Implementing Lean Six Sigma in a Kuwaiti Private Hospital

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Purpose: This study used Lean Six Sigma to reduce patient waiting time in a Kuwaiti private hospital obstetrics and gynaecology clinic. Approach: The DMAIC methodology (define, measure, analyse, improve, and control) was used. The ‘define’ stage involved identifying patients’ needs, system capabilities, and project objectives. The ‘measure’ stage assessed the system’s current state through data collection on waiting times. Dunnett’s test, control charts, and process capability analysis were used to ensure data accuracy. In the ‘analyse’ stage, an Ishikawa diagram and Pareto chart were constructed, showing that overbooking appointments, doctors’ unscheduled breaks, and doctors not arriving on time were the root causes of the problem. The ‘improve’ stage used an Arena simulation model to represent current and improved system status. The proposed solutions were implemented and monitored in the ‘control’ stage. Findings: A sigma-level improvement of 300% (0.5 to 2.0) was realized for appointment patients on Saturdays, with a 67% reduction in waiting time. For walk-ins, the sigma level improved by 288% (0.8 to 3.1), with a 55% reduction in waiting time. For weekday appointments, the sigma level improved by 111% (0.9 to 1.9), with a 63% reduction in waiting time. For walk-ins, the sigma level improved by 69% (1.6 to 2.7), with a 46% reduction in waiting time. A cost–benefit analysis estimated the present project value at $656,459, leading to a total of $5,820,319 in savings by 2025. Originality/value: This paper fulfils the need for process improvement, increasing patients’ satisfaction and hospitals’ profitability using Lean Six Sigma.

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The waiting time for patients in outpatient departments of university hospitals is a problem throughout the world. Outpatient departments face increasing pressure to improve the quality of their services through effective appointment scheduling in an effort to reduce waiting time. We analyzed the appointment scheduling system in the Obstetrics Gynecology Department at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, in order to construct a simulation-based decision support (SDS) system for the evaluation and optimization of scheduling rules and waiting time. The SDS system analyzed three various appointment scenarios and examined in comparison with the current situation to determine prioritization rules so that a service guarantee to a maximum number of patients. The system was able to identify a number of critical factors that influenced patient waiting time and the formation of long lines in the clinic. Sensitivity analysis indicated that patient waiting time could be reduced by 26.3% without requiring extra resources. Modifying the scheduling scenarios by adjusting the distribution of patients based on their type (new, follow up,..) for outpatient appointments can significantly improve patient waiting time in the clinic.
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Six Sigma process improvement methodology has been applied to reduce patients' waiting time in an outpatient pharmacy located in a cancer treatment hospital. Data concerning patients' satisfaction has been collected and analysed. Discrete event simulation (DES) model and design of experiments are utilised as a decision support tool to optimise staffing requirements. Throughout the different project phases, various improvement opportunities have been proposed to reduce patients waiting time. Sensitivity analysis was also performed to test the robustness of the processes against possible changes in the availability of staff in the pharmacy. As a result of implementing Six Sigma methodology, patients' waiting time are reduced by 50%.
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Medical and policy literature reports many six sigma applications at specific healthcare organizations. However, there is a lack of studies that investigate the broader status of six sigma in US healthcare systems. The purpose of this paper is to present the results from a national survey of six sigma programs in US healthcare organizations. Through the design, distribution, and analysis of a nationwide survey, this paper assesses the implementation of six sigma in healthcare facilities. Two sets of surveys were designed based on whether an organization has adopted six sigma or not. Findings from this paper indicate the common six sigma projects implemented in healthcare organizations, typical implementation durations, cost benefits, and major barriers in implementation, and so on. This paper is limited by the low-response rate owing to time and budget constraints. Through the dissemination of this paper, it is hoped that more organizations will become interested in this subject and participate in future studies. This work is the first study to investigate the implementation status of six sigma in US healthcare systems. It will share experiences amongst six sigma institutions and promote its application in many institutions. The findings will provide instructive information to six sigma practitioners and researchers, and particularly to health care management.
