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Introduction
Lean/Six Sigma in healthcare
Lean principles owe their origin to the Japanese car maker Toyota. They include tools that focus on eliminating waste from manufacturing processes and adding value for the customer. Some Lean tools, such as process and value stream maps, show promise in healthcare. They can eliminate inefficiencies and waste in workflow processes; improve patient scheduling processes; and patient satisfaction with care (Dickson et al., 2009; Wojtys et al., 2009). Six Sigma was developed by Motorola in the 1980s and focusses on reducing errors and variability in the production process using data and statistical methods. Six Sigma uses the define, measure, analyze, improve, control (DMAIC) approach to problem-solving and has been used in healthcare patient safety and quality improvement (QI) (Taner et al., 2007). Lean Six Sigma thinking combines Lean with Six Sigma’s data driven analytical tools to provide a unique approach to organizational problem solving and QI (Koning et al., 2006; Antony et al., 2003; Van den Heuvel et al., 2006). Lean Six Sigma emphasizes their complementary benefits: combining the pragmatic and value-centered Lean thinking with the data-driven Six Sigma (Arnheiter and Maleyeff, 2005; Kumar et al., 2008). In a recent literature review on Six Sigma in healthcare, Liberatore (2013) found Six Sigma applications in several inpatient care areas including admission, discharge, medication administration, operating room, cardiac and intensive care. About 38 percent of the applications focussed on process time and most were in hospitals, with less than10 percent in the ambulatory care setting. In this study, we used Lean Six Sigma techniques to address an organizational quality issue in one Mid-Western United States Veterans Affairs Medical Center (VAMC).
Project background
Many US veterans, particularly rural veterans, are dual users or use healthcare services within and outside the Veterans Health Administration (VHA). Receiving care from VHA and non-VHA systems can lead to uncoordinated care and poorer health outcomes. In this project, we used Lean Six Sigma principles to develop recommendations to improve the current systems and processes for medication co-management for dual care veterans. Our QI project aims were to: assess compliance with the veteran affairs’ (VA) dual care policy; collect data and describe the current system/processes for co-managing dual care veterans’ medications; and...