Lean Six Sigma Approach Research Articles

Management of Patients with Colorectal Cancer through Fast-Track Surgery.

Colorectal cancer (CRC) is the third most common cancer in men and the second most common in women globally. CRC is considered a priority public health issue due to its incidence and the high associated costs. Surgery is the predominant therapeutic approach for CRC. Given the involvement of the intestinal tract in the surgical process, there is a significant increase in postoperative morbidity rates, and the average length of hospital stay (LOS) tends to lengthen. In this research, we employed the Lean Six Sigma (LSS) methodology, specifically utilizing the DMAIC cycle, to identify and subsequently examine the effects of fast-track surgery on hospitalization times for interventions related to CRC at the AORN "Antonio Cardarelli" Hospital in Naples (Italy). The process analysis, guided by the DMAIC cycle, facilitated a reduction in the median LOS from 14 days to 12 days. The most notable improvement was observed in the 66-75 age group without comorbidities. The LSS approach provides methodological rigor, as previously recognized, enabling substantial enhancements to the process. This involves standardizing outcomes, minimizing variability, and achieving an overall reduction in the LOS from 14 to 12 days.

THE ROLE OF LEAN SIX SIGMA IN BOOSTING COMPETITIVE ADVANTAGE IN THE GOVERNANCE OF HEALTHCARE ORGANIZATIONS: A CONCEPTUAL FRAMEWORK

This study aims to present a conceptual framework that brings together reward and recognition, and customer focus (organizational factors), which can help organizations achieve a competitive advantage (CA) through applying Lean Six Sigma (LSS) in healthcare. A critical review of the models of reward and recognition, and customer focus, LSS, and CA measures was performed to create the conceptual framework. A synthesis of the existing literature provides the basis for the development of the conceptual framework of the LSS measures. The independent variables are reward and recognition, and customer focus. The mediator variable in this framework is LSS, and CA is employed as the dependent variable. The framework offers a systematic method of evaluating the determinants of LSS in healthcare. Accordingly, the newly developed conceptual framework identifies and describes the direct associations between organizational factors and CA in the healthcare (HC) sector and the indirect associations through LSS. This study is important for professionals working in HC seeking to achieve CA in hospitals. Additionally, this study is valuable to researchers and academics working in the LSS field as it explores the importance of LSS implementation in hospitals. In addition, limited studies have been conducted to explore the status of LSS implementation in HC and this study is expected to provide theoretical contributions to the LSS approach in healthcare.

Empirical analysis of strategies to overcome the barriers of LSS implementation in Indian small manufacturing enterprises: an application of ISM-MICMAC

PurposeThe purpose of this study is to explore and model the strategies to overcome the barriers of Lean Six Sigma (LSS) implementation in Indian small manufacturing enterprises (SMEs).Design/methodology/approachIn this research, 31 strategies of LSS implementation in SMEs have been identified through detailed literature review and out of them, 13 are finalized using statistical tools like CIMTC and Importance-Index analysis. Moreover, the consistency of finalized strategies was examined through reliability test using SPSS software version 22. The finalized strategies are modelled through interpretive structural modelling (ISM) and classified them using MICMAC based on their driving and dependency power.FindingsThe key findings of this techno-managerial study are identification and modelling of 13 strategies to overcome adoption challenges of LSS in context of Indian SMEs. The usage of ISM-MICMAC approach provides the guidance to industrialist consider the mutual interaction of strategies during planning and scheduling for LSS projects.Research limitations/implicationsDue to human involvement and judgements, there may be chance of biasness and subjectivity during construction of self-interaction matrix. Also, the number of identified strategies to overcomes barriers of LSS adoption may vary by altering nature, scope and region of research.Originality/valueLiterature is full of studies regarding LSS barriers and its rankings. Also, few studies explored the solutions of LSS barriers and prioritized them. To the best of the authors’ knowledge, our study is very rare to witness which expose the strategies to overcome the barriers and frame the mutual interaction are per the driving and dependence power of strategies. The application of ISM-MICMAC approach suggests a roadmap for implementing LSS approach efficiently through considering developed ISM model of strategies in context of SMEs.

