To the Editor:

Lean and Six Sigma are the latest Quality Improvement tools that are being increasingly used within the health-care industry.1 The article "Assessing the Evidence of Six Sigma and Lean in the Health Care Industry" by DelliFraine et al. gives a critical analysis of the effectiveness of the two QI tools suggesting that there is sparse evidence of its effectiveness; advising a cautionary approach in adoption of these tools in the absence of data on cost-efficiency and failures. However, within the healthcare context, difficulty to measure the success of such QI tools and the obstacles it faces should be taken into account which has not been factored in the suggestion.

One of the major obstacles within the health care context which might not be relevant in manufacturing is the ambiguity in defining the end results2 i.e. whether to consider the financial performance, process improvement or clinical outcome. To top it all, the perception varies from the funder to the provider and finally to the end consumer/ patient.2 The funder may be interested in cost savings whereas the patient may be interested in the improved service and treatment quality creating disparity. Often, the QI tools are used for improving clinical process and reducing errors thereby improving the clinical outcome1 rather than cost effectiveness.1 This creates difficulties for organisations and researchers implementing the tool to correctly assess and quantify its effectiveness which results in limited data on cost-efficiency. Having said that, various small and large organisations such as NHS are using the two QI tools worldwide.3

Patients should be considered at the centre of such approach and the staff along with the management should work in tandem for continual improvement leading to improved clinical outcomes. This could lead to either increased costs or cost efficiency.2 However, the trade-offs in terms of cost-savings and improved quality of service should be valued and balanced considering a long-term view.4

Thus, the organisations and managers need to consider a holistic picture by looking at the trade-offs in the long-run i.e. taking a decision based on "value creation" for end customer which in health-care are patients and other customers4 and should not be deterred by large initial investments.

-Anuj Saraogi, MHA, MBA, M.B.B.S

Project Manager, La Trobe University Cobram District, Health, Victoria, Australia.

REFERENCES