Lean Six Sigma in Aging Services

Lean six sigma is a powerful quality improvement methodology proven to improve efficiency and effectiveness. By combining the never-ending, systemic approach to identifying and eliminating waste of Lean with the principled, data-driven structure of Six Sigma, lean six sigma has the power to rapidly transform healthcare organizations.

Virginia Mason Medical Center and Thedacare began using lean six sigma in early 2000, and the philosophy has quickly made inroads across the acute and ambulatory care sectors. Unfortunately, it has been largely absent from long-term and community-based care, where performance improvement methodologies has remained stalled with older quality assurance-based models. Aside from missing valuable opportunities to improve performance and outcomes, the absence of lean six sigma robs LTC and CBC organizations of a powerful tool in creating vibrant, person-centered homes and communities. Indeed, lean six sigma could be a model for leading culture change projects:

1)      Lean six sigma places residents at the center of thinking. Rather than designing processes based on the needs of an organization or performing work based on worker autonomy, shouldn’t residents determine what we do? In lean six sigma thinking, value is solely determined by the customer—in our case, the resident. To be considered value, the product or service must be something the resident is willing to pay for (either monetarily or some other resource, like time), it must be changed or transformed in some way, and it must be done correctly the first time. To improve value, we must identify what the resident wants (gather the voice of the customer), optimize the process based on what we discover the resident wants (map the value stream and define the flow), and provide it at the right time (establish pull) while recognizing that change is a journey not a destination (continuous pursuit of perfection).

2)      Lean six sigma builds a culture of quality and efficiency. Think of the difference between a goal of zero defects and a goal of 99.9% accuracy: do you want to be the one out of every thousand residents who experiences an adverse event? Of course not! And neither does any resident. Lean six sigma philosophy creates a culture focused on doing the right work at the right time every time. It will reach into every corner of an organization and apply data-driven improvement tools to eliminate errors and waste. Since the methods are always focused on what a resident (or any other customer, for that matter) considers value, lean six sigma can help with any process anywhere in the organization.

3)      Lean six sigma is based on fundamental principles of team empowerment, active leadership, and decision making as close to the resident as possible. So much of culture change work has been on “warming the soil” of communities through staff empowerment, team building and open communication. Quality improvement activities, however, have either remained relegated to management roles or implemented broadly in half-hearted ways: the former is disempowering and the latter is discouraging; neither leads to an adoption of a culture focused on quality and efficiency. The beauty of lean six sigma is that it is based on the following key principles: interdisciplinary teams; resident focus; shared information; safety as a system responsibility; anticipated needs; and continuous waste reduction. Indeed, it’s an entire process improvement methodology rooted in the same principles as culture change!

Now is the right time for providers of aging services to embrace the promise and value of lean six sigma.



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