Sigma Process Research Articles

Connecting individual-level creativity to strategic management processes

PurposeThis study examines how structured procedures and psychological safety can enhance six sigma processes’ effectiveness and foster individual creativity within an organization.Design/methodology/approachThis study employs a novel methodological approach, combining structural equation modeling (SEM) and multi-value qualitative comparative analysis (mvQCA).This combination gave us a unique lens through which to view the complex connections between the constructs that were the subject of the investigation.FindingsThe results substantiate that a well-structured six sigma approach, paired with a psychologically safe environment, fosters knowledge exploration and exploitation as well as triggering conducive learning behaviors. These elements, in turn, augment individual creativity, which is found to be instrumental in boosting six sigma performance.Originality/valueThis study is one of the first to combine mvQCA and SEM to investigate the complex interplay between structured methods, psychological safety and individual creativity in enhancing six sigma performance. This research highlights the importance of fostering creativity in strategic management processes and the unrealized potential of combining these methods.

A Study on Examination Results Using Six Sigma Process

A Study on Examination Results Using Six Sigma Process

A-193 Optimizing Emergency Laboratory Operations Through Six-Sigma Strategies for Enhanced Efficiency and Effectiveness: A Pilot Study

Abstract Background Quality assurance is vital in laboratory diagnostics to ensure patient safety and accurate results. Laboratories employ internal and external quality control measures, particularly focusing on the analytical phase. Sigma metrics, representing process variation, play a crucial role in assessing accuracy, with Six Sigma setting high standards for operational excellence. This study aims to enhance laboratory testing procedures by analyzing the analytical phase. In 2022, the Emergency laboratory at KFAFH, Jeddah, achieved optimal sigma performance, marking a significant improvement in analytical testing. http://www.westgard.com/sigma-vp-kfafh.htm. In 2023, The study also demonstrated a 30% productivity increase, driven by sustained efforts and Sigma metrics implementation, leading to cost reductions and improved quality. Real-time patient moving averages enhance quality assurance, extending coverage to the total testing process. The primary objectives include redesigning IQC procedures and optimizing resource utilization. This will be accomplished by reducing the frequency of controls, minimizing unnecessary reruns, optimizing resource allocation, and managing total costs, all while ensuring compliance and averting violations. Methods A retrospective-prospective study was conducted at the Emergency Laboratory of King Fahad Armed Forces Hospital in Jeddah, Saudi Arabia, from May 2021 to October 2023. The study assessed 841,558 tests for 131,785 emergency patients. Forty-seven analytes were evaluated for Internal Quality Control and External Quality Control (CAP), with monthly data collection. Chemistry and Hematology parameters were analyzed using Unity Real-Time software on Alinity-ci and Alinity-hq analyzers. Data was collected in three stages: baseline, pre-Sigma verification, post-Sigma implementation, and a sustainability phase. The methodology involved DMAIC model tools like flowcharts, cause & effect analysis, and sigma metric scales. Six Sigma process tools, including DPM and process capability analysis, were used. Interventions included Six Sigma metrics for QC performance, DPM for TAT process improvement, and patient moving average Real-time for proactive risk management in reducing analytical testing variation. Results Excellent performance (> 6 sigma) was achieved for 70% of chemistry test parameters for three control levels.: This indicates a high level of process capability and reliability in laboratory operations, ensuring accuracy and consistency in test results. The study successfully reduced process variation in Emergency Room (ER) laboratory Turnaround times (TATs), leading to an increase in process capability as measured on the Sigma scale, which improved from 1.35 to 3.1, indicating a more robust and efficient laboratory operation. Reducing the cost and efficiency of internal failure controls by 29% and at the same time saving in labor cost/workload marked a decrease in QC frequency from 7.0% to 0.18%, reaching the target goal of TATs and satisfaction. Conclusions The adoption of Six Sigma methodologies resulted in a notable decrease in QC runs, signaling cost savings. These high-quality methods streamline laboratory operations, improve cost-effectiveness for the healthcare system, and ultimately benefit patients and clinicians. Six Sigma methodologies play a crucial role in selecting appropriate QC designs for each parameter, ensuring efficient control while maximizing cost-effectiveness. Emphasizing the importance of suitable QC strategies and continuous technologist training is vital for mitigating analytical errors and enhancing turnaround time through comprehensive automation of the analytical phase.

