Lean ART journey: painting a new landscape

Abstract

OBJECTIVE: We proposed to develop and implement a roadmap for introducing Lean and Six Sigma (Lean Six Sigma) within a large ART Unit. The aim was to improve the services we provide for couples participating in our IVF programme while reducing process and waiting times. DESIGN: Improving the patient experience is one of the challenges facing an ART Unit today. Continuous improvement (CI) methodologies that have been popularised by a number of high profile manufacturing companies are now being introduced into healthcare as a way of improving patient flow. During this study we combined two of these methodologies Lean and Six Sigma to develop a single patient focused implementation roadmap. This roadmap was designed to identify couple's key needs and to remove any unnecessary waste or variation that deviated from these key needs. We are not aware of any similar studies in an ART environment. MATERIALS AND METHODS: Over a 6 month period we researched, developed, implemented and audited a Lean Six Sigma roadmap across all areas of a tertiary referral /academic ART unit in Ireland. The roadmap was characterised with specific tools using the well-defined steps Define, Measure, Analyse, Improve and Control. Once the roadmap was developed it was implemented and audited. RESULTS: Using the fishbone diagram, process mapping and the deployment diagram we were able to identify the critical and controllable variables that made the patients journey more difficult and increased overall waiting time. We used a number of tools to capture the Voice Of The Patient (VOP). We then used 5S and Kaizen techniques to implement initiatives that removed variation and waste from the cycle of treatment. These changes resulted in a 28% reduction in the time the patient spent in the unit, 22% reduction in waiting time, and a 40% reduction in patient records. An audit of the changes found that the project had standardised processes and procedures leading to easier and smoother patient journey. CONCLUSIONS: This research describes for the first time a CI roadmap for an ART practise based on a Lean Six Sigma model. While this is a novel approach to fertility care its implementation and subsequent audit prove that these tools and technique will benefit the couple and the ART providers both quantitatively and qualitatively. In the era of a drive to continuous improvement, the introduction of lean six sigma practices has become imperative; the ultimate beneficiary of such efforts is the couple.