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Lean Six Sigma Project Examples | 17 Full Case Studies
Ready to begin your first Lean Six Sigma project? Looking for examples for inspiration or reference to get you started? Here are some project storyboards from different industries and from home. Remember, Lean Six Sigma can help you with more than just work!
- Reducing Underwriting Resubmits by Over 20%
- A Call to Change: Pioneering Lean Six Sigma at Los Angeles County
- Can Lean Six Sigma Be Applied in County Government?
- How the City of San Antonio Increased Payments for Street Maintenance Using Lean Six Sigma
- Reducing Bid Tab Creation Cycle Time by 22%
- Reducing Cycle Time for Natural Disaster Response by 50%
- Increasing First Run Parts From 60% to 90% With Lean Six Sigma
- Reducing Bent/Scratched/Damaged (BSD) Scrap for Building Envelopes
- Reducing Lead Time in Customer Replacement Part Orders by 41%
- Reducing Learning Curve Ramp for Temp Employees by 2 Weeks
- Reducing Purchase Order Lead Time by 33% Using Lean Six Sigma
- Herding Cats Using Lean Six Sigma: How to Plan for and Manage the Chaos of Parallel Processes
- Lean Six Sigma Increases Daily Meat Production by 25%
- Lean Six Sigma Helps Feed People In Need 45% Faster
- Accelerating Lean Productivity With Immersive Collaboration
- Reducing Incorrect Router Installations by 60% for Call One
- Reducing Software Bug Fix Lead Time From 25 to 15 Days
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Industries & Functions
LEAN SIX SIGMA CASE STUDIES
Our courses help organizations deliver measurable improvement results and create a Culture of Continuous Improvement.
FEATURED CASE STUDIES & SUCCESS STORIES
CASE STUDY: Improving On-Time Invoicing by 100% at Rhea Health
CASE STUDY: Lean Six Sigma Delivers 64% Improvement In Government IT Help Desk Resolution Time
CASE STUDY: Tennessee Valley Authority Closes the Budget Gap by $21M
CASE STUDY: How Lean Six Sigma Tools Improved Operations for a Development Team by 95%
CASE STUDY: Training Empowers City of San Antonio to Up its Pothole Repair Game by 480%
CASE STUDY: Saving 13 Minutes Means Saving Lives Quicker On The Battlefield
CASE STUDIES BY INDUSTRY
Case studies by function.
- Reducing Motion in the Pulmonary Function Lab by 85%
- Increasing Chronic Care Management Calls by 350% at Florida Community Health Centers (FCHC)
- Improving Practice Compliance for Pediatric Patients From 58% to 93% at Driscoll Children’s Hospital
- Improving On-Time Invoicing by 100% at Rhea Health
- Hospital Reduces 55% of Unnecessary X-Rays Using Lean Six Sigma
- How Lean Six Sigma Saved $4 Million at UC San Diego Medical Center, Featuring Lily Angelocci
- How Paymentshield, Leading Insurance Company, Uses Lean Six Sigma to Improve Efficiency by 69%
- Lean Six Sigma Saves $240,000 In Annual Warranty Claims for Food Processing Equipment Manufacturer
- First-Time Green Belts Save $2.5M at Commissary Supplier, The Keefe Group
- Lean Six Sigma Project Increases Production by 58% and Lowers Energy Costs by $263K for British Aerospace Supplier
- Call Center Uses Lean Six Sigma to Reduce Call Transfers, Boost Call Resolution and Shift the Culture
- Sheraton & Westin Hotels Improve Late Fees by 60%, Featuring Alex Filart
- Tacoma Public Schools Reduce New Employee Setup Time by 80%
- University Class Scheduling Increases Production by 56% With Savings of $226K
- Reducing Mail Packaging TimeFrom 415 to 96 Minutes, Featuring Franklin Garrett and Jared Church
- Reducing Late Approvals by 64%, Featuring Kymberly Epperson & Darlene Schlueter
- Reducing Training Preparation Time by 72% With Lynn Underwood & Matthew Helton
- Lightning Reporting – Reducing Report Lead Time From 16 to 4.5 Days With Tehseen Lazzouni
- Increasing Preschool Enrollment From 75% to 85%, Featuring Jennelle Klun
- Repurposing 2,600 Hours of Transportation Waste Toward Value-add Work With Hampton Sublett
- Reducing Classroom Incidents by 50% With Lesley Guertin
- How UC San Diego Saved 1,000 Hours a Year in the Employee Onboarding Process, Featuring Kristin Kielich