Getting mammograms shouldn’t be so bumpy: Improving mammogram workflow in VA community care.

345 Background: The interplay between VA-based care and Community Care (CC) has long been important for continuity of patient care, though transitioning care between the two is often fraught with problems. Mammograms ordered at VA San Diego (VASD) are often deferred to Community Care; while this process should be smooth and seamless, it is instead challenging to navigate, with inconsistent rates of completion and results often not relayed to patients leading to delayed/missed diagnoses. We applied extensive QI methodology towards overhauling the VASD Community Care Mammogram workflow to improve rates of CC mammogram completion and results released to patients in a timely manner. Methods: We evaluated the CC mammogram workflow and implemented interventions at VASD from 01/2022-04/2023. An A3 was used for tracking process improvement. Using Lean Six Sigma process improvement strategies, we identified several problematic areas within the CC Mammogram workflow that are prone to errors and can lead to patient safety issues. Weekly meetings/interviews were set up to identify pain points with the primary users to allow for continuous process evaluation and improvement. Primary outcome was the frequency with which a CC mammogram order had mammogram completed and result released to patient within the expected timeframe by VISN 22 metrics (BIRADS 0,3,4,5,6 <7 days and BIRADS 1,2 <14 days to notification). Results: Process mapping of the VASD CC mammogram process revealed significant waste and failure modes. Notably among these was the splintered tracking systems used across multiple users and lack of automated follow-up reminders. Multiple PDSAs involved standardizing workflow by developing an SOP that focused on standardization of tracking orders/results, creating automated task reminders, while also adding backup systems and double-checks. To centralize and standardize the patient tracking process, we repurposed the Coordinated Care Tracking System (CCTS), a VA-based tool that is used for tracking patients in other departments and creating reminders for follow up, while storing patient data in a centralized location. We also redesigned and streamlined the mammogram ordering menu within CPRS. Implementation of the above interventions increased monthly rates of mammograms completed and reported to patients in a timely manner from a median of 67.5% to 100% in all BIRADS groups by 10/2022, and sustained at 100% through 04/2023. Conclusions: Standardization of workflow and incorporation of CCTS software into the CC Mammogram process led to an appreciable improvement in rates of CC mammogram scheduling and timely result notifications. Improved tracking of CC mammogram patients has the potential to prevent unnecessary patient harm. It is worth considering whether CCTS and a similar standardized process should be incorporated into other CC programs, as these issues are not unique to VASD mammograms.

Using the Lean and Green Six Sigma Method at PT. XYZ, this Painting Process aims to Reduce Tosou Butsu Alloy Wheel Defects

Aluminium wheels are a significant component of the automotive industry, but opinions about their quality are primarily based on how they look. As a result, finishing is crucial to the production process in the wheel industry. Efforts must be made to reduce the frequency of Tosou Butsu flaws in the painting process, which most frequently occur in the paint section, even though there are still a lot of errors in the wheel production process. Therefore, to lessen the chance of Tosou Butsu faults developing during the wheel finishing process, the Lean & Green Six Sigma technique is applied. Measure, Analyze, Improve, Control, and Define are the five stages of the Six Sigma methodology (DMAIC). Conversely, the Six Sigma level has grown from 3,417?, which was the level before the Sigma was repaired, to 3,750? in Sigma level 3 conditions, or level 4 conditions, with the potential for Tosou Butsu defects to occur at 12104 for a million production processes. Six Sigma is then applied to In this investigation, the painting procedure was able to lower the percentage of Tosou Butsu faults from 0.0276 to 0.0121. In order to optimize efficiency and focus on system mechanisms that align with standard operating procedures and human resource development, the Six Sigma process needs to be applied regularly and refined until the Sigma level reaches 6?.

