A Realist Inquiry to Identify the Contribution of Lean Six Sigma to Person-Centred Care and Cultures

Abstract

A lack of fidelity to Lean Six Sigma’s (LSS) philosophical roots can create division between person-centred approaches to transforming care experiences and services, and system wide quality improvement methods focused solely on efficiency and clinical outcomes. There is little research into, and a poor understanding of, the mechanisms and processes through which LSS education influences healthcare staffs’ person-centred practice. This realist inquiry asks ‘whether, to what extent and in what ways, LSS in healthcare contributes to person-centred care and cultures’. Realist review identified three potential Context, Mechanism, Outcome configurations (CMOcs) explaining how LSS influenced practice, relating to staff, patients, and organisational influences. Realist evaluation was used to explore the CMOc relating to staff, showing how they interacted with a LSS education Programme (the intervention) with CMOc adjudication by the research team and study participants to determine whether, to what extent, and in what ways it influenced person-centred cultures. Three more focused CMOcs emerged from the adjudication of the CMOc relating to staff, and these were aligned to previously identified synergies and divergences between participants’ LSS practice and person-centred cultures. This enabled us to understand the contribution of LSS to person-centred care and cultures that contribute to the evidence base on the study of quality improvement beyond intervention effectiveness alone.

Lean Six Sigma Redesign of a Process for Healthcare Mandatory Education in Basic Life Support—A Pilot Study

“…However, LSS as a process improvement methodology has a focus on developing the capabilities of teams (doctors, nurses, and administrative and support staff) to manage and continuously improve their work [ 61 ]. As a learning organization, the study site also recognizes that when an organization begins to adopt LSS, individual and team-based learning is the focus, not just in the classroom, but in the practice area [ 3 ].…”

“…We found that the approach to the use of LSS within the study site was synergistic with the concepts of respect for persons and staff empowerment, themselves enablers of person-centered cultures [ 61 ]. The development of staff through support and respect is important for their engagement with LSS [ 2 , 3 ], and staff involved in this project advised they felt respected. We also experienced that the approach of giving to employees opportunities for development through the LSS education and training program within the hospital, rather than getting something from them, such as more productivity [ 63 ] is also synergistic with the person-centered value of respect for persons, which is enabled by empowering cultures [ 61 ].…”

“…The hospital supports an onsite education and training academy with links to a university-accredited Lean Six Sigma (LSS) education and training program [ 1 ] to facilitate staff education and training in the use of LSS, which the hospital uses as an improvement methodology. LSS use has demonstrated its usefulness in improving process efficiency and has been shown to have a positive impact on patient outcomes, and patient and staff experiences of care [ 2 , 3 ].…”

“…There was a lack of published research specific to the use of both LSS methodologies concerning mandatory training to draw on for this study. However, the literature reviewed by our team highlighted to us how the LSS methodology and concepts can significantly contribute to identifying non-value adding (NVA) and enhance process improvement [ 2 , 3 , 34 ]. Additionally, it highlighted that cross-functional team training in healthcare supports positive improvement intervention results [ 35 , 36 ].…”

Using Lean Six Sigma to Redesign the Supply Chain to the Operating Room Department of a Private Hospital to Reduce Associated Costs and Release Nursing Time to Care

“…The CTQ is designed to capture the key measurable characteristics of a process or service whose performance standards must be met to satisfy the service user [34] VOC Voice of the Customer Engaging with the customer to gather their feedback about their experiences with and expectations for your products or services [1,2,35] Gemba Observation of the actual process taking place [36] Fishbone Identifies root causes, representing the effect and the factors or causes influencing it [32] 5S…”