FOCUS: Organizational Improvement/Project Management

The manufacturing industry has been using Lean Sigma for years in pursuit of continuous improvement to obtain a competitive advantage.The objectives of these efforts are to use the Lean techniques for reducing cycle times and the Six Sigma concepts for reducing product defects.The Iowa Business Council with several advocates worked with the University of Iowa Hospital and Clinics (UIHC) and two other Iowa hospitals to determine whether Lean Sigma is adaptable in healthcare.A team of 15 people at UIHC used the Kaizen Breakthrough Methodology over a five-day period in an aggressive identification and elimination of non-value added activities in Radiology CT scanning.The results exceeded the initial project objectives and indicated that Lean Sigma is applicable in healthcare. Overall, the Lean Sigma project increased revenue by approximately $750,000 per year.The Kaizen process proved to be successful and interesting.Within three days, the team installed new workflow processes.This implementation-oriented approach is what differentiates Lean Sigma from other quality improvement processes. FOCUS: Organizational Improvement/Project Management 40 Journal of Healthcare Information Management — Vol. 19, No. 1 healthcare. The University of Iowa Hospital and Clinics (UIHC) hosted the event and chose to review computerized tomography (CT) scanning processes as a test project. UIHC, located in Iowa City, serves as the teaching hospital and comprehensive healthcare center for Iowa. It is one the nation’s largest university-owned teaching hospitals and annually records more than 740,000 clinic visits and in excess of 41,000 patient admissions. Maytag and Pella, with the support of TBM Consulting, have been using the Lean Sigma approach for several years in their manufacturing operations. The UIHC team was led by the expertise from these organizations through the Lean Sigma process during the course of the project. The overall goal established by the project sponsors, the head of radiology, and chief operating officer, was to eliminate a two-week lag time in scheduling outpatients for CT scans and having to refer patients to another facility, in some cases. To accomplish this goal, measurable objectives were set to increase throughput of the CT scanners by 5 percent and to reduce overall patient cycle time by 15 percent. A total of 15 people formed a Kaizen cross-functional team; one third of them had working knowledge of radiology processes, another third had general support knowledge, and the rest were from outside the radiology environment. There were two levels of leadership identified for the team. The first was a team leader from outside the process who was familiar with the Kaizen approach for coordinating, directing, and assigning activities. The second, very familiar with internal processes, was a sub-leader from within the radiology area. Two weeks before the weeklong process started, the team received manuals from TBM Consulting on Kaizen concepts and documentation on the project’s goals and objectives. The rest of this article outlines the weeklong Kaizen daily objectives as outlined by TBM Consulting and the day-to-day activities of the team, with the goal of understanding the Kaizen concept of creating incremental adjustments in processes for increasing quality and efficiency. Day 1: Project Kick-off and Expectations The Kaizen methodology objectives for the day were: • Introduce Lean Production and Six Sigma for creating Lean Sigma Transformation. • Receive conceptual training on Kaizen business processes, methodologies, tools, and techniques. • Discuss an overview of the project assignment from project sponsors. After team member introductions, the day began with a discussion of expectations and an educational session on the tools. Team members learned about the Kaizen experience (the word Kaizen comes from two Japanese symbols representing “change” and “good”), starting from its roots in Deming’s work at Toyota in the 1960s to its infiltration of the U.S. manufacturing market in the early 1980s. Many of the tools introduced were familiar to people who had been involved with quality improvement activities. The tools help create flowcharts, spaghetti maps, and quality maps, as well as assist in conducting time measurements. Because Lean Sigma requires participation from people with different levels of process improvement experience, the initial training ensured that all team members were equally knowledgeable. Although the tools used were not necessarily new, many had not heard of the Kaizen methodology, which promotes creating the “good changes” over a very short, intense period. Except for the initial kickoff meeting and the final day of reporting, team members were required to dedicate all their time to the project over three days using the Kaizen methodology. Our project, as well as those of the other hospitals involved, required the team to spend approximately 12 hours a day using the approach. For an industry that sometimes takes weeks or months to gather data and analyze a situation before making recommendations, this timeframe seemed difficult. The short timeframe caused several on the team to wonder whether this process would really work. Day 2: Getting Down to Reality The Kaizen methodology objectives for the day were: • Educate the team on the project. • Create an understanding of the existing workflow process and the time required to perform process steps. • Create an understanding of the information flow and actual travel routes to make processes work. • Identify value-added vs. non-value added activities. • Create an ideal workflow to reduce non-valued activities and variation and to improve quality. • Determine what process improvements could be made. The team assembled at 7 a.m. and started by learning about the Radiology Department and the CT project being studied. The CT scanning department operates five CT scanners, four located in the radiology department and the fifth in the emergency department. Outpatient and inpatient procedures were scheduled for the four scanners in radiology, while the emergency department device handled emergency patients and overflow work from the “...Kaizen methodology, which promotes creating the ‘good change’ over a very short,