The performance analysis using Six Sigma DMAIC and integrated MCDM approach: A case study for microlens process in Vietnam

The define-measure-analyze-improve-control (DMAIC) cycle is used by the author in the context of this project to conduct research on optimizing production procedures at a business that manufactures optical components, mainly focusing on visual defects. The DMAIC cycle and techniques for quality control like Pareto charts, and experimental design and MCDM are used in this project's research to lower the error rate in the production process. Multiple criteria decision-making (MCDM) is utilized during the analysis phase of the DMAIC process to aggregate the insights of specialists and attain a more comprehensive understanding of the factors that substantially impact and contribute to microlens manufacturing defects. This enhances the Six Sigma process's agility and dependability. Microlens product is specifically the research object. After applying the DMAIC cycle, the two primary defects identified were contamination and not polishing S1. Implementing the suggested steam ratio and packaging modifications led to a noticeable enhancement. The reasonable daily product rate increased from 69 % to 79 %, saving $1932,367 annually.

Product Quality Improvement of Stainless Steel Round Trash Can with Six Sigma Approach and Fuzzy Analytical Hierarchy process Method at PT. XYZ

PT. XYZ is a manufacturing industry that produces various cleaning equipment. One of the products that has a high level of defects are trash bins made of stainless steel. The purpose of this research is to improve the quality of stainless steel waste products. The method used is Six Sigma and Fuzzy Analytical Hierarchy Process. In the Define stage, the types of defects found were body dents, scratches, spots, and rough covers. In the Measure stage, the initial DPMO value obtained is 3.422. In the Analyze stage, the results of the analysis process are defects with the highest Risk Priority Number of 280. The next stage is Improve, where defects with the highest RPN value are prioritized for proposed improvements using Fuzzy AHP. Based on the results of the Fuzzy AHP assessment, it was found that the highest weight was alternative 3, namely the machine must be cleaned regularly after being used at 0.4322, alternative 2, namely the addition of material handling to facilitate product transfer of 0.2048, and alternative 4, namely the establishment of SOPs for product handling. of 0.2041. After the Improve stage, the final stage in the form of Control is carried out to see whether the implementation of the proposed improvements has a positive impact on the company. The DPMO results obtained after implementation were 3.6061.

Leveraging AI and Machine Learning in Six-Sigma Documentation for Pharmaceutical Quality Assurance.

The pharmaceutical industry must maintain stringent quality assurance standards to ensure product safety and regulatory compliance. A key component of the well-known Six Sigma methodology for process improvement and quality control is precise and comprehensive documentation. However, there are a number of significant issues with traditional documentation procedures, including as slowness, human error, and difficulties with regulatory standards. This review research looks at innovative ways to employ machine learning (ML) and artificial intelligence (AI) to enhance Six Sigma documentation processes in the pharmaceutical sector. AI and ML provide cutting-edge technologies that have the potential to drastically alter documentation processes by automating data entry, collection, and analysis. Natural language processing (NLP) and computer vision technologies have the potential to significantly reduce human error rates and increase the efficacy of documentation processes. By applying machine learning algorithms to support real-time data analysis, predictive analytics, and proactive quality management, pharmaceutical organizations may be able to identify potential quality issues early on and take proactive efforts to address them. Combining AI and ML improves documentation accuracy and reliability while also strengthening compliance with stringent regulatory criteria. The primary barriers and limitations to the current state of Six Sigma documentation in the pharmaceutical industry are identified in this study. It examines the fundamentals of AI and ML with an emphasis on their specific applications in quality assurance and potential benefits for Six Sigma processes. The report includes extensive case studies that highlight notable developments and explain how AI/ML enhanced documentation is used in the real world.

