Using Six Sigma, Lean, and Simulation to Improve the Phlebotomy Process

Six Sigma, lean, and simulation modeling are all popular methodologies, but they have rarely been used together in healthcare process improvement. This study explores how the three can be integrated together, using a process improvement effort in a large hospital to demonstrate the methodology. The system under study is the phlebotomy process in the emergency department of the St. Catharines Site of the Niagara Health System. The process starts when an order for a blood test is placed, and ends when the specimen arrives at the lab. Research outputs occur at three levels of detail. A structured framework integrating the three research methodologies is developed, which may benefit a variety of future hospital process improvement efforts, and could inform quality improvement efforts in other industries (this is the primary generalizable output from this study). In addition, insights are gained into the phlebotomy process—aspects that may benefit phlebotomy improvement efforts in other hospitals. Also, suggestions are made to reduce the flow time (by an average of seven minutes) of the process at the St. Catharines Site.

[1]  Sameh Al-Shihabi,et al.  Reducing waiting time at an emergency department using design for Six Sigma and discrete event simulation , 2010 .

[2]  Randall P. Sadowski,et al.  Simulation with Arena , 1998 .

[3]  J. Cutcher-Gershenfeld,et al.  Lean Thinking , 2019, Encyclopedia of Sustainable Management.

[4]  Alex Mu-Hsing Kuo,et al.  A Healthcare Lean Six Sigma System for Postanesthesia Care Unit Workflow Improvement , 2011, Quality management in health care.

[5]  Arie Hasman,et al.  Application of computer simulation analysis to assess the effects of relocating a hospital phlebotomy department , 2002, Annals of clinical biochemistry.

[6]  Mohamed Al-Hussein,et al.  Simulation application for resource allocation in facility management processes in hospitals , 2007 .

[7]  J. Paauwe,et al.  Toward a conceptual framework for exploring multilevel relationships between Lean Management and Six Sigma, enabling HRM, strategic climate and outcomes in healthcare , 2014 .

[8]  Djoko Setijono,et al.  Decision support system and the adoption of lean in a Swedish emergency ward , 2010 .

[9]  Zbigniew J. Pasek,et al.  Simulation-based verification of lean improvement for emergency room process , 2008, 2008 Winter Simulation Conference.

[10]  J D Polk.  Lean Six Sigma, innovation, and the change acceleration process can work together. , 2011, Physician executive.

[11]  J. McCullough,et al.  Using lean techniques to define the platelet (PLT) transfusion process and cost‐effectiveness to evaluate PLT dose transfusion strategies , 2012, Transfusion.

[12]  Shreeranga Bhat,et al.  Application of Lean Six Sigma methodology in the registration process of a hospital , 2014 .

[13]  Stuart R Lipsitz,et al.  Reduction in specimen labeling errors after implementation of a positive patient identification system in phlebotomy. , 2010, American journal of clinical pathology.

[14]  Milenko J Tanasijevic,et al.  A strategy for optimizing staffing to improve the timeliness of inpatient phlebotomy collections. , 2011, Archives of pathology & laboratory medicine.

[15]  Anuj Saraogi,et al.  Assessing the evidence of Six Sigma and Lean in the health care industry. , 2011, Quality management in health care.

[16]  Ellen M. Goonan,et al.  Applying Lean/Toyota production system principles to improve phlebotomy patient satisfaction and workflow. , 2009, American journal of clinical pathology.

[17]  Robert H Christenson,et al.  Effectiveness of barcoding for reducing patient specimen and laboratory testing identification errors: a Laboratory Medicine Best Practices systematic review and meta-analysis. , 2012, Clinical biochemistry.

[18]  Andrea Chiarini,et al.  Implementing Lean Six Sigma in healthcare: issues from Italy , 2013 .

[19]  Linda Trask,et al.  Barcode specimen collection improves patient safety. , 2012, MLO: medical laboratory observer.

[20]  Rhona J. Souers,et al.  Blood bank safety practices: mislabeled samples and wrong blood in tube--a Q-Probes analysis of 122 clinical laboratories. , 2010, Archives of pathology & laboratory medicine.

[21]  Ana K Stankovic,et al.  Specimen labeling errors: a Q-probes analysis of 147 clinical laboratories. , 2008, Archives of pathology & laboratory medicine.

[22]  K. Narasimhan,et al.  An Introduction to Six Sigma and Process Improvement , 2008 .

[23]  Thomas R Rohleder,et al.  Modeling patient service centers with simulation and system dynamics , 2007, Health care management science.

[24]  Zoe J. Radnor,et al.  SimLean: Utilising simulation in the implementation of lean in healthcare , 2012, Eur. J. Oper. Res..

[25]  Elizabeth A Wagar,et al.  Patient safety in the clinical laboratory: a longitudinal analysis of specimen identification errors. , 2006, Archives of pathology & laboratory medicine.

[26]  Maureen Swick,et al.  Application of Simulation Technology to Enhance the Role of the Professional Nurse , 2012, The Journal of nursing administration.

[27]  Robin Moore,et al.  Use of lean and six sigma methodology to improve operating room efficiency in a high-volume tertiary-care academic medical center. , 2011, Journal of the American College of Surgeons.

[28]  Antonio Costa,et al.  Linking Six Sigma to simulation: a new roadmap to improve the quality of patient care. , 2012, International journal of health care quality assurance.

[29]  Catharine B Fairbanks.  Using Six Sigma and Lean methodologies to improve OR throughput. , 2007, AORN journal.