Need of Lean and Quality Management in Healthcare Organization-A Review Paper Shweta Naik R.1*, Khyathi G.V.1, Lokesh A.C.1 1Faculty of Management and Commerce, M.S. Ramaiah University of Applied Sciences, Bengaluru 560054 *Contact Author E-mail: [email protected] Abstract

Healthcare organization, due to its complex nature needs to adapt to changing needs and regulations. To sustain in the competitive, technology-driven health care industry where customer demands are changing rapidly, hospitals need to incorporate theories and philosophy of quality and excellence. The core idea of this article is to understand the importance of implementing Lean Six Sigma methodologies in healthcare settingsand the possible benefits to both the patient and healthcare providers. The outcome of this paper is based on the various literature reviews and case studiesthat provide information on improvements achieved from using Lean Six-Sigma and other quality methodologies. The healthcare industry has to re-examine the entire workflow facilities and infrastructure design to provide the accepted level of quality and value-added services to the customers, along with improved efficiency of the employees by applying quality improvement methodologies.

Keywords: Lean Six Sigma, Quality Methodology, Efficiency, Healthcare Industry

1. INTRODUCTION Management science, Operations research and process engineering are directed at organizations and processes. Much of health services quality improvement smarter than to work harder and shifted the concept of implementations can be characterized as solution-driven employee-centric approach to employee-efficiency [1]. with identification of research finding and working Healthcare industry faces the challenge of increasing its towards rapid diffusion [6]. workload and demand at faster rate with minimal to zero errors to achieve patient satisfaction and improvement in overall revenue generation. Among 2. PURPOSE OF THE STUDY several other methodologies, Lean and Six Sigma concepts are most commonly used methodology [2]. A The motivation to write this paper is on the personal Hospital, Boston to improve wait time in phlebotomy experience during the Hospital departmental postings department applying lean method resulted in decreased and observation made on the several forms of wastes at wait times from 14-17 minutes to 4-5 minutes. This every step of the process be it resources, manpower or improvement was achieved initially by assessing the time of both employees and patient and their attenders. performance of the laboratory staffs, mapping each This made to dwell into various articles on managing steps of the laboratory workflow starting from patient wastes in hospital to improve work efficiency and arrival until report is dispatched. Then the work station quality in health care industry by using some was re-designed, non-value added steps were eliminated methodologies. This quest motivated to write a paper to finally achieve the desired result [3]. that sheds light healthcare sector using various quality improvement tools in different department to reduce 1.1. Healthcare Organization error and provide quality care with efficiency.

Quality of care provided in a health care sector is efficient or not is a debated topic all over the world [4]. 3. OBJECTIVES Healthcare is one such sector where quality and quantity go hand in hand as it deals with people and The objectives of the study are: outcome of their care. The present healthcare system Importance of Quality Management in needs to fulfill the criteria of rendering quality care and Healthcare Organization uplifting health with minimal cost. Quality management Lean Six-Sigma Concept in Healthcare and lean healthcare focuses on both the work efficiency Organization benefit from expanding its current interpretation of Incorporation of Lean in Healthcare structure to include broader perspectives on Organization Organizational attributes as primary determinants of