Improving Quality Health Care Services by Implementing DMAIC Approach in Paediatric Cardiology Department of Public Hospital of Sindh, Pakistan: A Case Study

Objectives: The hospital industry has changed its dimension from diagnosis to complete total patient satisfaction. This study aims to identify the critical variables that can enhance overall patient satisfaction in the hospital industry. The study identified three critical factors for any hospital to provide quality service. Methodology: The study adopted the lean Six Sigma process improvement methodology to identify the critical service factors in hospitals. Lean Six Sigma is a flexible problem-solving tool that comprehensively solves any problem. DMAIC process improvement methodology is used to define, measure, analyze, improve, and control the overall experience in the hospital. CTQ (critical to quality) was defined and represented by Kano methodology. After filtration through cause and effect analysis, three core dimensions and 25 sub-dimensions of critical quality were identified. The impacts of these 25 sub-dimensions were evaluated and prioritized using the Kano Model of patient satisfaction. This identifies the most critical service requirement. This study is an initiative for service quality improvement in the hospital industry. In the future, this technique can be modified and adopted by different public and private hospitals to enhance the practical implementation. Results: Findings indicate that healthcare organizations demonstrate enhanced system-wide capabilities, optimizing resource utilization. Understanding patient needs propels satisfaction and delight. Three overarching factors, with 25 sub-factors, significantly impact patient satisfaction, predominantly yielding positive effects across the categories. Conclusion: This research concludes that providing quality service is critical in the hospital industry. Quality service is pivotal in the evolving hospital industry, transitioning from a focus on diagnosis to holistic patient satisfaction. This study aims to identify critical variables essential for enhancing overall patient satisfaction, pinpointing key factors crucial for delivering quality service in any hospital.

Lean Six Sigma implementation in medical school.

426 Background: While medical schools teach advanced medical, surgical, and radiation interventions in oncology, we often don’t teach students how to identify deficits in existing modalities and methodically implement change. Medical students are underexposed to concepts of QI, and many medical educators feel that tools like Lean Six Sigma are too advanced or esoteric for student involvement. A gap exists to create a QI curriculum that invites medical student engagement, while also allowing them to develop self-efficacy to begin a lifelong career of continue process improvement in medicine. Methods: We previously demonstrated that a Value-based Care competition, can serve as a medical school QI curriculum with high levels of student engagement in both local and national competitions. Teams of students collaborate with key stakeholders at their hospital to implement QI projects through the Lean Six Sigma process improvement methodology. This competition is currently completing its third year, and recruiting for the 4th cycle. We performed a multi-year review of student engagement, the degree to which students progressed down the steps of Lean Six Sigma, and the outcomes of QI projects developed through these competitions. Results: For the 2022-23 competition cycle, six medical schools across the country (MCG, UCSD, Florida State University (FSU), Baylor, Penn State, and even internationally at the University of Queensland ran local competitions, representing a 50% growth over the previous cycle (four schools total in 2021-22). Of these schools, four of them are now participating in the National Competition to implement their projects using Lean Six Sigma; representing a 33% growth compared to last year (three schools total in 2021-22). In terms of implementation tools, students have successfully achieved IRB approvals, development of implementations timetables, defining and measuring controls and outcomes, and recruiting patients. Conclusions: Despite being busy with many other components of their medical education, and despite the entirely voluntary nature of the competition, there continues to be a strong appetite amongst medical students to participate in quality improvement. Students have demonstrated their willingness and ability to learn and implement QI projects using Lean Six Sigma. We have also employed a ‘see one, do one, teach one’ model of peer mentorship to create a sustainable multi-year, multi-school, and now multi-national curriculum that continues to grow.

