Using Lean Six Sigma for Reducing Colorectal Surgical Site Infections
Eldon Kao
The principles of Lean Six Sigma can be applied in all different types of scenarios and industries, from automotive to healthcare. Recently, Lean Six Sigma was used in a collaborative effort from The Joint Commission’s Center for Transforming Healthcare and the American College of Surgeons (ACS) for Reducing Colorectal Surgical Site Infections (SSI).
Surgical Site Infections (SSI) are the second most common healthcare-associated infection (HAI). According to a recent study, SSIs occur in 2%-5% of patients undergoing inpatient surgery, each SSI is associated with approximately 7 – 11 additional postoperative hospital days, and SSIs are believed to account for $3.5B to $10B annually in healthcare expenditures. The opportunity for improvement is clearly justified and the scope was focused on Colorectal SSIs which occur in higher rates in comparison to other surgeries.
Due to the complex nature of the problem, Lean Six Sigma and change management methodologies were used to determine the root cause of the issue and develop corrective and preventive measures. The project took place over two-and-a-half years with seven leading U.S. hospitals participating.
Importance of Standardization
In review of the uncovered contributing factors that increase the risk or likelihood of SSIs and targeted solutions that were developed to mitigate the contributing factors, the overarching theme was standardization. A number of inadequate or inconsistent practices were identified during the project which contributed to increased risks of SSIs. In order to get quality and consistent output, there needed to be a standardized process to ensure all actions are performed to a minimum level. In addition, the report also included an observation that there is no system for logging and distributing “best practices” among peers.
Tips on Sustaining Success
During the project, a number of attributes were identified that were shared amongst the most successful organizations at implementing their improvement solutions. Some of the attributes are listed below:
Emphasis on the use of data to guide and drive improvement decisions and implementations
A committed champion who led the project
A dedicated core team comprised of subject matter experts
Continuous engagement of the core team
Leadership that ensure project members were on task and had support
Many of these attributes are not resource heavy or technical in nature. The takeaway here is that successful implementation of a Lean Six Sigma program involves top-down support and continuous engagement to help build an organizational culture that is mindful of changes and holds everyone accountable for improving their role and responsibilities.
Results
Some of the results quoted were:
45% reduction in superficial incisional SSIs
32% reduction in colorectal SSIs
estimated cost savings of more than $3.7M for the 135 estimated colorectal SSIs avoided during the project period
the average length of stay for hospital patients with any type of colorectal SSI decreased from an average of 15 days to 13 days
Discussion
No matter the industry, the ready adoption of improvement solutions are frequently linked to organizational culture and awareness of Lean Six Sigma methodologies and philosophy as this case study reflects. What are the different ways you have promoted Lean Six Sigma in your organization?
You can view the project presentation in full below: (also available HERE)