Continuity of the supply chain is an integral element in the safe and timely delivery of health services. Lean Six Sigma (LSS), a continuous improvement approach, aims to drive efficiencies and standardisation in processes, and while well established in the manufacturing and supply chain industries, also has relevance in healthcare supply chain management. This study outlines the application of LSS tools and techniques within the supply chain of an Operating Room (OR) setting in a private hospital in Dublin, Ireland. A pre-/post-intervention design was employed following the Define, Measure, Analyse, Improve, Control (DMAIC) framework and applying LSS methodology to redesign the current process for stock management both within the OR storage area and within a pilot OR suite, through collaborative, inclusive, and participatory engagement with staff. A set of improvements were implemented to standardise and streamline the stock management in both areas. The main outcomes from the improvements implemented were an overall reduction in the value of stock held within the operating theatre by 17.7%, a reduction in the value of stock going out of date by 91.7%, and a reduction in the time spent by clinical staff preparing stock required for procedures by 45%, all demonstrating the effectiveness of LSS in healthcare supply chain management.

The aim of this study was to redesign an emergency department [ED] data management system to improve the availability of, and access to, data to facilitate patient flow. A pre-/post-intervention design was employed using Lean Six Sigma methodology with a focus on the voice of the customer, Gemba, and 5S to identify areas for improvement in ED data management processes and to inform solutions for improved ED patient flow processes. A multidisciplinary ED team includes medical consultants and registrars, nurses, patient service staff, radiology staff, as well as information technology and hospital management staff. Lean Six Sigma [LSS] diagnostic tools identified areas for improvement in the current process for data availability and access. A set of improvements were implemented to redesign the pathway for data collection in the ED to improve data availability and access. We achieved a reduction in the time taken to access ED patient flow data from a mean of 9 min per patient pre-intervention to immediate post-intervention. This enabled faster decision-making by the ED team related to patient assessment and treatment and informed improvements in patient flow. Optimizing patient flow through a hospital’s ED is a complex task involving collaboration and participation from multiple disciplines. Through the use of LSS methodology, we improved the availability of, and fast access to, accurate, current information regarding ED patient flow. This allows ED and hospital management teams to identify and rapidly respond to actions impacting patient flow.

Changes in healthcare tend to be project-based with whole system change, which acknowledges the interconnectedness of socio-technical factors, not the norm. This paper attempts to address the question of whole system change posed by the special issue and brings together other research presented in this special issue. A case study approach was adopted to understand the deployment of a whole system change in the acute hospital setting along four dimensions of a socio-technical systems framework: culture, system functioning, action, and sense-making. The case study demonstrates evidence of whole system improvement. The approach to change was co-designed by staff and management, projects involving staff from all specialities and levels of seniority were linked to each other and to the strategic objectives of the organisation, and learnings from first-generation projects have been passed to second and third-generation process improvements. The socio-technical systems framework was used retrospectively to assess the system change but could also be used prospectively to help healthcare organisations develop approaches to whole system improvement.

Healthcare systems internationally are working under increasing demand to use finite resources with greater efficiency. The drive for efficiency utilises process improvement methodologies such as Lean Six Sigma. This study outlines a pilot Lean Six Sigma intervention designed to release nursing time to care within a peri-operative environment; this was achieved by collaborating with stakeholders to redesign the process for laparoscopic hernia surgical case preparation (set up) material. Across 128 laparoscopic hernia surgical cases, the pilot resulted in a 55% decrease in overall nursing time spent in gathering and preparing materials for laparoscopic hernia surgical cases, with a corresponding reduction in packaging waste. The major impact of releasing nursing time to care within busy Operating Room environments enabled nurses to focus on continuing to deliver high-quality care to their patients and reduce pressure expressed by the Operating Room nurses. The results have led to an ongoing review of other surgical procedures preparation to further release nursing time and will be of interest to perioperative teams internationally.