He also questioned how less affluent institutions could marshal the hospitalwide resources necessary to institute Lean/Six Sigma projects.
Dr. Cima responded that the project required very few resources, and that smaller institutions actually may be in a better position to implement Lean/Six Sigma because they are less constrained by bureaucracy.
Dr. Cima acknowledged that the hospital population is unique in its commitment to the success of the institution, as opposed to individual productivity, but added that there are advantages for employees to come together in smaller settings like ambulatory, outpatient surgical practices. For example, surgeons may be able to return to the clinic earlier and see more cases if the surgical suite is more efficient.
"One of the efforts that has to be brought out to bring people together is to make sure everyone knows what they want out of it and what they are willing to give up," Dr. Cima said. "It is a collaborative effort."
During the discussion, Dr. Tyler Hughes of Memorial Hospital in McPherson, Kan., asked whether institutions can survive if they don’t push through these kinds of process improvements.
"I would submit that any institution that doesn’t look at their processes – and not just a step, but the whole process – will not be able to survive the next 10-15 years," Dr. Cima responded. "The government is clearly sending a signal that efficiency, value, and safety are the three main ways you’re going to survive."
The study was supported by the Mayo Clinic, department of surgery. Dr. Cima and Dr. Smith reported no conflicts of interest.