Lean Thinking And Six Sigma For Improving Efficiency And Quality In Healthcare

Issues in the Specialized Outpatient Clinic (SOPD) of Hong Kong Adventist Hospital

Lean Thinking and Six Sigma can be looked upon to be powerful methodologies for improving the efficiency and quality in the healthcare process. Where Lean Thinking emphasizes upon delivering value to the customers, Six Sigma emphasizes upon quantifying and reducing the variation of the processes (Koning et al., 2006). Lean Thinking in a Specialized Outpatient Clinic aim at improving the patient flow together with getting rid of the waste. Six Sigma on the other hand aim at identifying and quantifying the problems that the related to the variation in the process design.

Again, it has been observed that Six Sigma does not focus upon the processor speed and so it requires more time to realize the improvements that are achieved by applying Six Sigma. The organizations on the other hand that implement Lean Thinking tend to exhibit limited improvement across the organization and this is mainly due to the absence of the organizational infrastructure (Bendell, 2006). My current workplace i.e. the Specialized Outpatient Clinic (SOPD) of Hong Kong Adventist Hospital has been observed to be suffering from issues like the patients had to wait for doctor to call their names to enter into the consultation room and they were also not informed of the queuing time. The patients also had to wait for queue for around 20 minutes to get their blood pressure monitored in triage counter before they enter into the clinic waiting lobby.

Thus, in context to the above context, it can be said that it is important for the clinic to provide enough attention to the patients as early as possible. So, if the clinic implements Lean Thinking alone to solve the issue, the process if patient flow can be fast i.e. waiting time would be minimized, however the patients would be dissatisfied due to lack of attention from the doctors and the physician. On the  other hand if the clinic implements Six Sigma alone then it might be the case that patients would have a great visit to the clinic but the medical facilities would appear to incapable of keeping up with the required number of patients (Proudlove et al., 2008). Thus, it becomes important on the part of the Specialized Outpatient Clinic (SOPD) of Rampton to adopt a combination of both Lean Thinking and Six Sigma to eliminate the limitation of each method.

Six Sigma proposes the DMAIC (Define-Measure-Analyze-Improve-Control) problem solving approach to improve the efficiency and quality of the service being delivered and regain control (DelliFraine et al., 2010). It involves the following steps:

Proposed Solutions: A Combination of Lean Thinking and Six Sigma

I am currently working at a Specialized Outpatient Clinic (SOPD) of Hong Kong Adventist Hospital. It was observed that the clinic was suffering from issues like the patients had to wait for doctor to call their names to enter into the consultation room and they were also not informed of the queuing time. Moreover, the patients also had to wait for queue for around 20 minutes to get their blood pressure monitored in triage counter before they enter into the clinic waiting lobby. Thus, the average waiting time of the patients starting from the registration process to meeting the doctor was observed to be two hours. The other issues can be listed as follows:

• Congested waiting area due to the presence of patients and relatives from different lots.
• Long waiting time for the patients to see the doctor.
• Overtime and increased work pressure for the doctors, nurses and supporting staff members.
• Patients frequently turning up at the nurse station to enquire about their sequence in the queue and thus hampered their work.
• Workplace violence and increased complaints from the patients.

Analyzing the current performance of Specialized Outpatient Clinic (SOPD) of Hong Kong Adventist Hospital, it was observed that the clinic tends to follow a manual system of providing appointment to the patients and they also do not categorize the slot. They fail to inform the patients about the arrival time of the doctors creating a chaos regarding when the doctor or the physician is going to arrive. Again, the patients are also not informed of their queue number that kept them wandering around to wait for the doctor’s call and visit the nurse station frequently to know their queue number.

It has been observed that patients have to wait for queue for around 20 minutes to get their blood pressure monitored in triage counter before they enter into the clinic waiting lobby. The average waiting time of the patients starting from the registration process to meeting the doctor was observed to be two hours. Due to ill-management of the process, the doctors, nurses and supporting staff members have to work for long hours at least two times a week. The patient complaints have also increased i.e. average of 20 complaints in a month.

Analysis of the above aspects at Specialized Outpatient Clinic (SOPD) of Hong Kong Adventist Hospital, the root cause of the problem that was identified was that the clinic still follows the traditional paper records to provide appointments to the patients. They do not have a system to differentiate the patients as per their slots i.e. lack of technology for efficiently managing the process.

