Re-Engineering of Discharge Process with Emphasis on Sustainability:A Six Sigma Approach

A quality improvement initiative is incomplete if the improvement is not sustained. The concept of sustainability is not limited to achieving the change and adhering to it, but further commitment is required from the staff for continuous improvements in the organization. The application of Six Sigma for process efficiency and achieving break through results are quite obvious, but evidence on its sustainability is limited. So, the current study was designed to re-explore the applicability of Six Sigma to re-engineer the discharge process with emphasis on determinants of sustainability factors. The methodology chosen was DMADV approach of Six Sigma. Define phase involved scrutinizing the finer details of process and resources utilized. The mean Turn-Around Time was measured for credit (269 mins) and cash (241 mins) patients using a time motion study. The NHS sustainability model was utilized for assessing the existing sustainability score of process. Minitab and Minitab Companion software was used for analysis of process capability and value stream metrics analysis. The process was re-engineered by streamlining the activities based on the standards given by NABH 4^th Edition, JCI 6^th Edition and best practices followed in different healthcare settings. Specific roles and responsibilities of staff were re-defined for the improved process. Failure Mode and Effect Analysis and control and impact matrix was conducted and provided to process stakeholders for ease of implementation. Validation of process improvement was done by value stream metrics analysis and discussion with the hospital administrator. The outcomes of the study were simplified process and discharge pro-forma which can be further utilized for application of Six Sigma in similar healthcare settings.