- Reducing Training Non-Compliance by 97% | Town of Oro Valley
- Reducing IT Onboarding Rework by 57% | Town of Oro Valley
- Lean Six Sigma Delivers 64% Improvement In Government IT Help Desk Resolution Time
- Lean Six Sigma Saves Kern County Probation Department $400K in Labor Hours
- Saving 13 Minutes Means Saving Lives Quicker On The Battlefield
- The City of San Antonio Improves Pothole Repair Problem by 480%
- King County Improves Lead Time by 54%
- Reducing Cost Center Addition Lead Time by 40% With Megan Rulien
- How Lean Six Sigma Reduced Travel Expense Approval Time by 94% With Eunjoo Greenhouse and Valerie Ceban
- Reducing Fund Request Lead Time From 22 Hours to 8 Hours, Featuring Chris Franco
- Reducing Payment Processing Errors at LA County by 88%, Featuring Alex Ogunji
- Streamlining Capital Delivery for the Wastewater Treatment Division With Sandy Kilroy & Bill Wilbert
- King County Improves Veteran Supplier Record Setup by 56%, Featuring Jim Shoemaker
- LA County Reduces Election Day Troubleshooting by 78%, Featuring Matt Newhouse
- Improving the Capital Design Review Process at Wastewater Treatment Division by 30%, Featuring Roger Browne
- Reducing Hiring Time From 10 Months to 36 Days, Featuring Kent James & Cassaundra Rouse
- How King County Treasury Reduced Taxpayer Late Fees by 62%, Featuring Ana Schoenecker & Laura Wilson
- Reducing Lead Time for Completing Technical Service Requests by 98%, Featuring Abigail Calderon and Jennifer Storm
- Reducing Procurement Process Lead Time by 20 Days, Featuring Kara Cuzzetto
- Decreasing Payroll Processing Time by 80%, Featuring Meghan Taylor
- Reducing Position Eligibility Review Time by 30%, Featuring Kimberly Fleming
- How the City of San Antonio Increased Payments for Street Maintenance Using Lean Six Sigma
- Tennessee Valley Authority Closes the Budget Gap by $21M Using the Power of Lean Six Sigma
- How Lean Six Sigma Tools Improved Operations for a Development Team by 95%
- Reducing Provider Payment Process Rework From 25% to 5%, Featuring Nancy Sorbo
- Increasing Enrollment in Teen Parent Program by 50% Featuring Laura D’Angelo
- Increasing Timely Discharge of Early Intervention Children From 35% to 50% With Linda Stiles
- Improving In-Kind Reporting Accuracy by 100% With Brenda MacIsaac
- Improving Grant Submission Cycle Time by an Entire Week With Amanda Booth
- Increasing Audit Processing Time by 68%, Featuring Lynne Emmons
- Improving Purchasing Process for Supplies Leads to 42% Quick Win, Featuring Angie Grabiec
- Increasing Audit Processing Throughput by Over 100% With Lynne Emmons
- Tacoma Public Schools Reduces New Employee Setup Time by 80%
- How UC San Diego Saved 2,000 Hours a Year in the Employee Onboarding Process With Kristin Kielich
- Reducing Lead Time for Completing Technical Service Requests at LA County With Abigail Calderon and Jennifer Storm
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As an instructional designer with 30 years of experience in education and adult learning, this is one of the best e-learning experiences I have had the pleasure of completing.
I thoroughly enjoyed your Green Belt course and believe it to be comprehensive and very easy to use.
We have found the resources and templates particularly valuable as we build our team and establish standard work for our projects.
After completing our Green Belt Training through GoLeanSixSigma.com, each of our Lean Six Sigma projects resulted in decreasing steps in a process, improving quality to customer satisfaction, and saved resources.
GoLeanSixSigma.com’s flexible approach to learning gives you a lot of flexibility in terms of when you can review the course material, apply what you learn and take the certification exams. This was important to our busy team. The previous training we went through was a week-long boot camp that took us away from our daily work and there was no commitment to do any project afterwards. With GoLeanSixSigma.com, we were applying the tools to a real project which solidified learning much better.
