Applying Health-Six-Sigma Principles Helps Reducing the Variability of Length of Stay in the Emergency Department

Abstract

ABSTRACT Background Reducing length of stay (LOS) is one of the urgent problems in health care systems worldwide. Popular methods that are used to reduce LOS are the Lean and the 6 Sigma, which in practice result in limited improvements. In this paper we introduce and test a tailored method for implementing the 6 Sigma principles in healthcare (we call H-6S). Methods The study took place within the emergency department (ED) of the "Josephtal Medical Center" in Eilat, Israel. Our analysis focused on the processes of examining and treating patients from admission to ED until discharge home. The analysis was done during the second quarter of 2018. The implementation of the recommendations took place during Q3 2018. The reported results are from Q3 2018 to Q2 2019, compared to the corresponding period in 2017 (experienced team). Results In Q2 2017 LOS was 2.42h ± 2.07h (experienced team, N=9928). In Q2 2018, the LOS was 2.62h± 7.04h (before the H-6S, inexperienced team, N=9484). In Q2 2019 following the intervention it reached 2.3h±1.74h (N=7647). The differences between the SDs of the three periods are significant. Conclusion Implementing H-6S dropped variance of LOS within 3 months and remained low for the whole year. Each new team of physicians who enters the emergency department should be thoroughly instructed as to the routines and expectations of the system from them, which should narrow the differences of previous education between them.