RUAS-UAS JMC 11 Vol. 03, Issue 02 4. METHODOLOGY Six Sigma is described by its approach of customer- oriented, based on the critical analysis of the A systematic review study was carried out to prepare quantitative data it emphasis on decision making this article. Around 40 related articles were reviewed capability and importance on cost reduction. Six Sigma from websites such as EBSCO, Goggle scholar, comprises of five phases Define, Measure, Analyze, PubMed Central between February 2016 and May 2016. Improve, and Control (DMAIC) this methodology can Among them 21 articles were selected, analyzed to be appliedto solve aproblem [14,15]. Lean and Six write this paper. Sigma methodologies have strongly integrated strengths that are useful for developing innovations systematically in healthcare service [14]. Lean Six Sigma reflects its effects on human resources, rather 4.1. Quality Management in Healthcare than concentrating only on its technique and effectiveness for improved efficiency in processes and Organization product quality [15]. Lean is an approach that tends to be qualitative, while six sigma tend to be quantitative. first introduced into the business world by Armand Total Quality 4.3. Incorporation of Lean in Healthcare Control - - Joseph Juran and W. Edwards Deming [7]. The following the exploration of the Toyota model. Lean is perception of TQM in any organization always focus on a versatile concept that requires organizations to exert providing services of higher quality to enhance effort along several dimensions simultaneously. Joseph customer orientation, continual improvement and Juran linked manufacturing industry to healthcare employee engagement along with management advising to implement principles and philosophy of lean commitment and leadership [8]. The demand of quality and management for value creation through elimination in health care is a major issue as it need to define quality as desired by customer perception and management philosophy to develop a hospital culture satisfaction with respect to the quality of care received. characterized by increased patient and other stakeholder Five broad attributes have been identified for satisfaction through continuous improvements, in which understanding quality namely Reliability, Assurance, all employees (managers, physicians, nurses, laboratory people, technicians, office people etc.) actively author reviewed the 15 selected literature review and participate in identifying and reducing non-value added arrived at the conclusion of identifying eight important This applies to both the operative TQM practices : top-management commitment (or level and managerial levelin the organization[4]. The leadership), teamwork and participation, process lean in healthcare involvesspecial practices, and hence management, customer focus and satisfaction, resource Lean approaches need not to belargely articulated management, organizational behavior and culture, indicating that the process is particularly or exclusively continuous improvem Lean. Lean methodologies needuniformity so that From the review it was concluded that the continuous improvement cycles results to better and implementation of the above practices are vital for desired outcomes as well as for improved patient TQM success in healthcare organizations resulting experience or efficiency gains [17]. Lean performance improvement , patient expressing being implementation always expects to overcome traditional satisfied, improvement in quality care rendered and mindsets of health care providers and administration minimal operational costs [10]. Hence, TQM as a and accepting that lean thinking is not just about corporate strategy can create an organization that reducing waste, but also intensifying efficiency, with inextricably links every employee, department and patient care as the core concept[18]. Application of Lean Six-Sigma methodology in Catheter laboratory to achieving total quality in every aspect of services [11]. improve workflow efficiency. In the cath lab, initial assessment was done and gathered data was analyzed 4.2. Lean Six Sigma Concepts before implementing lean tools such as , Change management, heijunka,pull, mistake proofing, single piece flow, Just-in-Time, layout change. These Lean comprises of tools and methodologies those implementations resulted in improved patient flow, results in identifying and eliminating all kind of wastes, better cath lab utilization both in the form of manpower adding value to the product and/or services as expected and other resources, thus improving work efficiency by the customers [12]. The Toyota car company was the and patient satisfaction [19]. The Red Cross Hospital, first organization to approach Lean and implement it in Beverwijk, Netherland adopted Lean Six-Sigma in 2002 its production department with the vision to resulting in tremendous improvement in various section accomplish: a continuous improvement in the system of the hospital such as reducing length of hospital stay consisting of ordered inventory management, reduction for COPD(Chronic Obstructive Pulmonary Disease), in waste and quality improvement techniques. Lean reduced invoice errors at purchase department, reduced exercises a continuous learning cycle that is stimulated time taken to prepare intravenous medication, revising by the experts in the processes of health care, whether it is the patients and/or families, healthcare staffs and antibiotics. Implementation of Lean Six-Sigma in other supportive staff [13]. Six Sigma was originally Healthcare industry proves to be a strong tool that helps introduced by Motorola Company in the year 1987 with in service innovations reducing unnecessary waste and a concept of company-wide QI (Quality Improvement). time consumption [14].

RUAS-UAS JMC 12 Vol. 03, Issue 02 5. DISCUSSION 7. CONCLUSION

These article emphases on the importance of adopting in manufacturing industry to efficiently deliver the lean six sigma in a healthcare industry to improve the products and services in a much better, faster way with quality services and its positive impact on both low cost; now it is adopted even by healthcare services. customer and the healthcare providers. Implementing Healthcare industry is a complex sector and sustaining Lean Six-Sigma in certain healthcare areas such as the implemented methodologies requires lots of efforts Operation Theater and its benefits derived are to be from all the stakeholders involved in the service either researched. In recent years, lean six sigma is widely directly or indirectly. Quality issue in healthcare is accepted as it improves revenue being generated by the always the topic of concern and incorporating theories business and service excellence. Though challenging to such as six sigma and lean provides additional benefits implement the methodology in the all department to improve the existing services and facilities as it is simultaneously, undertaking a project of one unit for proved successful in manufacturing industries too process improvement is advisable with eventual [12,14]. But, it takes greater effort to understand what incorporation of the same overall to attain the planned vision and mission of quality assurance. Lean and six sigma benefits by waste reduction and zero or minimal defects, non-value added activities or 8. REFERENCES motion in the existing process flow, and providing the quality services that not only increases the customer [1] Laurie Peterson-Wright. 2013. Applying the satisfaction but also increases the work efficiency. Value Stream Mapping Approach to Laboratory Improvement in turn-around time (TAT) of laboratory Processes. 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