Control Phase for a Six Sigma Healthcare Emergency Department Project




Malhotra, Sheetal

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This project involved application of Six Sigma tools and methods to improve the emergency department processes by decreasing length of stay and increasing patient satisfaction. The Gallup poll patient satisfaction survey at the hospital showed patients were dissatisfied with the amount of time taken in the Emergency Department (ED). A potential decrease in the patient wait time and increase in revenue was realized to answer both the Voice of the Customer and the Voice of the Business. Using Six Sigma tools and techniques, Define, Measure, Analyze, Improve and Control (DMAIC), the process was closely studied and the key problem areas were identified. The current controls for the above factors were reviewed and actions were recommended for improvement. The project also included visits to Emergency Departments of other hospitals in the region in an effort to understand how similar problems were being addressed. After the recommended changes had been in place for one month, data analysis showed an improvement in patient satisfaction and decreased waiting times in the ED. The process requires continuous efforts at improvement and monitoring to maintain the improved service at the ED. After a control plan was put into place, the hospital staff that were a part of the process improvement team would be solely responsible for maintaining the improved status. It is sometimes seen that without professional motivation and guidance, the staff may become too busy or not stay motivated enough to regularly monitor the ED processes and stop the ED from slipping back to the prior state. Similar data collection and analysis was completed after the changes had been in place for six months to study the effectiveness of the control phase in terms of patient length of stay, patient satisfaction and revenue earned by the hospital. The financial data for the months of October 2003 to August 2004 were obtained and used to analyze the economic impact of the Six Sigma process improvement project. The analysis showed that there was a significant decrease in waiting time after the changes had been in place one month and this improvement continued to be seen even after six months. Differences in length of stay were seen in the total length of stay, the time from triage to ED bed and from ED bed to discharge or admission. For both the Minor Emergency Clinic (MEC) and the non-MEC patients, a difference was seen in the time that the patient was in the ED bed. No differences were seen for any processes before the patient reached the ED bed. When the LOS for the MEC and the non-MEC patients was compared before and after the changes, a significant difference was seen for the nonMEC patients suggesting that the process had become faster. A difference was seen in the total length of stay, time taken from Triage to ED bed and time in the ED bed till discharge. These changes were reflected in the increased patient satisfaction ratings for the months after the changes had been brought about and also in the increased revenue that the ED generated due to improved and faster processes. The hospital had an increase in monthly ED earnings of $250,212 from October 2003, (when the project was started) to April 2004 (mean earning per patient = $719.97), when the changes had been in place for a month. The revenue showed an increase of $461,633 between the months of October 2003 (with a mean per patient = $ 576.00) and August 2004 (mean earning per patient = $756.58), when the changes were in place for six months. Also, it was seen that due to the improved process after the changes had been in place for six months, there was a steady rate of increase in revenue as seen from the fact that there was an increase in the total monthly earnings in August 2004 as compared to April 2004 ($211,421).



six sigma, hospitals, emergency services, quality control standards, healthcare


Malhotra, S. (2004). Control phase for a Six sigma healthcare emergency department project (Unpublished thesis). Texas State University-San Marcos, San Marcos, Texas.


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