Lean-Six Sigma for Healthcare [horizontal ellipsis][horizontal ellipsis] A Senior Leader Guide to Improving Cost and Throughput Chip Caldwell, Jim Brexler, Tom Gillem. Milwaukee, Wis: ASQ Quality Press, 2005. 195 pages (plus supplementary CD-ROM, Hardcover, Member price: $40.95; list price: $68.25.
The authors have written this book specifically for CEOs and "senior leaders who desire to harness the power of Lean-Six Sigma as their major strategic weapon for progress" (Preface). However, the authors see the book as a must read for managers at all levels. One of the most compelling reasons for senior nurse leaders to read this book is the authors' statement that "Lean-Six Sigma tools are one of the most powerful tools in solving the nursing shortage" (p 9). If your CEO is using Lean-Six Sigma as a solution and you are implementing other solutions, then understanding Lean-Six Sigma will help with the strategic dialogue between you and the CEO in aligning initiatives.
As I travel the country, I hear a variety of comments from Performance Improvement or Quality Improvement coordinators such as, "all I do is manage data for regulatory agencies" or "we use Deming's PDCA" or "we went Six Sigma but that takes too long so we are doing Lean." You can hardly read a journal and newspaper or watch a news show without some mention of our healthcare system and its performance. The current trend in healthcare performance is Lean-Six Sigma. If you have already started your Lean-Six Sigma journey or you might be doing so, this book is a very practical guide to the latest approach to managing performance and quality in healthcare. So what is Lean-Six Sigma?-by definition "virtual perfection, no errors, no waste" (p 6). The key elements of Six Sigma are (1) a strategy deployment approach; (2) a belief system; (3) a statistical calculation; and (4) a suite of project improvement methods. Lean-Six Sigma is a rigorous, highly analytic, disciplined approach to performance and quality and is driven intensely by senior management.
The authors have created a glossary of definitions to help the reader get through these complex tools and concepts. Lean is a QI concept designed to reduce waste and process cycle time. Sigma quality levels are the common metric used to measure variation from the quality goal without error. Six Sigma is 99.999% error free (pp 158-159). This very practical book has 56 figures, 7 tables, a glossary of definitions, templates, worksheets, and a Six Sigma solution set. The CD-ROM includes PowerPoint presentations, Excel spread sheets, and PDF files or Word templates. The book is learner friendly; for example, they place a light bulb where they want the reader to slow down and think about a concept and a hammer where they want the reader to refer to a tool in the CD-ROM or an appendix. This is important because this methodology is not easy.
Most of us in healthcare know we are not near Lean-Six Sigma as an industry. In fact, medical errors are an issue for us. We also know there is waste and that resources are scarce; so this is something we all need to address. Of particular interest to nurse leaders is many of the very processes targeted for improvement have nursing at the center. It is imperative that nurse leaders understand these complex approaches as nursing is a complex science central to patient care.
For example, the authors discuss "in quality and out of quality staffing." This concept is credited in the beginning of the book to Lynne Sisak, BSN, MBA, Master Black Belt. Staffing is considered a cost of quality issue, and the authors observe that great effort is made to bring staff in when they are on the short side of "out of quality," but when they are on the overage side of "out of quality," little effort is exerted to bring them back into quality (pp 23-25). This has great implications for our front-line manager trying to allocate and manage staffing resources. The authors give other examples, many of which involve nursing, for example, triage nurse in the emergency department, case managers in hospital units, and achieving a 10-fold improvement in critical care unit adverse drug events.
I myself have always wondered if our system were error free and free of waste-assuming that we could indeed achieve that-how many and what kind of nurses would we need? Are we prepared to answer that question? What concerns me is that CEOs enthusiastically embrace this methodology but do not actually change the system and return us to the 1990s where we downsize without the concurrent systems improvements. Because of this concern, senior nurse leaders need to educate themselves on Lean-Six Sigma, and so they are the voice of nursing and patients at the table. Because this book is so practically laid out and includes a multiple of concepts, including Deming's PDCA and Norton and Kaplan's Balanced Score Card, etc, this would be a practical source for your own learning.
-Elizabeth (Betty) Falter MS, RN, CNAA, BC
President, Falter and Associates, Inc Tucson, Ariz