![]() This is not meant to be an exercise in process-mapping but rather to look at a big-picture problem – long PIA time – and understand how PDSA, Lean, and Six Sigma would each tackle it. The mechanism for flagging to the ED physician that a new patient is ready for physician initial assessmentĮach of these can be further broken down into sub-steps.The process for bringing new patients from the waiting room into the ED once a destination has been determined.Whether patient registration is combined with, or separate from, triage.How many triage nurses are working at this given time. ![]() 4 In doing so, you realize that there many factors impacting PIA time, including (but not limited to): As a first step, you decide to follow the flow of a single patient from walking into the ED waiting room to the time when they are first assessed by a physician, otherwise known as the physician initial assessment (PIA) time. You speak to your ED Chief who suggests that you start by making some observations in order to find opportunities for improvement. You have noticed over the course of your training that wait times have been getting longer, such that by the time a patient is brought into an examination room, the patient has already been in the ED for at least two hours. You are an Emergency Medicine resident on a rotation in the Imaginary Community Emergency Department (ED). 3īecause PDSA, Lean, and Six Sigma could all be used to tackle similar problems, let’s see how they would each work in the same scenario. 2 Unlike PDSA and Lean, which encourage incremental changes, the Six Sigma paradigm encompasses the Define-Measure-Analyze-Improve-Control (DMAIC) methodology, which uses a data-driven approach to solve problems requiring large-scale transformation. Conceivably, once a process is fully optimized with zero waste and perfect value, the application of Lean to that specific problem is finished (although it is virtually impossible to achieve such perfection in healthcare). 1 Lean, on the other hand, seeks to eliminate waste and streamline processes to provide maximum value to the patient. PDSA is an integral part of the larger Model for Improvement (MFI), which we discussed in our previous post. As a result, the cycle of improvement could theoretically continue forever as the improvement team could always target new issues or seek greater improvements (although as we discussed in previous posts, having a defined aim statement will help). The PDSA process is cyclical: the potential for improvement is endless. Here, we will practically apply each methodology to one quality problem to highlight the different applications of each approach. ![]() In our last post, we briefly introduced the theory behind Lean, Six Sigma, and PDSA cycles. Deciding on which one to use requires an understanding of their inherent strengths and weaknesses. Each of them can often be applied to the same quality issue. PDSA, Lean, and Six Sigma are three different frameworks that can be part of your quality improvement armamentarium.
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