Enhancing Vessel Segment Extraction in Retinal Fundus Images Using Retinal Image Analysis and Six Sigma Process Capability Index

Enhancing Vessel Segment Extraction in Retinal Fundus Images Using Retinal Image Analysis and Six Sigma Process Capability Index

Analisis Pengendalian Kualitas pada Produk Batang Rokok Sigaret Kretek Mesin (SKM) Menggunakan Metode Six Sigma dengan Pendekatan DMAIC di PT. XYZ

This study aims to determine the causes of defects in Kretek cigarettes at PT. XYZ, and how to minimize defects in Kretek cigarettes using the DMAIC approach at PT. XYZ. Data analysis was performed using the six sigma concept, which includes DMAIC. The research results are (1) the causes of defects or defects consist of 4 factors: humans, methods, materials, and the environment. The human factor is that operators leave the machine during production fatigue and lack concentration. The method factor is not checking raw materials and the lack of instructions. Material factors include raw materials or materials of poor quality with the category of non-sticky glue and dislodged filters, and for environmental factors, there is engine noise and ambient temperature. (2) The results of the analysis of the DPMO Sigma Quality Level and Process Capability values for cigarette stick products with an attribute defect in the form of non-sticky glue produce an average DPMO value of 550716.8432 with a sigma level of 1.38. In contrast, the attribute defect in the form of Dislodged Filters produces an average DPMO value of 234511.2977 with a sigma level of 2.23. These results are categorized as low process capability, so their performance needs to be improved. Thus, recommendations for appropriate corrective actions are given, namely by providing training and training to workers. They offer directions in strengthening SOPs for checking raw materials, improving the quality standards of raw materials received, and equipping workers with equipment such as masks and ear plugs as well as higher concentrations during the production process so that defects can be minimized.

National Value-Based Healthcare Competition for Medical Students

Background Although we have amazing tools like immunotherapy and radiation therapy to offer our patients, all too often the process of delivering this world-class care simultaneously burdens our patients. Medical school curriculums are only beginning to appreciate the importance of including value-based care education in their curriculums. As future physicians, it is our responsibility to contribute to solving these deficiencies in our process, but to do so we need to build educational tools that expose us to these concepts, is engaging enough to justify devoting ever limited time in medical school, and empowers us to be able to act. Methods Our team designed and implemented a National Value-based Care competition, that provides a longitudinal curriculum for students to voluntarily learn about value-based care through three components: 1) Local School Competition, 2) National Competition, 3) Peer mentorship/leadership. In the first phase, the local school competition, teams of 4-5 medical students review a standardized patient case (based on a real patient), identify value deficits in the process, explore one specific value deficit in detail and propose a solution. In the National Competition, the winners from each school, compete to implement their solution and collaborate with key stakeholders at their hospital through the Six Sigma process improvement methodology. Finally, the winners from each school become the mentors and local competition organizers for the next year. Results In our first year, we focused on our own medical school (MCG), and had 6 teams of students representing 28 students from the M1 and M2 classes submit their final project. We received positive feedback from the students, their faculty mentors, as well as the faculty judges. We then exported, including 4 schools: MCG, Florida State University (FSU), Baylor, and Penn State. Across the four schools we had 30 teams participate representing 134 medical students. The top three winning teams all produced real world projects that were either IRB approved or seeking IRB approval. Discussion We created a case competition that increased engagement with key value-based healthcare concepts for students. It is worth noting, that participation was entirely voluntary, so our results suggest students across multiple school are interested in these topics and even willing to see a project all the way through when provided an engaging and incentivizing process. We are now training the next generation of student competition organizer to prepare for the next set of local and national competitions. Although we have amazing tools like immunotherapy and radiation therapy to offer our patients, all too often the process of delivering this world-class care simultaneously burdens our patients. Medical school curriculums are only beginning to appreciate the importance of including value-based care education in their curriculums. As future physicians, it is our responsibility to contribute to solving these deficiencies in our process, but to do so we need to build educational tools that expose us to these concepts, is engaging enough to justify devoting ever limited time in medical school, and empowers us to be able to act. Our team designed and implemented a National Value-based Care competition, that provides a longitudinal curriculum for students to voluntarily learn about value-based care through three components: 1) Local School Competition, 2) National Competition, 3) Peer mentorship/leadership. In the first phase, the local school competition, teams of 4-5 medical students review a standardized patient case (based on a real patient), identify value deficits in the process, explore one specific value deficit in detail and propose a solution. In the National Competition, the winners from each school, compete to implement their solution and collaborate with key stakeholders at their hospital through the Six Sigma process improvement methodology. Finally, the winners from each school become the mentors and local competition organizers for the next year. In our first year, we focused on our own medical school (MCG), and had 6 teams of students representing 28 students from the M1 and M2 classes submit their final project. We received positive feedback from the students, their faculty mentors, as well as the faculty judges. We then exported, including 4 schools: MCG, Florida State University (FSU), Baylor, and Penn State. Across the four schools we had 30 teams participate representing 134 medical students. The top three winning teams all produced real world projects that were either IRB approved or seeking IRB approval. We created a case competition that increased engagement with key value-based healthcare concepts for students. It is worth noting, that participation was entirely voluntary, so our results suggest students across multiple school are interested in these topics and even willing to see a project all the way through when provided an engaging and incentivizing process. We are now training the next generation of student competition organizer to prepare for the next set of local and national competitions.

