Magazine article American Nurse Today

The Power of Lean Six Sigma

Magazine article American Nurse Today

The Power of Lean Six Sigma

Article excerpt

Lean and Six Sigma are well-established quality improvement tools. Combining the two creates a synergistic effect, boosting effectiveness. In the hospital where I work, we used Lean Six Sigma to reduce hospital acquired pressure ulcers (HAPU) by 60%. In this article, I answer common questions related to these tools so you can apply them in your own organizations.

What is Lean?

Lean Thinking, Lean Methodology, Lean Management, or simply Lean is an integrated system of principles, practices, tools, and techniques that aim to eliminate waste, decrease production time, and improve process efficiency.

Lean originated with Toyota Motor Corporation of Japan where it was developed as a tool for improvement. It serves as a framework for management to ensure the greatest value for customers while maximizing the resources used. Its strengths lie in engaging front-line employees to develop standardized solutions to common problems, and its focus on the customer.

What is Six Sigma?

Six Sigma was introduced by Motorola in 1987 and further developed by General Electric in the 1990s. The term Six Sigma traces its roots to statistics. In the early 19th century, Carl Frederic Gauss introduced the concept of the normal curve. Yes, the ubiquitous figure in all statistics books--the bell-shaped curve. Because Six Sigma is a continuous improvement methodology focused on decreasing variation, six sigma ([sigma]) stands for the standard deviations to the left and the right of the mean (average) in the graph. See the graph ( that statistically represents Six Sigma.

Six Sigma emphasizes that the less deviation from the mean the better. Its strengths lie in its emphasis on organizational infrastructure, deployment plans, analytical tools (including statistics), quality improvement, and controls.

Six Sigma aims to identify and correct the causes of errors, thereby reducing the rate to Six Sigma level, that is 3.4 defects per million opportunities (DPMO). Simply stated, a Six Sigma process has a 99.99966% defect-free rate.

In a 2010 article, Sedlack and colleagues stated that the literature reports an incidence of bile duct injury during laparoscopic cholecystectomy of 1 per 1,500, which represents an error rate of 95 DPMO. When the authors compared that error level to the aviation industry's level, it translates to 20 commercial airplane crashes daily in the United States! The aviation industry would have no tolerance for this number of crashes. The public would protest if this happens and no one would want to get on a plane. Obviously, healthcare needs to lessen or eliminate its errors.

What is Lean Six Sigma?

Lean Six Sigma (LSS) combines the strengths of two quality improvement methodologies. Its goals are to create robust processes, uphold quality culture, improve metrics, and increase customer satisfaction. It helps an organization produce goods and services efficiently, with less waste and less variability, using resources efficiently without compromising quality.

Strengths of the hybrid include:

* engagement of frontline staff

* customer focus

* commitment of management

* process improvements

* interdepartmental or interdisciplinary involvement

* teamwork

* productivity/cost saving benefit

* dedicated and structured approach

* error and waste reduction/elimination. …

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