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Healthcare planning: Lean Six Sigma by stealth?

Tony Virtue, senior healthcare planner at Essentia Trading Ltd, based at Guy’s and St Thomas’ NHS Foundation Trust, discusses important concepts in health management. He argues that some of the tools and techniques used in Healthcare Planning are similar to those used in Lean Six Sigma.

What is Healthcare Planning? 

Healthcare Planning is the integration of a range of skills to achieve solutions that are aligned to objectives, are clinically and financially sustainable and that create high-quality environments for patients and staff. Healthcare Planning is commonly deployed across a wide area of healthcare provision, including acute, community, primary care and mental health. The depth of Healthcare Planning is also large, ranging from high level strategic reviews of clinical services, to developing detailed operational policies at the commissioning stage of projects. 

What is Lean Six Sigma? 

Lean Six Sigma is actually a composite of two methodologies (Lean and Six Sigma), both of which can be used to help make process design and operations more efficient. Though they overlap in a number of areas, they have different focuses. Lean has a big focus on the elimination of waste (non value added items) within a process, whilst Six Sigma focuses on variance reduction within a process. One key Lean concept – how well-designed systems use ‘pull effects’ to streamline flows – is highly relevant to healthcare. Just think of discharge planning, operating theatre scheduling or the movement of patients through an emergency department. 

Healthcare Planning links to Lean Six Sigma 

Healthcare Planning regularly uses flow and process mapping and adjacency planning to help define and optimise flows of people, materials and processes within a healthcare setting. In addition, Healthcare Planning uses a range of analytical tools such as demand and capacity and simulation modelling to analyse process waits, movement, transportation and inventory issues. As illustrated in Figure 1, these Healthcare Planning tools often overlap the seven classic Lean waste issues: transport; inventory; movement; waiting and delays; over-production; over-processing; and defects. 

As stated above, the Healthcare Planning role often includes strategic elements. Strategic elements (activities) include development of documents such as business cases, strategic plan/design briefs, supported by a range of stakeholder meetings and engagements. These Healthcare Planning functions are similar to the classic Six Sigma improvement process, namely: process definition; process measurement; analysis of process; improving the process; controlling the process; and transferring (implementing) the process. Table 1, below, illustrates the interrelationships between key Healthcare Planning Processes and the Six Sigma Improvement Process. 

Both Lean and Six Sigma have concepts of value as a key criterion. Value here might be described as services designed for the customer (good clinical outcomes), designed for efficient provision of service and at the right cost. A key element of Healthcare Planning is the development of high-quality models of care to ensure good clinical outcomes for patients. High-quality models of care in healthcare are founded on evidence-based information, one of the core principles of Six Sigma. 

Bringing it all together – model development 

The ‘process measurement’ phase within a project is a key element for both Lean Six Sigma and Healthcare Planning – but as a modeller I would say that wouldn’t I? Process measurement feeds the evidence-based analysis and the development of robust quality processes – a key element in Six Sigma. Often, the collection of data can provide valuable insights into the existing process flows. A key output of the process development phase is often model development. Quantitative analysis is a key Healthcare Planning role. Techniques such as demand and capacity, scenario modelling and simulation modelling are often used by Healthcare Planners to develop size and space requirements. 

Summary 

This article has illustrated that many tools and techniques used by Healthcare Planning are similar to those commonly used in Lean and Six Sigma – see the relationship diagram in Figure 2 on p97. 

Essentia Trading Ltd (ETL) and its highly skilled team of Healthcare Planners understand Healthcare Planning and the linkages between Lean Six Sigma and healthcare. The ETL Healthcare team (drawn from backgrounds including medicine, architecture, finance, engineering and operational research) have accumulated many years implementing Lean Six Sigma type tools and techniques in a wide range of healthcare settings. Examples include the recent use of Lean criteria to evaluate design proposals for Dublin’s New Children’s Hospital, which identified opportunities for improvements in flows and elimination of waste. Perhaps Healthcare Planning has and does deploy Lean Six Sigma by stealth. But, if these are good effective tools for the planning of healthcare, is that such a bad thing?

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