Impact of Six Sigma Practices on Teaching-Learning Effectiveness: A Case Study of the University of Okara

The study aimed to assess the impact of implementing Six Sigma practices on teaching effectiveness. This exploratory research, conducted at the University of Okara, centred on teachers from various departments. Qualitative data was gathered via semi-structured interviews and analyzed using thematic analysis. The findings revealed that faculty members were unintentionally addressing three phases (define, measure, and analyze) of the Six Sigma process due to a lack of awareness. Students were knowledgeable about their educational standards and rights, and their issues were addressed when communicated. However, the remaining two phases (improvement and control) of Six Sigma were neglected by university teachers, with quantity taking precedence over quality. Teachers acquainted with Six Sigma practices demonstrated greater teaching effectiveness. The study recommends raising awareness among teaching staff about Six Sigma practices and ensuring their implementation for better outcomes. Expanding the data collection scope for result triangulation is also suggested.

Measurement of Process Capability of Manufacturing Process of Levetiracetam by Applying Concept of Six Sigma

Abstract: Background: A process capacity study is a study that uses capability indices to compare the output of an in-control process to specification constraints. Cp, Cpk, Ppk, and Pp are some of the statistics that can be used to assess process capability. The goal of the six-sigma study of levetiracetam tablets is to enhance and adjust the process to produce defect-free tablets and to maximize customer satisfaction. Process capability guarantees that procedures meet industry firm specifications while lowering process variation, which is essential for obtaining product quality characteristics. Before the batch is commercialized, this capacity research should be used in the industry. It is a cost-effective strategy that can shorten the inspection process. Materials and Methods: The control and capabilities of Antiepileptic tablets are described in this study. The research focuses on data collecting and analysis of process capability utilizing statistical software such as MINITAB 19.1. Results: The results of process capabilities for all the processes like hardness test, thickness test, disintegration test, loss on drying and friability tests were found to be above 1.33. Conclusion: The existing capability of the process is judged to be capable in this research. Keywords: DMAIC phases, Epilepsy disorder, Levetiracetam, Process capability index, Six sigma process.

Medical University of South Carolina case study: A structured approach to improving quality metrics for achieving maximum pay-for-performance incentive payments