My staff and I are very happy with the Green and Black Belt programs with GoLeanSixSigma.com. The material is easy to follow and the examples around Bahama Bistro are very helpful.
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Category: Case Studies
The Cost of Customer Misalignment (& How to Fix It)
This consumer products company has a large portfolio of products. Working with key customers, the company develops and promotes brand marketing programs to help the customer improve their sales which increases the company’s revenue as well. The CEO of the company realized the percentage of successful promotions was less than he expected. At the same […]
Data Transformations Helped One Company Better Analyze Their Process Data
Normality of the data is an underlying assumption for the use of many statistical tools. When normality doesn’t exist, transforming the data may be necessary. Let’s see how one company did that.
How Design of Experiments (DOE) Helped a Pharma Company Extend Product Shelf Life
Through the use of Design of Experiments (DOE), a pharmaceutical company was able to extend the shelf life for one of its life saving liquid oncology medicines. Let’s see how this saved the company money, lowered the price of the drug and helped save lives.
Chi-Square Analysis Helped This Company Increase Sales by 8.9%
Chi-square analysis is a powerful tool for examining the relationship between variables formatted in a table. One consumer products company used it to look at its consumers in a different way, resulting in a significant increase in sales and profitability of its product portfolio. Traditionally, an organization’s sales and marketing department makes advertising decisions based […]
Using Failure Modes and Effects Analysis (FMEA) Reduced Adverse Medical Events at This Hospital
After experiencing multiple adverse medical events, one large hospital system moved from the sole use of a reactive root cause analysis approach to include a proactive Failure Modes and Effects Analysis strategy, which significantly reduced adverse medical events. As was the strategy at the time, a large tax supported public health system relied on root […]
Conjoint Analysis Helped This Company Develop a Blockbuster New Packaging Design and Sell More Product
Stop guessing what your customers value in your product or service. Use conjoint analysis to determine what features are most important to them and have the data to support your decisions. Conjoint analysis is often described as a design of experiments (DOE) for marketing. It is a structured way to help you identify and evaluate […]
Basic Six Sigma Tools Helped This Company Reduce Waste and Product Rejections
How hard can it be to make orange juice? As one large global company found out, no single Six Sigma tool will solve all the problems in an organization. However, the integration of a number of tools such as correlation, Measurement System Analysis (MSA), control charts, and process capability will help solve many of them. […]
Using Binary Logistic Regression Helped a Global Financial Company Win More Business
Let’s look at the financial division of a global conglomerate. One of its businesses was providing loans to corporate clients. Although a dominant player in the market, the company still had to compete with other organizations to provide financing and lending to myriad businesses. By using binary logistic regression to help refine its lending offers, […]
Control Charts and Employee Engagement Helped This Company Save Over $150,000 in One Year
Providing the proper organizational environment for engaging people in your continuous improvement effort will provide large benefits for your organization. In this study, we look at how the combination of using control charts and providing an environment for people engagement helped one company achieve significant financial benefits. Control charts are a powerful tool for understanding […]
Verifying Their Data With Measurement System Analysis (MSA) Saved This Company $1M
Most businesses today brag about how they make data driven decisions on important company issues. But, what if the data is not accurate or reflective of what is really going on in the company? You might be making the wrong business decisions and inadvertently costing your company lots of money. Let’s see how one company […]
How Root Cause Analysis (and Employee Engagement) Can Save Lives and Prevent Injuries
A company producing commercial ink products noticed that injury rates during one step in their manufacturing process were rising after the introduction of a new product. A Lean Six Sigma Master Black Belt (MBB) consultant was hired to help the company try to resolve this serious problem. Was there a simple solution, or would it […]
Using SIPOC-(R) to Assess Team Culture Leads to Meaningful Dialogue About Communication
Culture is the “white whale” of leadership: in Moby Dick, Captain Ahab was obsessed with capturing the white whale, and modern leaders have a similar obsession with developing organizational culture. Lean Six Sigma organizations task themselves with fostering a culture of continuous improvement (or kaizen) that draws from customer requirements, objective data and metrics, and […]
Case Study: Using RACI and Swimlane in the Pandemic
The problem: Healthcare providers needed to safely care for patients over the course of the pandemic. But how could they keep everyone safe without adequate supply of N95 masks?
