Structured Syncope Care Pathways Based on Lean Six Sigma Methodology Optimises Resource Use with Shorter Time to Diagnosis and Increased Diagnostic Yield

Abstract

AimsTo conduct a pilot study on the potential to optimise care pathways in syncope/Transient Loss of Consciousness management by using Lean Six Sigma methodology while maintaining compliance with ESC and/or NICE guidelines.MethodsFive hospitals in four European countries took part. The Lean Six Sigma methodology consisted of 3 phases: 1) Assessment phase, in which baseline performance was mapped in each centre, processes were evaluated and a new operational model was developed with an improvement plan that included best practices and change management; 2) Improvement phase, in which optimisation pathways and standardised best practice tools and forms were developed and implemented. Staff were trained on new processes and change-management support provided; 3) Sustaining phase, which included support, refinement of tools and metrics. The impact of the implementation of new pathways was evaluated on number of tests performed, diagnostic yield, time to diagnosis and compliance with guidelines. One hospital with focus on geriatric populations was analysed separately from the other four.ResultsWith the new pathways, there was a 59% reduction in the average time to diagnosis (p = 0.048) and a 75% increase in diagnostic yield (p = 0.007). There was a marked reduction in repetitions of diagnostic tests and improved prioritisation of indicated tests.ConclusionsApplying a structured Lean Six Sigma based methodology to pathways for syncope management has the potential to improve time to diagnosis and diagnostic yield.

Lean Six Sigma: a new approach to the management of patients undergoing prosthetic hip replacement surgery

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“…The key point of LSS is to treat all work as a process, analyze the factors that affect quality by using quantitative methods, then identify and improve the critical factors to achieve a higher percent of pass or customer satisfaction . There is a well‐known potential for the productive use of LSS in healthcare . The process of cesarean section reduction is complex, requiring the coordination of several different groups including pregnant women, obstetricians, anesthetists, and midwives.…”

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“…7-9 LSS originated from Motorola in the 1980s and is increasingly used in the healthcare field. [2][3][4]6,8,[10][11][12] In our hospital, the cesarean section rate was found to increase…”

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“…For these reasons, we will focus on the Model for Improvement, with some Six Sigma and Lean tools described in subsequent articles. This overlap in methods and tools emphasizes that these three frameworks have many similarities, despite their differences (Table 1), and successful quality improvement usually requires the application of multiple tools from each of the different frameworks (39,40).…”