To get healthcare costs under control and ‘bend the cost curve’, the Centers for Medicare & Medicaid Services is driving a shift from the fee-for-service (FFS) reimbursement model, which rewards quantity over quality, to value-based care payment models that encourage efficient delivery of high-quality, lower-cost care. Commercial payers are also shifting away from FFS and tying payment to quality metric scores and performance. The Medical University of South Carolina (MUSC) participates in one of the state’s largest pay-for-performance (P4P) initiatives. The payer uses a scorecard that assigns points, associated with incentive dollars, for meeting or exceeding benchmarks in publicly reported quality metrics. In late 2020, MUSC and ECG Management Consultants partnered to assess MUSC’s flagship hospital performance, analysing historical scorecard performance and improvement opportunities. MUSC’s biggest challenges included clinical practice variation, data accessibility and competing priorities, particularly during the COVID-19 pandemic. The hospital was leaving money on the table for process and outcomes measures for harm avoidance and patient safety, unplanned readmissions and appropriate use of emergency department and outpatient cardiac imaging. To overcome quality improvement (QI) barriers, multidisciplinary workgroups were established for each of the focus areas. Workgroup participants used MUSC’s IMPROVE methodology, incorporating Lean, Six Sigma and continuous process improvement best practices to effect change. From this foundational, structured QI approach — focused on a select group of metrics — MUSC is projected to earn US$11.6m in incentives between fiscal years 2023 and 2025, while improving clinical outcomes and patient safety. MUSC will apply the critical success factors and lessons learned to other QI opportunities across the entire MUSC Health system as the organisation strives to reduce process and outcome variability. Hospitals and health systems that engage in efforts similar to those undertaken in the ECGMUSC collaboration can build a foundation of strong QI capabilities and realise improved incentive payment dollars under P4P arrangements.

Impact of the implementation of the Lean Six Sigma process within Moroccan environmental SMEs

Lean Six Sigma is a management approach used to improve the efficiency, quality and performance of processes within companies. When applied to environmental businesses in Morocco, Lean Six Sigma can bring several significant benefits. Lean Six Sigma aims to eliminate waste, inefficiencies and non-essential processes. By applying it to Moroccan environmental companies, it is possible to optimize operations, improve productivity and reduce costs. That can contribute to more efficient use of resources and better management of projects. Environmental companies have the primary mission of minimizing their impact on the environment. Applying Lean Six Sigma can help identify sources of pollution, reduce waste, improve energy efficiency and promote sustainable practices. That helps build their environmental credibility and meet stakeholder expectations. Lean Six Sigma emphasizes customer satisfaction and product or service quality. By integrating this approach, Moroccan environmental companies can improve their production processes, eliminate defects and errors, and provide better quality products and services to their customers. That can promote customer loyalty and increase their competitiveness in the market. The application of Lean Six Sigma within environmental companies in Morocco can bring significant benefits, such as improved operational efficiency, reduction of environmental impacts, improving the quality of products and services, strengthening the culture of continuous improvement and developing employee skills. This is the case that we have dealt with in This article in order to measure the Impact of the implementation of the Lean Six Sigma process within Moroccan environmental SMEs. By adopting That approach, Moroccan environmental companies can strengthen their competitiveness, environmental sustainability and ability to meet stakeholder expectations.

PSUN219 Increasing Frequency of Hemoglobin A1c (Hba1c) Measurements in Hospitalized Patients With Diabetes: A Quality Improvement Project Using Lean Six Sigma