Conference Paper
This paper describes a simulation based lean six sigma approach to improve the operations in an outpatient eye clinic in Singapore. The concept of the simulation based lean six sigma approach and its application into healthcare industry are examined and illustrated using an example of outpatient eye clinic. The six sigma DMAIC (Define, Measure, Analyze, Improve and Control) phases are adopted to identify opportunities for improvements based on lean tools like Value Stream Mapping. A simulation model is then built for study the systems stochastic behavior during the improvement phase. The experiments based on our model and hypothesis tests are conducted with positive results, showing that the redesigned appointment system is able to reduce patients waiting time by 23.7% in average.
An outpatient clinic is a very complex department to manage. The management of the outpatient department should given greater emphasis on its medical facilities in order to ensure the services provided are in high quality, which conforms to customer or patient satisfaction. Long waiting time for treatment at the department is always the main problem faced by the management, and even worst the consultation time is tremendously shorter than the waiting time. This situation has been a common complaint by the patients and remains to occur even though an appointment system is implemented. The implementation of inefficient appointment and inconsistent service time contributes to the dissatisfaction among patients as well as giving a huge impact to the healthcare's overall operations. Therefore, the purpose of this study is to analyze the multiphase patient flow system in Obstetrics and Gynecology Department (O&G Department) of a specialist centre by developing a simulation model that illustrates the actual patient flow in the department. The Arena 7.0 software package is used to develop the simulation model in order to examine the patient flow, especially the waiting time involved. In addition, 120 questionnaires were distributed to patients to gather direct responds and opinions towards the services provided. The information gathered was used to aid the model improvement process. The result obtained from the simulation model shows that a long waiting time does exist in the system. Based on the developed simulation model, two proposed experimentation are being done to find the right solutions to reduce the patients' waiting time and at the same time enhanced the quality of services of the O&G Department. The proposed experimentation model can be effective to the system and is possible to be implemented in the department.
The importance of aligning any lean initiatives with a company's business objectives is explored. Business purpose always has two aspects - what needs to be done better to satisfy customers and what needs to be done better to survive and prosper as a business. Fortunately, addressing the former issue often solves the latter, but the problem must be precisely determined at the start. With a simple statement of business purpose in hand, it is time to assess the process providing the value the customer is seeking. A process is simply a value stream - all of the actions required to go from start to finish in responding to a customer, plus the information controlling these actions. It is important to remember that all value is the end result of some process and that processes can only produce what they are designed to produce - never something better and often something worse.
Six Sigma, originally initiated by Motorola and General Electric, offers a process improvement strategy that has been successfully applied in manufacturing. Service firms have recently trended toward Six Sigma methodology for internal processes and consumer centric. The paper discusses implementing Six Sigma in the health-care sector. The paper introduces the challenges that face implementing Six Sigma in services, with a special focus on the health-care industry, and the application of Six Sigma in health care. A case study about Mount Carmel Health System’s successful implementation of Six Sigma is presented. Finally, the paper concludes with the potential of Six Sigma in health care.
Reducing waiting time in outpatient services of large university teaching hospital -a Six Sigma approach
  • T Dinesh
  • S Singh
  • P Nair
  • T Remya
Dinesh, T., Singh, S., Nair, P. and Remya, T. (2013), "Reducing waiting time in outpatient services of large university teaching hospital -a Six Sigma approach", Management in Health, Vol. 17 No. 1, pp. 31-37.
Improving outpatient waiting time using simulation approach
  • A Jamjoom
  • M Abdullah
  • M Abulkhair
  • T Alghamdi
  • A Mogbil
Jamjoom, A., Abdullah, M., Abulkhair, M., Alghamdi, T. and Mogbil, A. (2014), "Improving outpatient waiting time using simulation approach", in Al-Dabass, D., Colla, V., Vannucci, M. and Pantelous, A. (Eds), EMS 2014: UKSim-AMSS 8th European Modelling Symposium, IEEE Computer Society, Los Alamitos, CA, pp. 117-125, doi: 10.1109/ems.2014.85. Table VII. Improvement checklist
Corresponding author Yazan Al-Zain can be contacted at: For instructions on how to order reprints of this article
  • R Hughes
Hughes, R. (Ed.) (2008), Patient Safety and Quality: An Evidence-Based Handbook for Nurses, Agency for Healthcare Research and Quality, Rockville, MD. Corresponding author Yazan Al-Zain can be contacted at: For instructions on how to order reprints of this article, please visit our website: Or contact us for further details: