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Lean Six Sigma and the patient experience

October 10th, 2012

by Anthony Cirillo

Recent articles looking at Lean and Six Sigma efforts report that they reduce costs and improve efficiency.

Some also praise how the models enhance employee satisfaction and buy-in as employees become more involved in collaborative problem solving. I said "some" because others look at it as one more thing to do that is pulling them away from patients.

Is any of this translating into better patient experiences?

First, let's look at the tools. Lean and Six Sigma are different.

Six Sigma is a customer-focused, data-driven process that looks for root causes of defects due to excessive process variation. Using the DMAIC structure--define, measure, analyze, improve and control--it looks at customized solutions to specific, systemic problems that affect the end customer.

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Lean looks at waste and process flow. Its goal is to implement standardized solutions in a prescribed manner in blitzes called Kaizens. It is about introducing continuous flow and flexibility into processes. There is a clear focus on the customer, taking non-value added process steps out of the equation.

Together, Lean Six Sigma can be very effective, where Lean increases process efficiency, velocity and flexibility and Six Sigma improves quality through decreased defects.

In reviewing typical scenarios, not all of the problems addressed by these processes are patient facing. Staff squirreling away supplies. Physicians waiting for test results. Misdiagnosis. Overtreating. They impact the patient to be sure. But more typical patient-facing problems are long wait times and being kept informed.

So you can introduce processes that lower wait times and implement communication standards to keep people informed. But is the care any more compassionate and empathetic when it's delivered? No more so than before, because it is delivered one person to another and the process might have changed but the people haven't.

Healthcare is quick to build hotel-like structures to make the experience better. And introduce processes to make the care more efficient. But the experience happens face to face. And people can tell when someone is scripted (a customer service, quick-win Lean solution) as opposed to when someone is genuinely concerned about them.

Which brings us to this: Fifty percent or more of healthcare Lean Six Sigma initiatives fail. I heard one presenter this year say that we are Lean-ing compassion out of healthcare.

And writing on July 5, Steven Garfinkel, managing director of the American Institutes for Research in Chapel Hill, N.C., wrote in a Hospital & Health Network Daily column. "We cannot be sure that Lean is more effective than other process improvement techniques."

These efforts fail because organizations can't align their people around them. And when combined with the complex and political nature of healthcare, it is easy to see why it is difficult to attain traction.

But let's get back to a Lean principle: Focus on the customer. I would argue that customers of hospital leaders are the employees. They need to give employees the tools to become aligned and in so doing provide the foundation upon which all other change initiatives can both be sustained and thrive.

As I argued last month, an organization can't change someone's behavior. An individual can change their behavior when that behavior is in line with their beliefs and values. A person can change their behavior when these are not aligned only when they start questioning their beliefs. They can only start questioning their beliefs if they have a better understanding of themselves.

With one in five nurses reporting being depressed, that is a shaky foundation upon which to build change. We need to first help healthcare heal itself, and that starts one person at a time. Yes it is my same lament, but here it goes. Igniting individual passion and purpose results in more authentic, compassionate and empathetic caregivers.

It's time to light the fire that has been tamped down.

Anthony Cirillo, FACHE, ABC, is president of Fast Forward Consulting, which specializes in experience management and strategic marketing for healthcare facilities. He also is the expert guide in Assisted Living for About.com and Healthcare Channel Partner for CEO².

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