Waste Reduction in Pipe Industry Through Lean Six Sigma Implementation

This research investigates to manage waste in longitudinal submerged arc welded (LSAW) steel pipes by the utilization of Lean Six Sigma (LSS) tools, with an emphasis on promoting sustainability through waste reduction. The DMAIC approach was implemented to ascertain underlying causes, enact modifications, and oversee practices. Reusing, recycling, and repurposing of materials was employed to minimize production waste. The findings demonstrate a noteworthy decrease in waste with regards to the overall weight of raw material, from 5.3% to 3.4%, and a reduction in monetary losses by 58.07%. The implementation of the LSS methodology has been shown to augment customer satisfaction, minimize waste and variation, and improve sustainability in numerous industries. The effectiveness of the LSS approach in managing waste and promoting sustainability in the LSAW sector was validated by consistent results, as evidenced by the control plan. Given the crucial significance of efficient waste management for sustainable production and consumption, this research underscores the potential of LSS as a resilient methodological approach to reduce waste and advance sustainability in the industry.

P091 Timing Efficiencies in Tertiary Care of Patients on Non-invasive Ventilation

Abstract Introduction A lean six-sigma (LSS) approach to clinical redesign looks at aspects of patient flow, value to consumer and any areas that may be considered wasted time. This LSS approach was used to find areas of improvement in a tertiary care hospital for patients on non-invasive ventilation. The solution developed was to implement a remote download service. Methods Root cause analysis, current state process and effects analysis, staff surveys and time and motion work sampling studies were conducted. There was a post implementation time and motion work sampling study for the remote download service introduced in 2023. Results Motion, transportation, inventory and waiting time and reporting software were found to impact workflow. Time efficiencies were found for non-invasive ventilation download reports with a mean time of 14.8 mins (std 6.7min) pre-implementation down to 2.5 mins (std 0.6min) with remote software. There was an additional time saving due to batch processing prior to clinics of 2.5 mins (std 0.4mins) per patient. Staff reported workload capacity and documentation as two key barriers to effective processes. Discussion LSS identified areas to improve value and flow for staff in sleep clinics and patients on non-invasive ventilation.

P042 Lean Six Sigma Approach to Improve Non-Invasive Ventilation Patient Care

Abstract Introduction A lean six-sigma (LSS) approach to clinical redesign looks at aspects of patient flow, value to consumer and process inefficiencies. We used LSS quality management approach for clinical redesign of our non-invasive ventilation patient care. Current recommendations suggest that patients using non-invasive ventilation (NIV) require therapy for a minimum of 4 hours per night for optimal health benefits, with less than this amount defined as low adherence. This information is collated for each patient at each clinic visit. The aims of this study were to improve the identification of patients on non-invasive ventilation that are poorly adherent to paediatric specialist support, decrease the time taken for entry of NIV adherence data for all patients and evaluate process/es for scalability for future growth. Methods A LSS approach was used with identification of variation, waste and patient flow concerns in diagnostic stage. Rapid improvement events, diagnostic and solution design workshops were conducted to determine root cause, key issues and possible solutions. A preferred solution was adopted through team collaboration. Results A diagnostic stage identified two key areas: a 45% increase in telehealth and 162 man-hours of manual data entry for patient care. The solution initiated was to extract NIV machine data remotely and automate data collection. Discussion Healthcare is well suited to using the lean six-sigma approach to facilitate team collaboration in all aspects of clinical redesign of a healthcare pathway. Automating aspects of patient care may improve patient health and staff satisfaction.