Abstract Background Studies have shown the predictive value of hemoglobin A1c (HbA1c) on inpatient glycemic control, and its value for discharge planning. There is little data on HbA1c testing adherence to American Diabetes Association (ADA) guidelines among inpatient providers, and anecdotal evidence suggests that most inpatient providers do not have a standardized approach to HbA1c measurement. The Lean Six Sigma method is a management system that originated in the automobile industry and has become widely used in healthcare to improve the efficiency of processes. The objective of this study was to determine the impact utilizing Lean Six Sigma methodology to increase frequency of HbA1c measurements among hospitalized patients with a known history of diabetes, in line with ADA guidelines. Methods This was a quality improvement study performed in a 240-bed community hospital, evaluating inpatients (≥16 years) consecutively admitted with a diagnosis of diabetes (ICD-10 code E8-E13 and O24) between January 2016-June 2021. Patients were excluded if they had a HbA1c in the health system electronic health record (EHR) in the prior 3 months. The Lean Six Sigma approach was utilized to define the problem and implement solutions. The intervention bundle delivered between November 2017 and February 2018 included 1) provider and nursing education on the utility of HbA1c in patient care, 2) change in laboratory protocols for more rapid turnaround of HbA1c, 3) modifications to the EHR including a glucose management tab and insulin order set that included HbA1c. Hospital encounter and patient-level data were extracted from the EHR via bulk query. Demographic characteristics were calculated. Frequency of HbA1c lab sent while inpatient was compared pre- (Jan 2016-Nov 2017) and post-intervention (March 2018-June 2021) using chi-square analysis. Results 17,869 patients were included (7,332 pre- and 10,537 post-intervention). Demographics did not differ between pre and post intervention periods (mean age [range]: 78.1 [16-106] years, sex: 52.3% male, race: 52.1% White, 25.1% Black). Only 53.5% of patients who met criteria had a HbA1c measured during hospitalization before intervention. This frequency increased to 70.2% postintervention. The improvement in the frequency of HbA1c measurement was sustained more than two years following the initial interventions and continued to improve over time. Conclusion This novel approach was successful in improving adherence to guideline-based measurement of HbA1c in hospitalized patients. This is the first quality improvement project in a community hospital utilizing the Lean Six Sigma process for this purpose and may represent a valuable methodology for community hospitals to improve inpatient diabetes care. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

The reliability and process capability assessment of suspended growth sewage treatment plant in Melaka, Malaysia.

This paper presents the promising method of synchronizing the Six Sigma and reliability analyses at 15 sewage treatment plants (STPs) operating in Melaka, Malaysia. Five different suspended growth treatment technologies in various capacities were investigated. The sequential batch reactor (SBR) and extended aeration activated sludge (EAAS) processes, conventional activated sludge (CAS), aerated lagoon (AL), and oxidation pond (OP) were compared using innovative Niku's treatment reliability and Six Sigma process capability method for biological oxygen demand (BOD5), chemical oxygen demand (COD), total suspended solids (TSS), oil and grease (O&G), and ammoniacal nitrogen (NH3-N) effluent parameters and justified the importance of understanding the lognormal behavior of the effluent parameters in interpreting the performance monitoring results and discharge compliance. The results showed that the SBR and EAAS systems relatively fulfilled the highest performance (>95%) compared to conventional systems to ensure the high quality of effluent discharge. Although the whole system is incapable of removing nutrients efficiently, ranging between 42.31% and 90.48%, may lead to eutrophication issues. Process modification and treatment control should become a critical priority in order to reduce variability, improve stability, and increase the efficiency of nutrient removal. These initiatives promote global sustainable development goals (SDGs) 2030 and the domestic water sector transformation (WST) 2040 by treatment cost reduction, improving environmental sustainability and guaranteeing social and health benefits.

SMEs in Automotive Supply Chains: A Survey on Six Sigma Performance Perceptions of Czech Supply Chain Members

Six sigma is understood as a technique for the continuous improvement in process quality; however, it has been rarely scientifically analysed in small- and medium-sized enterprises (SMEs). SMEs representthe vast majority of enterprises throughout economies and contribute to automotive supply chains in various tier ranks. As SMEs are known to lack resources and skills while focusing on short-term benefits rather than on long-term gradual improvements, the aim of of this paper is to analyse the perception of six sigma process capabilities in automotive supply chains assuming differences in company size, supply chain rank and six sigma duration. This was tested with Fisher’s exact test. Companies with less than 1000 employees, subsuppliers and companies with a six sigma implementation in the last 3 years struggled to meet six sigma principles, suggesting that mainly small companies inhibit a risk for the supply chain. These findings contribute to the existing theoretical body of knowledge by identifying a three-to-five-year period for six sigma implementations until six sigma maturity. Practically, the findings contribute to the research by explaining the need for a continuous supplier development over a three-to-five-year period until the company meets its performance requirements, with a supply chain risk incorporated in lower-tier ranks and with small companies.