In order to deal with the identified problem, the clinic needs to adopt an effective queue management system. This would be possible by installing Queue Display Management System to manage the queue and reduce the waiting time of the patients. On the other hand, in order to reduce the waiting time of the patients while getting their blood pressure monitored, two automatic blood pressure monitors can be implemented in the triage section.  

Proposed Implementation Plan

The implementation of the above systems should be standardized and should be sustained over time (Pocha, 2010). The ongoing performance should also be monitored to measure the progress of the performance and analyze whether the waiting time for the patients have been reduced or not.

Specifying Value

Implementation of the Queue Display Management System and two automatic blood pressure monitors would prove to be beneficial in reducing the manpower requirement and frequency of overtime working on the part of the staff members of Specialized Outpatient Clinic (SOPD) of Hong Kong Adventist Hospital. The above solutions would prove to be cost effective in the long run since it would reduce the overall cost of operation and lead to operational efficiency as follows:

• It would facilitate in efficiently managing the patient queues.
• The system would facilitate the patients and doctors with real time queue status information.
• It would reduce the waiting time of the patients and service delivery time.
• It would enhance the level of satisfaction on the part of the patients by implanting a fair and transparent system.
• It would make the service area less crowded with the patients.
• It would facilitate in efficiently organizing the waiting area.
• It would also reduce the complaints and workplace violence.

This is the step where the project would be undertaken to implement the Queue Display Management System and two automatic blood pressure monitors at Specialized Outpatient Clinic (SOPD) of Hong Kong Adventist Hospital by 30^th June 2017. The stages involved are:

Planning

In this phase, the project director together with the other team members would meet to take decisions regarding the specific requirements of the project together with the time within which the project need to be completed without hampering actual operations (Brandao de Souza, 2009).

Thus, it was decided upon that the project need to be completed within 2 months (8 weeks) i.e. by 30^th June 2017 and the budget that was decided upon was £750,000. These systems would be implemented to replace the traditional manual practice of managing and coordinating the patients, their appointments and queues for enhance quality service delivery.

Controlling

In this phase the systems would be implemented in stages and once the systems would be implemented it would be tested and run to analyze whether it functions efficiently or not. After the testing, if any problem is encountered it would managed by the technical team. After the implementation of the system the operators and customers would be surveyed in context to the design, usability and ease of accessibility and on the basis of the feedbacks the required changes would be made to the software to meet the specific requirements of the clinic (Shirley, 2011). After the software has been developed and tested, the infrastructure of the clinic would be developed. This would involve setting the hardware, software, internet, personal computers, display screen, token machines and speakers and automatic blood pressure monitors in order to support the functioning of the developed Queue Display Management System.

Risk Management Plan

Closing

After the installation is complete with required infrastructure development, the training would be provided to the staff members responsible for training the other staff members who would be actually operating the system. So train the trainer concept would be used. After the training, survey would be conducted to gain an insight of staff members regarding how comfortable they are while operating the system (Coplan & Masuda, 2011). After the feedbacks are collected the project would be closed and a technician would be appointed at the clinic, who would be responsible for providing any kind of assistance to the newly developed Queue Display Management System.

Activities and Time Allocated

Activities	Time (Days)
Preparation of the undertaken project	8
System Architecture design	5
Business blueprint development	10
Hardware and Software configuration	5
Authorization	4
Infrastructure development	6
Implementation of the system	8
System Testing	6
Preparing the list of the target users and organizing training program	8
Going Live	2

The mapping process would provide opportunity to the project stakeholders to visualize the big picture of the process and the system that would be implemented for the first time. The system would then be analyzed by a process improvement team that would include the representatives of all the stakeholders in the process and thus analyze whether the overall average waiting time of the patients has been reduced by at least 80% of the earlier waiting time i.e. 2 hours. Moreover, in the present system the schedulers and the clinic operators would also be provided the autonomy to schedule the patients without any consultation.    

The process and the system would be continuously monitored and efforts would be made towards continuous improvement of the system i.e. a Lean legacy.