Lean Six-Sigma Approach for Sub-Contract Licensing and its Process Improvement across the Manufacturing Supply Chain using GUT Priority Matrix

This study aims to examine how Lean Six Sigma as a quality management tool could enhance productivity in a manufacturing organization, ZITRON. In addition, this study also aims to show how DMAIC (defined, measured, analyzed, improved and controlled) is operationalized for overall process improvement in ZITRON manufacturing. Lean management takes care of waste across all processes and focuses on speed and time within a firm while Six Sigma is a strategy that focuses on eliminating defects, reducing costs and also reduces process variability. As such, this study utilizes the Lean Six-Sigma approach as a tool to ensure more efficiency is achieved in terms of source, make, delivery and process efficiency. Methodologically, there are five phases in the Lean Six Sigma strategies which are defined, measured, analyze, improve and controlled (DMAIC). The findings show that Lean Six Sigma can help to eliminate waste, and cost-reduction, and help eliminate variations in processes within the manufacturing. However, SIX SIGMA tools have been used to solve the problem which is a delay in processes in manufacturing. Based on this research paper, focuses on the manufacturing problem which is a delay in processes. By using Six Sigma, the problem that existed in manufacturing has been solved through process improvement. This work is originally following a self-method in which the data is collected by using observation techniques to identify the existing problem and solution-seeking within the manufacturing.

Lean Six Sigma to reduce the acute myocardial infarction mortality rate: a single center study

PurposeCardiovascular diseases are the leading cause of death worldwide. In Italy, acute myocardial infarction (AMI) is a major cause of hospitalization and healthcare costs. AMI is a myocardial necrosis event caused by an unstable ischemic syndrome. The Italian government has defined an indicator called “AMI: 30-day mortality” to assess the quality of the overall care pathway of the heart attacked patient. In order to guarantee high standards, all hospitals had to implement techniques to increase the quality of care pathway. The aim of the paper is to identify the root cause and understand the mortality rate for AMI and redesign the patient management process in order to improve it.Design/methodology/approachA Lean Six Sigma (LSS) approach was used in this study to analyze the patient flow in order to reduce 30-days mortality rate from AMI registered by Complex Operative Unit (COU) of Cardiology of an Italian hospital. Value stream mapping (VSM) and Ishikawa diagrams were implemented as tools of analysis.FindingsProcess improvement using LSS methodology made it possible to reduce the overall times from 115 minutes to 75 minutes, with a reduction of 35%. In addition, the corrective actions such as the activation of a post-discharge outpatient clinic and telephone contacts allowed the 30-day mortality rate to be lowered from 16% before the project to 8% after the project. In this way, the limit value set by the Italian government was reached.Research limitations/implicationsThe limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.Practical implicationsThe LSS approach has brought significant benefits to the process of managing patients with AMI. Corrective actions such as the activation of an effective shared protocol or telephone interview with checklist can become the gold standard in reducing mortality. The limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.Originality/valueLSS, applied for the first time to the management of cardiovascular diseases in Italy, is a methodology which has proved to be strategic for the improvement of healthcare process. The simple solutions implemented could serve as a guide for other hospitals to pursue the national AMI mortality target.

A global study on applicability of ISO 18404:2015 for SMEs: an exploratory qualitative study

PurposeISO 18404:2015 standard defines the proficiencies to the attainment of distinct competency levels with either Lean Manufacturing or Six Sigma or separately combined strategy Lean Six Sigma (LSS). The purpose of this paper is to perform a detailed investigation of the applicability of current LSS competency standard in SMEs and examine the need for further improvement.Design/methodology/approachA qualitative-based semi-structured interview method was utilized globally by interviewing a group of LSS professionals with knowledge about the LSS implementation working in different leading organizations. All participants were asked to review the standard before the interview process to ensure that they are familiar with the standard.FindingsThe results reveal that the current ISO 18404:2015 standard does not fit SMEs to implement the LSS approach as it has several shortfalls that need to be fixed before its adoption or an urgent need to develop a more customized LSS standard for SMEs. The outcome further helps organizations understand theoretical knowledge about ISO 18404:2015, its role in operational excellence implementation, pros, cons, critical success factors and required changes for further improvement within the standard.Research limitations/implicationsThere were very limited baseline studies in the literature. A mixed method strategy that includes qualitative and quantitative data would yield better data so that more robust outcomes can be derived from the research.Originality/valueTo the best of authors' knowledge, this is the first empirical research on the applicability of ISO 18404:2015 for SMEs, which encapsulate opinions of LSS professionals working in several SMEs.

