five Days” is the motto of this chapter. A faster emergency department, faster door-to-balloon (D2B or DTB) time, a faster operating room, faster medical imaging, and a faster lab. All of this can be accomplished with Six Sigma. The book makes a very good point when they say “Every department—ED, ICU, nursing floor, radiology, lab, housekeeping, and bed management; all think that it is doing the best job it can. Everyone is working hard, everyone wants to do a good job, but:
The fact is, current hospital management practices discourage accelerating patient flow.”
Chapter 2, Lean for Accelerated Patient Flow
Chapter 3, Simple Steps to a Better Hospital
Chapter 4, Reducing Defects with Six Sigma
The next chapter we look at is Chapter 4, where the book starts to look at Six Sigma concepts. The chapter starts by discussing the low-hanging fruit that often slows an organization down. The topic of quality improvement is so important in the healthcare industry. The low-hanging fruit is usually visible everywhere from the emergency department to the management conference room. When it’s that visible, anyone can pluck it with a little common sense and a bit of trial and error. This particular book doesn’t cover the concept of a Gemba walk, but essentially it’s describing one. Walking to each department and visually inspecting it for errors or operational inefficiencies.
The remainder of this chapter covers the subjects you’d expect: DMAIC (calling it duh-maic”, something we really hate at the Management and Strategy Institute), Control charts—to measure customers’ critical-to-quality (CTQ) requirements, Pareto charts—to focus the root-cause analysis, Fishbone (Ishikawa), Eliminating “Never Events”, Geometric-Mean Chart—g Chart (rarely covered) and Root-Cause Analysis.
Chapter 5, Simple Steps to a Cheaper (More Profitable) Hospital
Initially we were going to skip this chapter in our review, but lets face it, this is really what hospitals want to know. If you’re reading this book and already have Lean Six Sigma experience, it may be the only chapter you read. The chapter starts with the following paragraph: “It should come as no surprise that a faster, better hospital will be cheaper to operate and more profitable. When you’re not dealing with all the delays in the emergency department (ED)–admission–discharge process, fewer patients will be boarded in the ED, reducing diversion and patients who leave without being seen (LWOBS). More patients can be seen more quickly, increasing revenue. When you’re not dealing with the extra costs of preventable falls, infections, and medication errors, it will make the hospital more cost-effective and profitable.” The goal is profitability. Even non-profit hospitals need to cover the bills. The book advises hospital administrators to count and categorize your misses, mistakes, and errors. Start by fixing the biggest category first. Finally, verify results. Without saying it, it almost seems like the book is recommending Kaizen events at the department level to highlight small-waste issues. They use a log of Pareto-chart examples in this section, making it very easy for the reader to understand. While this chapter isn’t very long (16 pages), it is a chapter you’ll want to be sure to read.
Chapter 6, Six Sigma for Hospitals
Chapter 7, Excel Power Tools for Lean Six Sigma (Yay! A Six Sigma book that covers Excel, not expensive statistical software!)
Chapter 8, Is There an Improvement Project in My Data?
Deep-diving in data, this is our favorite part of Six Sigma. We’ll be honest, the book isn’t heavy on statistics. That’s probably a good thing, if you work in a hospital you probably aren’t interested in becoming a statistical mathematician. The book covers just enough of the key topics to make you understand Lean Six Sigma’s power in healthcare. Like the previous chapter, this chapter covers a lot more information on Microsoft Excel. Using pivot tables to sort data and creating Pareto charts. If you won’t be using Excel for your Six Sigma project, you can skip this chapter.
Chapter 9, Sustaining Improvement
Chapter 10, Laser-Focused Process Innovation
Chapter 11, Statistical Tools for Lean Six Sigma (Deeper into statistics than chapter 8, but still readable for the average practitioner.)
Chapter 12, Implementing Lean Six Sigma in Hospitals
This book will help you prepare for the following certifications: