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Pursuit of Continuous Improvement in Healthcare
By  Alvin Villegas|Mar 12, 2016|

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Back in 2012, I was confined for a week and a half in a hospital in Manila due to an ailment.  As I’d been away from my kids for a while, I really felt the joy and excitement as the day of my release from the hospital came nearer.  However, on the day of my discharge I was made to wait for 4 hours from the time we started settling our hospital charges.  I was told about the lengthy documentation process and numerous approvals were the causes of the delay.  I was about to wear my Lean Six Sigma hat and on the brink of jumping on the cause(s) of the delay but my condition didn’t allow me to do such.  On the flip side, the services of the hospital weren’t that bad at all while I was confined there.  The nurses carried out their duties pretty well and they seemed to be well trained.  The doctors are equally competent, they explained what I was going through and made me feel confident that I’ll recover from my illness.  It is however sad that the competence of its personnel is not complemented by efficient processes. It would have been a perfect and an excellent patient experience for me if it were not for the long discharge process.

Upon discharge, I was thinking how many more patients of this hospital had the same experience? And perhaps this issue is not unique to just the discharge process and that the same inefficiencies could also be thriving in other processes of this hospital? I may just be a statistic in this hospital, but boy do I know Quality and Value when I see one.

The patient care landscape has changed over the years. The totality of patient experience is now gauged both from the medical capability of the healthcare institution and its ability to serve the patients in an efficient and customer-centric manner.  In a JAMA (Journal of the American Medical Association) article written by a Canadian Doctor in 2011, the basic question of “What Do Patients Really Want from Healthcare?” was explained as that of an end to end service from cure/relief of illness, timeliness of care, kindness of healthcare staff, affordability of the services, and efficiency of processes, among others.  Even though that the study was done in North America, the same patient experience is being desired by our countrymen to exist in healthcare institutions in the Philippines.  But the convoluted array of problems of many healthcare institutions in the Philippines coupled with not knowing what to do and where to start, hound our local healthcare executives.  A silver bullet approach to achieve the gold standard of quality is through the JCI accreditation, but to date only five hospitals in the Philippines have afforded to acquire such accreditation.  What is available, affordable and could be implemented both from a short term and long term perspective that could help healthcare institutions improve the total patient experience is through the practice of Lean Six Sigma. 

Lean Six Sigma has been around for quite some time now.  It started from the manufacturing sector, then progressively moved to the services sector, which includes the Healthcare Industry.  The basic tenet of Lean Six Sigma hinges on the determination of what value is from the clients’ perspective and designing robust processes around these requirements.  This business management approach does not only address the Voice of the Customer (VOC), e.g. Client Satisfaction, but also the Voice of the Business (VOB), e.g. Cost of Operations.  Healthcare management issues such as resource capacity constraints, patient dissatisfaction, eroding sales revenue, staffing shortages, process inefficiencies, etc. are typical themes for Lean Six Sigma implementation. 

A lot of western hospitals have already reaped the benefits of the practice of Lean Six Sigma, below are some examples:

  • Reduction of overtime in a hospital cytogenetic lab from more than 55 hours a week to just 9, producing annual savings of about $93,000 while reducing turnaround time.
  • Shorten wait times in a hospital’s Children's radiology department by reducing MRI wait time by 90 percent - from 25 days to within 2 - by obtaining insurance authorization earlier, streamlining scheduling, and improving coordination between radiology staff and the doctors who sedate children undergoing MRIs. The hospital can now perform more than 112 MRIs a week, up from the previous high of 84, helping to boost revenue.
  • Reduction of excessive wait times in the Emergency Department. Through data collection and analysis, the hospital’s project team found that the average cycle time to treat and release, walk-in ED patients were more than three hours. As a result of the project, improvements were made to the Emergency Department process that not only decreased cycle time by 37%, but also raised patient satisfaction.
        (Source:  www.isixsigma.com)

It is never too late for the healthcare industry in the Philippines to pursue continuous improvement through Lean Six Sigma.  It is also not saying that Lean Six Sigma is the only approach that will help achieve excellence in patient care, but with its appropriate execution combined with other hospital and business management solutions, the elusive vision of providing an affordable, efficient and quality healthcare in the Philippines could be a reality.
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  • NeoMar 21, 2016

    Make sense! :)

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