Has the time come for Lean Six Sigma to be as pervasive in healthcare as X-ray machines? (transcript)

Medicine has long focused on the individual because of the huge variations in individual patients: how they respond to treatment, their overall level of health, genetics and so on.

But now, according to Grace Duffy, a consultant who specializes in organizational and process improvement within the healthcare sector, there is a massive shift underway towards looking at how the community as a whole can treat and prevent health issues.

"We’re seeing a cultural shift from the individual healthcare and treatment of the patient to a community health awareness, where we’re going more toward prevention than we are toward treatment of individual clinical incidents," she explains.

In this PEX Network interview, Duffy argues that combining medical and community expertise with management and quality disciplines like Lean and Six Sigma, can help deliver better patient outcomes and value for money.

Editor's note: This is a transcript of a video interview and has been edited for readability. To watch the original interview, click here.

PEX Network: Lean Six Sigma process improvement has been around the healthcare sector for a number of years now, especially in North America, and yet it feels like it’s becoming more and more pervasive. Do you think we’re on the verge of a bit of a tipping point, where Lean Six Sigma in healthcare is going to be as pervasive as, say, X-ray machines?

Grace Duffy: Well, I certainly hope so. In all honesty, I think it’s long overdue. The concepts and the universality of healthcare really lend themselves to the tools and the concepts of Lean and Six Sigma. Certainly, in our cost-conscious environment now, globally, the Lean concepts are very, very important, and I’ve seen those needs for reduction in waste – to be pervasive, as you call it - for some time now.

Six Sigma is coming along, but what we’re finding, especially in the clinical side, is that the data is there to help us in using Six Sigma. But the variation is broad in the human genome that when we look at Six Sigma and we look at tolerances and process levels, it’s taking us a while to understand how to translate those issues from the variation required for the individual into the reduction of variation that we like, and the tolerances and the control that we have in Six Sigma. So that something we’re working on.

PEX Network: What impact is the Patient Safety and Affordable Care Act [commonly known as ObamaCare] having on healthcare organizations?

Grace Duffy: It’s having a very significant impact. We’re seeing a cultural shift from the individual healthcare and treatment of the patient to a community health awareness, where we’re going more toward prevention than we are toward treatment of individual clinical incidents.

So the thought process is having to broaden. I’m not going to say change, because medicine is one of the most ancient sciences there is and it’s always been focussed on individual treatment.

It’s a more egalitarian concept that says we’re looking at making care affordable throughout the community. So the doctors and the nurses and the organizations that support them are having to come away from individual treatment to how we can use our resources - scarce as they are - across the whole community for healthcare, and that’s really what the Affordable Care Act is looking at. That’s a difficult transition for a lot of healthcare professionals to make.

PEX Network: So how are the healthcare organizations that you’ve been working with responding to this?

Grace Duffy: In a variety of ways, based on their organizational culture. The culture in hospital and healthcare is somewhat unique. It is, as I said, a very old and medical science culture and has some very specialized professionals within it. Those professionals are looking at the responsibility that they have to the science. Yet they also need to understand how they work together.

The Affordable Care Act and the other changes and challenges that we’re seeing in healthcare now along with the opportunities that the Lean and Six Sigma concepts give us, are creating longer communication channels.

Now we’re having to look globally at how we can use technologies coming in from all over the world and also how we can use resources across a larger supply chain. The hospital is now being seen as the centre point in the community for community health, not individual illness or event treatment, and that is difficult for a physician and a nursing science that has looked at the individual, looked at the data generically as you get population samples and as you get statistical results, and then making an instantaneous decision based on an interview with one individual human being.

That communication channel is not only with the patient and the physician or the treatment giver. It is now with a series of partners who might have a better competitive advantage in providing a service to give patient care, or to give community health involvement.

I’m seeing it in Inova hospitals. I gave a presentation yesterday, for instance, on an affordability model that Inova hospitals in northern Virginia are using and are now getting awards for, in finding statistically significant reduction in mortality based on sepsis using Lean and Six Sigma approaches and tools.

But they’re also seeing that not only are they reducing mortality by using Lean and Six Sigma, but they’re also gaining back lost funding. In ten months they had returned $800,000 to only two of the seven locations for the Inova healthcare, for the reduction of sepsis in these two locations plus one of the feeder rehabilitation centres. They’re now seeing incredible results in using the tools of Lean and Six Sigma.

In the public health arena - and I spend a lot of time in community health - we’re seeing the need to have the communications of population preventive health and not just protective health. This is the case in the US and in the Far East as well as in Europe.

So we’re again looking at a broader picture than we have historically, and that is a significant impact to an environment that has specifically been the doctor and the nurse and the patient.

Now we’re having to back up, and it’s difficult. Those are an awful lot of channels that we have to work with, and now instead of looking at a Lean and Six Sigma cause-and-effect chart, we’re looking at interrelationship digraphs. How are all these partners working to meet the health needs of a total community?

PEX Network: So what advice would you give to healthcare providers who are looking to adopt a process-based approach to management?

Grace Duffy: I’d say, keep an open mind. Look at the tools and the data that we already have. We know that we understand the human mind, the human body. We understand the techniques of clinical health. We understand how we work with the patient. That really isn’t going to change.

The human genome hasn’t changed really a lot in 40,000 years, so we can count on that. The challenges and the opportunities now in what we have in this new egalitarian concept of community health is that we can use the skills and the brilliance and the academic achievements that we have in healthcare to work more closely with additional partners to bring in the skills that they have.

The issue that we run into is that the language is different. When I come in as a Lean Six Sigma Master Black Belt, and I start talking about quality management systems or I start talking about interrelationship digraphs, a physician’s going to look at me and turn me right off. A nurse is going to say, but you’re not a registered nurse. Why should I listen to you? You don’t know my world. And, in all honesty, they’re right, but I know the other stuff, and so if we can share the information that we have...

There are some wonderful papers being written now, wonderful books being written now, that combine the quality and the performance excellence fields with the medical fields. If we can academically connect those two, then I would suggest to all of the professionals involved that we can all gain, that we can get where we want to go. We just need to trust it a little bit.