How Lean Six Sigma is helping hospital emergency rooms

It’s no secret that the use of Lean Six Sigma has spread to the healthcare sector.  Hospitals around the world now use some form of process improvement technique to streamline their internal processes.

The role of Process Improvement Advisor and Healthcare Process Analyst has grown 200% in the past five years as hospitals look to eliminate waste from their processes.  Often certified as Lean Six Sigma Black Belt’s, the specialists works directly with front-line staff and leaders to improve and sustain processes to provide high-quality, safe, and efficient patient care. They work to meet process objectives that are aligned with organizational goals. They are collaborators, facilitators, teachers and mentors for process improvement initiatives in partnership with clinical and non-clinical team leaders.

hospital emergency room

Lean Six Sigma in hospital emergency rooms

Emergency rooms bring a unique challenge to process improvement.  The goal of an emergency room is to save lives; financial considerations are often left to resolve later.  With proper planning however, Lean Six Sigma tools can be used to improve the emergency rooms in hospitals around the world.  Here are three tools every emergency room should use in its decision-making.

5S Quality

5S, and its safety-focused offshoot 6S, focuses on tidiness.  The goal of 5S is to ensure the least amount of movement and the most efficient use of tools and procedures.  Originally used in the manufacturing industry, the healthcare industry quickly realized its adaptation was also suitable for the clinical setting.

5S uses Sort, Straighten, Shine, Standardize and Sustain, breaks down each department, and analyzes its processes.  In an emergency room, administrators can check to see that all required emergency equipment is placed bedside or in a centralized location.

Hoshin Kanri

Hoshin Kanri, or strategy deployment, are complicated words to describe a very simple concept: breakthrough initiatives to improve the health of patients. It can be likened to the way that the point of a compass always points towards the North Pole.

Hoshin Kanri infographic

Hoshin Kanri operates at two levels:

The strategic planning level and the daily management level.

In the daily management level, it addresses the more routine aspects of business operations.  Hoshin Kanri can be thought of as the application of Deming’s Plan-Do-Check-Act (PDCA) cycle to the management process.  The PDCA cycle represents a generic approach to continuous improvement of activities and processes.

Organizations interested in implementing Hoshin need to have established concepts, tools and methods associated with quality management, including:

  • View work activities/duties as a series of work processes.
  • Empower those closest to the work (and external customers) with the authority to make decisions related to their work.
  • Align all employees around the organizational goals and priorities.
  • Believe that people are naturally “good” and want to do a good job.
  • Continual improvement of products, services and work processes.
  • Use regularly quality improvement tools and methods.

Recognize the interdependency among people and functions that necessitate a team approach to work and problem solving.

Statistical Process Control (SPC)

For Six Sigma projects, the goal is to maintain statistical process control (SPC).  The measures most commonly used include:

  • The Sigma level
  • The Rolled Throughput Yield (RTY)
  • Defects per Unit (DPU)
  • Defects per Million Opportunities (DPMO)
  • The First Pass Yield (FPY)


Consequential metrics are both business and process metrics. Consequential metrics measure anything that goes wrong as a result of improving the primary metric. The negative consequences are called consequential metrics.

Statistical Process Control is used to monitor processes and may be applied to production or business processes.  Statistical Process Control uses statistical methods to ensure that the process is stable and monitor the processes for timely identification of special causes.  All processes are subject to variation.

In a hospital emergency room, doctors and nurses don’t time to focus on SPC, but administrators do.  Every aspect of a patient’s emergency visit can be analyzed, from admission to discharge.

Explaining the benefits of Lean Six Sigma and 5S to hospital administrators

The benefits of Lean Six Sigma in healthcare may be obvious to some, but many hospital administrators will need to be convinced about its effectiveness.  Management in healthcare relies heavily on quality data, not promises.  The decision-making process is based on data analysis obtained over months, if not years.

When approaching hospital management about implementing Lean Six Sigma, it’s often best to start with smaller department-wide implementation.  A shorter Kaizen Sprint can be implemented within the emergency room first.  This will allow staff and management to see quick benefits that appear in weeks, not months.

Focus primarily on clinical outcomes, not financial.  Discuss how Lean Six Sigma can improve quality and safety performance in areas such as readmissions, sepsis, hospital-acquired infections, venous thromboembolism, ventilator-associated events, falls, opioids, behavioral health and more.  Help management to interpret data, such as performance on clinical quality measures, and provide guidance on identifying and prioritizing opportunities for improvement.