Improved Rescue Time from a Bolling Mill Machine
While a Bolling mill machine creates uniform sheets of rubber with ease, it also poses a danger to an operator’s hands. Reducing rescue time and improving safety measures made for a successful Yellow Belt project in one lab.
Quick Wins Can Successfully Launch Operational Excellence in Healthcare
If the Mayo Clinic can do it, so can you! Let this case study at the medical organization’s Phoenix Transplant Center be your guide to operational excellence in healthcare settings.
Case Study: Streamlining a Hiring Process
How do you elevate a recruiting free-for-all into a standardized, efficient and well-respected process that gets new hires in the door faster? Hello, Lean Six Sigma!
Case Study: Edward Jones Adds Robotic Process Automation with Lean Six Sigma
In only three years, Edward Jones has realized more than a million dollars in cost avoidance through the use of bots combined with LSS.
Case Study: DMAIC Project Improves Hospital’s On-time Completion of Administrative Tasks
Healthcare is a heavily regulated industry and requires substantial amounts of paperwork. Paperwork may not be as pressing as patient care, but it must be done in a timely fashion. A Lean Six Sigma project reduced the task delinquency rate in its residency program.
Case Study: Reducing Purchase Order Cycle Time, Part 2
A Green Belt project aimed at reducing the cycle time for purchase orders finds the bottleneck and dramatically improves the process, exceeding the project’s original goals, and even realizes bonus benefits.
Case Study: Reducing Purchase Order Cycle Time, Part 1
Using the DMAIC methodology, a Green Belt project aims to reduce the cycle time for purchase orders and straighten up a direction-less process.
From Chaos to Order: Reinvigorating a City’s Finance Department
The City of Fayetteville, North Carolina, faced a staffing crisis in its Finance department. Thanks to a DMAIC project, in just 14 weeks the City was able to turn the department’s chaos around.
Creating Customer Delight – A Case Study in Diagnostic Clinics: Part 5 of 5
In this continuation of a multi-part case study, recurring problems are identified and eliminated at the diagnostic clinics’ newly established centralized laboratory.
Creating Customer Delight – A Case Study in Diagnostic Clinics: Part 4 of 5
This now five-part case study focuses on improving customer satisfaction at two of a company’s diagnostic clinics – Centers A and B. In Part One, the company worked at Center A to reduce patient turnaround time, a defining component of patient satisfaction. In Part Two, the chain’s improvement story focuses on increasing patient delight at […]
Case Study: Sime Darby Adds $250M with Lean Six Sigma
Who Is Sime Darby Plantation? Sime Darby Plantation is the world’s largest sustainable palm oil producer and has four areas of focus: Upstream: 248 estates and 72 mills where fresh fruit is processed into crude palm oil Downstream: Production of oils and fats, oleochemicals, biodiesel, other palm oil derivatives and renewables in 16 countries Research […]
Lean Six Sigma PM Briefcase
Lean Six Sigma Case Studies for PMOs, Program Managers, and LSS Practitioners
The studies in this section demonstrate the application of several important Lean Six Sigma principles, techniques, and methods to solve problems in real business situations.
The lean six sigma case studies focus on product engineering , manufacturing operations , and cross-functional programs.
Product Upgrade Pre-launch Out-of-Box Failure (OOBF)
Explore the use of these techniques: Why 5 Times Failure Modes, Effects, and Criticality Analysis (FMECA) Process Flow and Value Stream Mapping
Engineering Case Study
Engineering projects encompass:.
New product development On-market product enhancements Design correction for field experience problems
Production Six Sigma Quality Improvement Project
Explore the use of these techniques: Problem Definition Statement Fishbone Root Cause Analysis Turning Data into Actionable Information Corrective Action / Preventive Action (CA/PA) Statistical Process Control (SPC)
Production Operations Case Study
Production operations projects encompass:.
Expansion, quality improvement, cost reduction Automating labor-intensive processes Optimizing internal and outsourced production
Rapid Response Problem-solving on a Customer's Field Return
Explore the use of these techniques: 8D Problem-solving Framework Fishbone Root Cause Analysis Implement Corrective Action / Preventive Action (CA/PA)
Cross-Functional Program Case Study
Cross-functional program projects encompass:.