Value-Based Care in Arthroscopic Rotator Cuff Repair: A Lean Six Sigma Approach for Optimizing the Surgical Recovery Period

Background There is an overall need to optimize the surgical recovery period after rotator cuff repair, and there is no lean six sigma (LSS) protocol on how to effectively manage follow-up without increasing burden on patients or providers. Materials and Methods The Kanban board outcome assessment tool was managed by athletic trainers and was used to organize the recovery period. Using ICD-10 codes, we benchmarked our outcomes from May 2017 to February 2019-4633 rotator cuff repairs recorded in a global registry (Surgical Outcomes System). Statistical analysis was done by two-tailed, two-sample t-test, and multiple linear regression. Results Fifty-seven patients with a survey compliance rate of 82.4% and a minimum follow-up of 2 years were compared to 4633 patients in a global registry with 58% compliance at 2 years. Pretreatment baseline scores were also significantly worse in our LSS cohort. Despite this, our analysis identified a statistically significant improvement in Visual Analog scales, American Society of Shoulder and Elbow Surgeons, and Veterans-Rand 12 physical and mental scores in our LSS cohort compared to the global registry (P < 0.01). Subgroup analysis of partial, complete, and massive rotator cuff tears in our cohort also compared favorably to the global registry. Our LSS protocol resulted in 12 scheduled patient-provider interactions with two physician follow-up appointments postoperatively. Conclusions Our LSS approach yielded clinically significant 38% less pain and 20% improved shoulder function at 2 years postoperation compared to a global registry. Quality of life measures also improved by nearly 20% for both physical and mental health. Our LSS model improved patient outcomes following arthroscopic rotator cuff repair.

Establishment and implementation of an improvement plan using Lean Six Sigma methodology to minimize variation in ordering laboratory tests

Background/aim Ordering laboratory (laboratory) tests by physicians is a part of the pre-preanalytical laboratory phase, which is a high error-prone process. Many of the laboratory tests ordered are unnecessary, where excess ordering represents as much as 25–40% of all ordered tests. The present study aimed at establishing and implementing a quality improvement project to avoid misutilization of laboratory tests using the Lean Six Sigma (LSS) methodology that could help to minimize variation in the laboratory requests ordered by clinicians. Materials and methods LSS approach methodology with its five phases, namely, define, measure, analyze, improve, and control (DMAIC), was applied to define and solve the problem of ordering of inappropriate laboratory tests. Sigma levels of the ordering process of selected laboratory tests were measured before and after implementation of the selected solutions. The stability and capability of the ordering process were retested after implementing the project. Results The sigma level of alanine aminotransferase/aspartate aminotransferase tests ordering process has been improved to 1.2 sigma, which represented 45% improvement. The sigma level of urea and creatinine ordering has been improved to 2.16 sigma, which represented 43.1% improvement, saving about 14 520 LE per year. Conclusion Successful implementation of LSS significantly improved laboratory test ordering. Simple modification in the laboratory request form could be an important source of improvement and a cost reduction tool in the pre-preanalytical laboratory phase. LSS is an evidence-based powerful tool that could improve the health care sector in general and the clinical laboratories in particular.