Project Phase	Risks Involved	Strategies
Project Preparation	· There exists high probability in context to lack of coordination among the project team members. · The top management of the hospital might be much involved in the implementation of Queue Display Management System	In order to mitigate the risk, the decision would be taken in joint consultation of the project management team and the top management of the hospital (Heeks, 2006). The team members for the project would be selected on the basis of their experience, skills and their roles and responsibilities with project aim and objectives would be clearly defined.
System Architecture design	· The project team might lack the knowledge of the specific requirements of Specialized Outpatient Clinic (SOPD) of Rampton Secure Hospital. · Poor estimates (Barber, 2006)	The project team would be involved in each and every meeting starting from the planning phase to the closing phase of the project. Open communication system would be promoted so that the project leader can directly communicate about any issue and queries with the top management to prevent any kind of lack of knowledge and mismatch between the requirements and delivery of the project. The cost estimates of the project and resources would be made in consultation with project team, consultation team, suppliers and top management.
Defining authorization	· Miscommunication and biased delegation of authority among the team members.	The roles and responsibilities of the team members would be defined as per their level of expertise, skills and knowledge and it would be mandatory on the part of the team members to meet at the beginning and end of every day during the tenure of the project to keep each other updated of the progress and requirements (Cochran & Roche, 2009).
System testing	There might be a mismatch between the desired outcomes and actual outcomes.	In order to avoid the risk, the project would be monitored and each and every phase of the project would be tracked to gain the knowledge of the progress and whether objectives are being met or not.
Training	The existing staff members might face problem in operating the newly implemented system (Haimes, 2015).	Train the trainer concept of training would be adopted.
User Acceptance Testing	The staff members might not be willing to accept the change.	The staff members would be involved in the project by communicating them the benefits and advantages of the new system. Their feedbacks would be taken after completion of the every phase of the project (Cayirli et al., 2008). Their feedback would be taken regarding the ease of use of the system. This would make them feel engaged and valued thereby help in resisting the change.

Conclusion

So, it can be concluded that the above project on the part of Specialized Outpatient Clinic (SOPD) of Hong Kong Adventist Hospital would prove to be beneficial in smooth functioning of its operations that would lead to reduced cost of operation, improved service quality and reduced waiting time for the patients. Moreover, it is also important that the clinic should efficiently take into consideration the risks that it might face during the project and formulate strategies to mitigate the same.  

References 

Barber, R. (2006). Understanding internally generated risks in projects. International Journal of Project Management, 23(8), pp.584-590.

Bendell, T. (2006). A review and comparison of six sigma and the lean organisations. The TQM magazine, 18(3), 255-262.

Brandao de Souza, L. (2009). Trends and approaches in lean healthcare.Leadership in health services, 22(2), 121-139.

Cayirli, T., Veral, E., & Rosen, H. (2008). Assessment of patient classification in appointment system design. Production and Operations Management, 17(3), 338-353.

Cochran, J. K., & Roche, K. T. (2009). A multi-class queuing network analysis methodology for improving hospital emergency department performance. Computers & Operations Research, 36(5), 1497-1512.

Coplan, S., & Masuda, D. (2011). Project management for healthcare information technology. McGraw Hill Professional.

DelliFraine, J. L., Langabeer, J. R., & Nembhard, I. M. (2010). Assessing the evidence of Six Sigma and Lean in the health care industry. Quality Management in Healthcare, 19(3), 211-225.

Haimes, Y. Y. (2015). Risk modeling, assessment, and management. John Wiley & Sons.

Heeks, R. (2006). Health information systems: Failure, success and improvisation. International journal of medical informatics, 75(2), 125-137.

Koning, H., Verver, J. P., Heuvel, J., Bisgaard, S., & Does, R. J. (2006). Lean six sigma in healthcare. Journal for Healthcare Quality, 28(2), 4-11.

Pocha, C. (2010). Lean Six Sigma in health care and the challenge of implementation of Six Sigma methodologies at a Veterans Affairs Medical Center. Quality Management in Healthcare, 19(4), 312-318.

Proudlove, N., Moxham, C., & Boaden, R. (2008). Lessons for lean in healthcare from using six sigma in the NHS. Public Money and Management,28(1), 27-34.

Shirley, D. (2011). Project management for healthcare. CRC Press.