Product service actions and recalls Root cause analysis and CA/PA Market and customer responsiveness General management problem-solving
Lean Six Sigma Training Certification
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Six Sigma Project Success by Roman Benton
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Texas Department of Licensing and Regulation
June 18th, 2019
Introduction The Texas Department of Licensing and Regulation (TDLR) is a growing state agency with increasing volumes of records to manage. Previously, most of TDLR’s records were housed at one of the State’s primary storage and archive facilities. In 2012, when accounts receivable verified that the cost to store the agency’s records and documents had […]
Demonstration of Six Sigma Principles through Catalent Pharma Solutions
August 16th, 2013
Six Sigma has been used by numerous companies since 1986 when Motorola developed these principles as best practices. Customer satisfaction is increased by reducing the number of defects produced by a company. This process has been successfully implemented by major companies such as General Electric. Chief Executive Officer, Jack Welch, has made Six Sigma famous […]
Six Sigma Improves the Environment: A Look at a Baxter Manufacturing
Six Sigma best practices are instrumental in changing the way businesses operate. Motorola recognized this in the 1980s when the company employed Six Sigma principles in manufacturing processes. What began as a methodology to reduce defects in a production line has evolved into a way for all industries including healthcare, telecommunications, education, finance, military and […]
Aerospace Manufacturer Streamlines Processes and Improves Cycle Time
Six Sigma best practices were devised to eliminate the defects in processes. Motorola developed this concept to help improve processes within the company. With improved processes, increased revenue typically follows. After General Electric adopted Six Sigma principles, the company increased revenue by $300 million. This is just one example of why companies are interested in […]
3M Case Study – Pollution Prevention
August 15th, 2013
Six Sigma best practices are designed to help companies reduce the number of defects in business processes. Defects are defined as product defects or undesirable events. For instance, one company may describe excessive pollution as a defect. This is an undesirable event that should be removed to make the process more efficient. The concept of […]
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Lean Six Sigma in Healthcare: A Case Study
Author: Eduardo Amezcua, Lean Consultant, Shingo Facilitator, and Black Belt
Most examples of Lean Six Sigma projects involve manufacturing processes. This is mainly because it was developed in that environment. But LSS is a methodology that works well in a variety of industries. It is increasingly being used in healthcare to improve quality of care and save on costs.
My interest in applying Lean Six Sigma goes back to an experience I had as a college student. While I was studying for my master’s degree I had to go to the hospital. I thought it was going to be a quick stop at the ER. As you might guess my visit took longer than expected.
The staff at the hospital worked fast to gather all my personal information. Then the waiting began. After nearly two hours I was still waiting to be seen by a doctor. Eventually I needed an IV and my stay at the hospital lasted for two days. It was at this point I realized I would write my master’s thesis on applying lean in healthcare.
The healthcare industry is fascinating. There are so many processes involved in taking care of a patient that I think sometimes not even hospital management realizes the true level of complexity they face. As a patient you do not want to deal with all the paperwork involved, all the time spent waiting on test results and doctors to make decisions. Plus the food isn’t very good. You wish you could just get well and leave.
As LSS practitioners we know it is important to go to the gemba , to observe the process, and to document the process through mapping. An analysis of a detailed map helps us to understand which steps are customer value add (CVA) activities. In healthcare – as in other industries – the percent of time doing CVA activities is minimal. The waste we find in healthcare processes will really open your eyes to do tons of improvement projects.
I‘d like to share an interesting case study in healthcare where the DMAIC methodology was used to solve a challenging problem. What I enjoyed the most about this example is how staff at the hospital worked along with engineers to improve the general process directly affecting patient care.
In Italy there are around 100,000 hip prothesis surgical implant procedures performed every year. This represents a cost of €1.3 billion ($1.54B). This single procedure is a big expense in a country where healthcare is provided by the government. Healthcare costs represented 14.2% of the total public spending in Italy in 2012.
At the University Hospital ‘Federico II’ located in the city of Naples, Italy, they decided to improve their prothesis implant surgical process. They chose Lean Six Sigma as the approach to improve patient care and reduce costs. The ‘Federico II’ University is one of the oldest secular universities in Italy. The hospital has about 1,000 beds and is an important resource for southern Italy.
First, the project team was formed with hospital staff from different areas including administrative, two surgeons, and three engineers. Yes, it was a very multiskilled team.
The team started by working on the project charter. They set a goal to reduce the hospital length of stay (LOS) to less than 14 days, on average, for this procedure. A counterbalancing goal was to maintain quality of care.