Fuzzy AHP approach for barriers to implement LSS in the context of Industry 4.0

PurposeThe purpose of the present work is identification and prioritization of barriers to Lean Six Sigma (LSS) implementation in Indian manufacturing industries in the context of Industry 4.0 (I4.0) to surmount the impediments in the path of successful implementation.Design/methodology/approachIn total, 27 barriers identified through critical review of literature and expert's opinion are evaluated with Cronbach's alpha values including item-total correlations or corrected item-total correlations (CITC) using statistical tool. Finally, 20 barriers were analyzed and ranked employing Fuzzy Analytical Hierarchy Process (FAHP).FindingsThe study depicts that “Lack of leadership, advisory and monitoring,” “Lack of clarity about economic benefits” and “Lack of integration of LSS with smart tools/I4.0” are potential barriers to drive the path for proper implementation of LSS in Industry 4.0 with due consideration of its technologies in Indian manufacturing industries.Practical implicationsThe study provides better knowledge platform for academicians and researchers about hidden aspects of LSS implementation barriers in view of advanced manufacturing technologies. This research will help the practitioners to design their business plans in implementing new quality improvement tools to get advantage in current competitive environment.Originality/valueThe barriers are selected based on literature and opinion from industry and academic experts. Five major criteria are decided after incorporating inputs. The ranking of the barriers is attained by well standard mathematical technique. This will enable the practitioners to design strategies to eliminate the hindrances in order to shape the right path for effective implementation of LSS approach in view of advanced manufacturing technologies.

Die and Punch Wear Reduction in Stamping Process by Lean Six Sigma Approach

This research aimed to reduce die and punch wear and improved the quality of the production process with the application of the Lean Six Sigma methodology. Die and punch had limited capability in cutting material edges in the case study company. The root-cause analysis showed a correlation between the hard coating and the lubricant effect on wear reduction using the design of experiments and DMAIC based on the Six Sigma approach. The results indicated that a combination of AICrN-PVD coating and aloe vera oil provided the most outstanding results in terms of wear reduction. Moreover, it had the potential to minimize the cost of product defects or repairs significantly. These findings showed the effect of the Lean Six-Sigma approach at the die production process, which increased operational efficiency and consistency to enhance business performance and meet customer requirements.

Application of lean Six Sigma methodology using DMAIC approach for the improvement of bogie assembly process in the railcar industry

The quest for waste reduction, quality improvement and operational efficiency during the assembly process of the railcar bogie necessitates this study. Using a case study approach, this study employs the Lean Six Sigma (LSS) approach for process improvement of the railcar bogie assembly process. Primary data relating to the assembly process such as the labour and material flow, up and down times were collected at every stage of the assembly operation. The improvement process of the assembly process featured the use of some Lean tools such as the Kaizen, Value Stream Mapping, Pareto chart, Single-Minute Exchange of Die (SMED) and 5S. The investigation of the current assembly process with the use of the LSS technique indicates that the process efficiency is low due to waste generation. The results obtained showed significant improvement in the process cycle efficiency (PCE) by 46.8%, via the implementation of the Kaizen continuous process improvement approach, 27.9% reduction in the lead-time, 59.3% increase in the value added time and 71.9% reduction in the non-value added time after the implementation of the LSS approach. The findings of this work demonstrated the feasibility of the LSS approach for waste minimisation and process performance improvement in a bid to achieve operational excellence in a manufacturing organisation.

The Fields of Interest of Lean Six Sigma through PDCA cycle and 4P Excellence Model

The aim of this paper is to review the focus of research carried out on Lean Six Sigma (LSS). A screening of 116 papers related to LSS from renowned and open database searches including DOAJ, ResearchGate, MDPI on the period of 2006 to 2021 have been done. This paper provides a review of Leans Six Sigma (LSS) in the context of the Plan Do Check Act cycle and the 4P Excellence Model to identify areas for future research and opportunities to deliver business excellence. 21% of the papers (25) contribute on Plan phase of using LSS, 62% of the papers (72) are focused on «DO» phase which is the practical deployment of LSS, 15% of the searches (17) related to Check phase which concerns the questioning of the methodology and 2% of the papers is looking for adapting and adopting the LSS, this is the Act phase. From the 72 papers classified as focused on «DO» phase, 70% of the papers are focused on processes which are using the LSS tools for achieving a specific goal of reducing waste and variation. How to innovate the Products by LSS approach took the second interest, it represents 26% of the various papers. People, Partnership and Leadership which are fundamentals for culture change share the last part. We have also seen a great interest in publications in the tangible parts of using LSS in processes and products during a visible period from 2006 to 2013, then several studies look more into the importance of the non-tangible parts of using LSS as an improvement process after 2013.

