Lean six sigma and stroke in rural hospital – The case of Baruch Padeh Medical Center

Abstract

PurposeThis case study aims to demonstrate the strengths of the Lean Six Sigma (LSS) methodology to improve the acute ischemic stroke (AIS) treatment rates and reduce process lead time at Baruch Padeh Medical Center (BPMC), a rural hospital in the Galilee region of Northern Israel. The LSS project redefined the BPMC stroke care pathway and increased its efficacy.Design/methodology/approachThe LSS methodology was implemented in September 2017 by integrating lean principles and the Six Sigma DMAIC (Define–Measure–Analyze–Improve–Control). Existing procedures, field observation, ad hoc measurement and in-depth interviews were utilized, and the GEMBA method was implemented to identify root cause and improve actions optimizing the stroke pathway.FindingsThe presented case shows the usefulness of the LSS methodology in improving quality performance in a rural hospital. The intervention allowed the BPMC to improve the intravenous tissue plasminogen activator (IV-tPA) administration rate (+15.2%), reducing the process lead time. The lead time of door-to-computer tomography decreased from 52 to 26 min, and the door-to-needle time decreased from 94 to 75 min.Originality/valueThe present case study shows the implementation of the LSS methodology aimed to improve the IV-tPA administration rate and reduce the stroke pathway lead time in a rural hospital. The case demonstrates the potential for the LSS methodology to support the AIS pathway optimization and represents a guide for healthcare organizations located in rural areas.

Advances in Stroke: Quality Improvement

“…Embedding ongoing review of performance data within existing structures of care, strengthening a QI culture, leadership engagement, and incentives that recognize excellent care are strategies that support program sustainability. 2,5 For example, including a clinical champion as part of the sustainability plan was a factor for successful sustainment of gains in transient ischemic attack care quality. 2 Scaling QI interventions that were successful in one setting to other units requires attention to contextual factors that may inhibit or promote program implementation and may involve local adaptations.…”

“…4,12,13,20,25 For processes of care that involve many disciplines, process mapping ideally included staff members from all involved services. 5,13 For example, Hennebry et al 13 included paramedics, telephone operators, clerical staff, laboratory staff, porters, radiographers, nurses, and physicians in process mapping to improve door-to-needle times. Fishbone analysis (sometimes referred to as cause-effect diagramming) was used to identify root causes of quality problems.…”

“…21 The team compositions included individuals from neurology, emergency medicine, radiology, nursing, speech-language pathology, and administrative staff. 5,8,12,13,16 The degree of engagement across team members varied between studies. Across all experimental studies, 1,8,12,13,16 the multidisciplinary QI interventions significantly improved patient care across prehospital, acute, and posthospitalization care.…”

“…Fishbone analysis (sometimes referred to as cause-effect diagramming) was used to identify root causes of quality problems. 5,12,14 Noshad et al 18 used electronic medical record data to both describe a process of care and the degree to which observed care varied from protocols (which could identify subgroups for whom care routinely varies from the ideal).…”

“…However, as in prior years, the overwhelming majority of studies were focused on hyperacute care. Although 1 study was from a rural setting, 5 the majority were from urban settings within developed nations. Many intervention studies reported both consolidated process measure results and an all-or-none metric.…”