Next, they began working on the SIPOC. In creating the SIPOC the team decided to focus on the CARE PROCESS which consisted of administrative services. The team decided the actual surgery itself would be out of scope. In other words, the goal was not to change how surgery is performed but to eliminate all the waste around it.
The team decided to collect historic data from 19 months of admissions to the UOC Orthopedics and Traumatology Center. This represented a total of 79 patients who had this surgery performed during this period. The data was found to be normally distributed, with an average LOS of 18.9 days.
The team decided to keep things simple. They developed a High-Level Process Map to identify value and waste. One that everybody could understand.
As part of the root cause effort the team invited other staff who played a role in the process for help. A group of nurses, physical therapists and anesthesiologists were asked to participate in a brainstorming session to determine possible reasons for the high LOS. By involving a mix of hospital staff with varying degrees of knowledge of the process they were able to get both an insider perspective and some good ‘external’ ideas.
Next, the team decided to create an Ishikawa (fishbone) diagram. Four main categories of root causes were identified:
- Hospital staff
In Figure 1, we can see the very high-level process map the team created to show process flow:
The team brainstormed on potential improvements to the process. Some of the actions chosen may sound simple, but the key is they were changing the process to improve. As part of the Analyze Phase the team determined that patients were admitted to the hospital, and then had a surgery risk assessment performed. This assessment involved examinations plus diagnostic and laboratory tests. These activities could take days to complete.
To solve this “waste” the team implemented a pre-hospitalization service. With this new approach the patient goes through all the risk assessment steps without being hospitalized, prior to the surgery.
This is analogous to applying the lean concept of SMED (i.e., 4-Step Rapid Setup) involving moving internal setup activities to external setup activities. Using this approach, the surgery itself is the internal setup. By moving pre-surgical activities and post-surgical activities to external activities the length of stay could be shortened, and patients spend less time in the hospital.
The following table mentions some of additional root causes identified and the solutions implemented which were developed as part of the Improve Phase:
The team decided to run a pilot of the improved process which incorporated these improvements, along with other actions. If we observe Figure 2, it has two stages, the first stage represents 18 months of data. The second stage represents 12 months of data after the implementations were done. The length of stay was reduced from an average of 18.9 to 10.6 days – a 44% reduction! In addition, the variation in LOS was improved, with the standard deviation going from 2.9 to 1.8 days (38% improvement).
To ensure the new, improved process was sustainable the team focused on three main areas:
- Periodical review of the implementation
- Internal audit checklist modified
- Run chart of LOS data which was updated periodically
As we can see, the hospital went beyond its original goal without compromising the heath of the patients. The average cost for a day in a hospital is €674. Assuming the same rate of implant surgeries, the estimated annual cost saving is around €260,000 ($307,000). The result obtained was great.
When you truly realize how much waste you have in your system you will surprised. But what is most gratifying – and leads to real culture change – is the satisfaction which comes from doing small improvements that have great results. Remember – Lean Six Sigma can be used in a wide variety of environments. It doesn’t matter if a product or a service process. There is always room for improvement.
Cesarelli, Mario. “Lean Six Sigma: a New Approach to the Management of Patients Undergoing Prosthetic Hip Replacement Surgery.” Journal of evaluation in clinical practice. 21.4 (2015): 662–672. Web.
More about Eduardo Amezcua:
Eduardo Amezcua’s formal background training is in Industrial Engineering with a Master in Science (Quality and Productivity) with the proficiency to help companies improving and creating a continuous improvement culture. He has done industrial engineering projects in several industries such as food processing, ceramics, printing, beverage and software. He delivers training and consulting in manufacturing and service environments. Since a young age, he worked in multicultural environments in New Zealand, Mexico and USA.
Coaching New Belts: Why, ...
LSS Lessons from Vaccine ...
About the author.
Russ is the LSS Program Manager at TMAC, and started the program in 2003. He is a Lean Six Sigma Master Black Belt with over 23 years of experience working in a wide variety of industries, and with small firms up to Fortune 500 companies. He has taught dozens of LSS classes from Yellow Belt up to Master Black Belt. He has also coached hundreds of LSS practitioners on their projects and advised managers on their LSS program. Before joining TMAC he worked at George Group, the first firm to integrate Lean and Six Sigma.