Reduce the patient's waiting time and improve the patient's flow using lean six sigma in physiotherapy department

Background: Lean Six Sigma (LSS) is the latest generation of improvement approaches. The amount of waiting time directly impacts in patient experiences in physical therapy outpatient care. Patient waiting time data supports, patients referred to the physical therapy department for an appointment waited a minimum of 3 weeks. The physical therapy staff found this frustrating as patient's conditions often became more chronic during the wait and they often needed to take prolonged periods of sick leave. Physical therapists felt that to provide a better quality service they should reduce the waiting time of the patients. Aim: The aim of this study was to reduce the patient waiting time and improve the patient flow with optimized patient experience to using LSS methodology in an Outpatient Physical therapy Department (OPD). Subjects and Methods: LSS define–measure–analyze–improve–control methodology was adopted with using different quality tools. Results: A number of nonvalue added activities were identified within the process, and actions were initiated to systematically eliminate different forms of waste using the principles of lean thinking. The Non value added activities of Rework, Rejections, delayed approval Process leads to revenue loss were identified and eliminated from the process. Cause-and-effect analysis was carried out to identify the potential causes for unacceptable waiting times, and data were collected to validate these causes by the GEMBA investigation. As a result of this project, the average waiting time was reduced from 13.5 days (2 weeks) to 4 days to execute the first physical therapy session from the insurance approval. The Action plans were implemented on different levels of the process and specifically allocated to team members of Physicians, Physiotherapists, Patient's Administrators & Insurance Coordinator. Conclusion: There was a significant reduction in waiting time and improving the patient flow was achieved in the outpatient services of the physical therapy department using the LSS approach.

IMPROVING SERVICE LEVEL PERFORMANCE BY IMPLEMENTING LEAN SIX SIGMA IN SMES OF THE GAMING PERIPHERALS INDUSTRY IN PERU: A CASE STUDY

Lean Six Sigma (LSS) is one of the essential and applicable techniques for any organisation in the 21st century, including small and medium-sized enterprises (SMEs), that wish to grow their competitive advantages. The LSS approach’s insights offer an optimal vision for reducing technical gaps and assessing performance indicators. This case study aimed to improve service-level performance in a gaming peripherals SME by incorporating traditional engineering tools into the Define, Measure, Analyse, Improve, and Control (DMAIC) framework, validating its results through a two-month pilot plan, and analysing process improvement via statistical software. The study’s findings revealed that SMEs could effectively control delays in order processing through statistical control planning regardless of financial capabilities. Keywords Lean Six Sigma, Service Level, DMAIC, SME, Gaming Peripherals

Assessment of Critical Failure Factors for Implementing Lean Six Sigma in Manufacturing Industry: A case study

In the present scenario manufacturing industries have been facing problem-related to cost, quality, and customer satisfaction. To overcome such problems, the organizations are ready to adopt continuous improvement (CI) approaches such as Lean Six Sigma (LSS) which keeps them stable when the demand for products or services fluctuates. LSS is a breakthrough improvement approach that helps to improve the bottom-line result of the company by utilizing its tools and techniques. The successful adaptation of the LSS approach provides a significant improvement in key metrics but deficiency of proper implementation shows a negative effect. To prevent such a situation, need to know about their failure factors. The objective of the present study is to assess the critical failure factors (CFFs) for LSS framework implementation in manufacturing organizations. The leading CFFs for LSS have been identified and selected through a structured literature review and expert opinion. The CFFs based model for LSS implementation has been developed using the Interpretative Structural Modelling and Matrice d’ Impacts Croises Multiplication Appliquee a un Classement (ISM-MICMAC) approach. Previous studies related to such concerns have not developed a structural hierarchical model that is necessary to tackle CFFs towards the LSS implementation process. Such an interrelation helps decision-makers, planners to systematically guide about the barriers that affect the implementation process and help for further implementation success. The developed structured model will also help LSS practitioners, consultants, researchers to anticipate the potential CFFs to implement the LSS framework in their industry for continuous improvement and achieve a leading position in a competitive market.

