Lean Six Sigma (LSS) is a combination of two process improvement methods. Lean is a system that works to eliminate waste, making processes faster and simpler to follow; it is about doing more with less and speeding things up. Six Sigma reduces process variation; it is about consistency. When combined to create LSS, business processes can be improved through faster methods and better quality, which lead to increased customer satisfaction, cost-savings, and improved employee morale. Perhaps most important, LSS can shift the way in which problems are handled and make them go from reactive repair to proactive prevention.
We often hear about LSS as a concept. But how does it apply to our daily supply chain activities? I’ve outlined the key principles of LSS and how you can incorporate them into your department’s operations.
Focus on and understand your customer
The supply chain customer really includes everyone who is affected by a piece of equipment or product—from the clinicians, finance, ancillary staff, and other support areas to the patients. Although our day-to-day tasks might not always seem like they involve actually caring for patients, the work we do in supply chain directly supports the efforts of caregivers.
The health of our communities is paramount. Keeping patients healthy also has financial implications for our organizations: A substantial portion of healthcare reimbursements are tied to the quality of the patient (customer) experience. The supply chain professional is key to maximizing this value. By communicating with physician, nurse, and finance colleagues (who are also our customers) and listening to their concerns, we can make better, value-based purchasing decisions, and in turn, deliver better care to our patients.
Identify and understand how the work gets done
We should all have a solid understanding of how the supply chain impacts the efficiency of virtually everything in the hospital. But how do we truly understand the value of our decisions and the impact they have on other areas of the hospital? We must map the value stream (i.e., lay out every point in the process), from contracting to requisition, from distribution to inventory stockrooms and par areas, and from clinical end-user to sterile reprocessing (a lean management method). We can no longer afford to work in a vacuum, strategically or financially. Understanding how and why we select products—factoring in the clinical and financial perspective—enables us to make better decisions. Further, it is vitally important to reframe our processes and consider how item A influences the outcome for a patient versus item B. We are already leaders in change management and process mapping. We must become leaders in value as well.
Manage, improve, and smooth process flow
Hospital staff members are being asked to work together in new ways. Because supply chain touches all areas of the hospital, it is uniquely positioned to lead process improvements, not only within the supply chain, but in other areas as well. When a value stream has been mapped, we can look at each point and make amendments. For example, the way in which inventory management is handled has a direct impact on patient throughput. How can we better work with the nursing staff to make this process most efficient? Keep in mind that LSS is all about ongoing improvement. Don’t be discouraged if successes take time—continue to pay attention, have the right conversations, refine, and improve.
Remove unnecessary steps and waste; reduce variation.
Waste and variation can take the form of time, supplies, or processes. Whatever form they take, they directly influence clinical outcomes, patient satisfaction, and organizational goals. So by keeping the lines of communication with our colleagues open, we enable multidisciplinary collaboration that reduces waste and variation.
Start by asking a few simple questions (both within and outside of supply chain):
- Do we have a systematic way of performing our typical day-to-day work?
- Do we have protocols in place to deal with the rarer issues that can cause further setbacks?
- Are we all following the same process or do we each perform tasks differently?
- In what ways and in what capacities do members of our team interact with other teams in our hospital?
- Are we doing things one way because that’s the way we’ve always done them or is there a better way?
Investigate the answers to these questions to identify where there is variation or wasted time. Remember, managing supply chain practices efficiently means ensuring predictability where possible. This includes making sure that the best quality products and equipment are where your customers need them at the time they need them in order to deliver optimal clinical outcomes.
Involve everyone in process improvement
The key components for creating effective cross-functional teams are communication, empowerment, and recognition that the whole team (not just one person) contributes to patient care. Every member of the multidisciplinary team must understand the new healthcare environment and how their role contributes to the larger organizational objectives. This understanding helps them become better team players and helps them determine the best process for any given initiative.
Team members also need to feel comfortable enough to come forward with thoughts, suggestions, and concerns, to ask questions if there is something they don’t know or for which they require further training. There should be no silos and no refusals—and there are no bad ideas. Although supply chain professionals are not bedside clinicians, we strive to reduce healthcare delivery barriers for our clinical customers, enabling them to provide the best outcomes at the lowest possible cost.
Make systematic improvements
Process improvements should be organized and efficient. One popular method is the Six Sigma DMAIC: define, measure, analyze, improve, and control. When a problem is identified, the first step is to define the steps that need to be taken to resolve the issue. Data are then used to measure the current processes. This helps to help clarify how well or inefficiently things are working. It also helps pinpoint the problem. After analyzing the issue to find the root cause of the problem, begin to improve the process issue. If your improvement method is a success, the control phase begins. The control phase is particularly important for sustained functionality. Meet with members of the team to get feedback. Do they see a difference in performance? Are there any hiccups that need to be addressed? Use data to ascertain what has actually improved and how. Lastly, develop a plan to review the processes regularly to ensure that changes are being maintained.
While LSS offers a road to operational effectiveness, it also lays the foundation for effective change management, which is essential for value-based care. LSS initiatives can be managed by department heads, but to be successful, they require a bottom-up, team-based approach. Meaningful change can only occur when empowered staff collaborate and truly understand the issues and the end-to-end value stream.