Empirical Investigation of Lean Six Sigma Enablers and Barriers in Indian MSMEs by Using Multi-Criteria Decision Making Approach

Lean Six Sigma (LSS) is an inclusive approach based on the concept of waste and variation reduction to achieve quality and sustainability. The successful adoption of any approach depends upon the awareness and readiness measures of a particular one. This paper contributes toward Micro-Small and Medium Enterprises (MSMEs) to adopt a comprehensive LSS approach in their existing system through the identification, analysis, and prioritization of LSS enablers and barriers. In the present study, 25 enablers and 21 barriers of LSS adoption are identified through literature review and are validated by using questionnaire-based survey. The screened enablers and barriers are further formulated into logical groups using factor analysis. These formulated groups are prioritized through Analytical Hierarchy Process (AHP) and compared the obtained results with the fuzzy decision-making trial and evaluation laboratory (Fuzzy-DEMATEL). The result reveals that among the main group of enablers, “management-based factor” is the top-ranked followed by “training- and education-based factor” and “technology-based factor” with AHP weights 0.4008, 0.2742, and 0.1465 respectively. On the other hand, among the main groups of barriers, “training and education based factor” is at first rank trailed by “management-based factor” with AHP weights 0.4780 and 0.2915 respectively. The outcomes of current research will facilitate the MSMEs to make a favorable environment toward the LSS approach for increasing productivity and profitability dynamics. An engineering manager can use this paper to enhance social sustainability through the incorporation of LSS approach in the communities where they work. Moreover, this study provides a guiding reference for practitioners and academicians to undertake similar nature of problems into other industrial sectors.

Coupled Effect of Electronic Medical Record Modifications and Lean Six Sigma Methodology on Rheumatoid Arthritis Disease Activity Measurement and Treat‐to‐Target Outcomes

ObjectiveRheumatoid arthritis (RA) disease activity assessment is critical for treatment decisions and treat to target (T2T) outcomes. Utilization of the electronic medical record (EMR) and techniques to improve the routine capture of disease activity measures in clinical practice are not well described. We leveraged a Lean Six Sigma (LSS) approach, a data‐driven five‐step process improvement and problem‐solving methodology, coupled with EMR modifications to evaluate improvement in disease activity documentation and patient outcomes.MethodsA RA registry was established, and structured fields for Routine Assessment of Patient Index Data (RAPID3) and Clinical Disease Activity Index (CDAI) were built in the EMR, along with a dashboard to display provider performance rates. An initial rapid‐cycle improvement intervention was launched, and subsequent LSS improvement cycles helped in standardization of clinic workflow, modifying provider behaviors, and motivating better documentation practices. Trends related to CDAI score categories were compared over time using run charts.ResultsOur project included 1322 patients with RA and 10 241 encounters between April 2016 and December 2019. Initially, RAPID3 completion rates increased from 16% to 50%, and CDAI from 15% to 44% from the RCI intervention. Post LSS intervention, the RAPID3 rate increased to more than 90% (sustained at 85%), and CDAI rate increased to more than 80% (sustained at 72%). The patients in the low disease/remission category increased from 54% to 66% (p < 0.001), and those in the high disease category decreased from 15% to 7% (p < 0.001), demonstrating improved T2T outcomes.ConclusionCombining EMR modifications with systems redesign utilizing LSS approach led to impressive and sustained improvement in disease activity documentation and T2T outcomes.