A Lean Six Sigma approach to reduce overcrowding of patients and improving the discharge process in a super-specialty hospital

Lean Six Sigma (LSS) is a popular Continuous Quality Improvement (CQI) methodology being implemented by the developed countries in the healthcare domain, but, largely unexplored by the Indian subcontinent. This study is carried out in an Emergency Department (ED) of a super specialty hospital in India, which is experiencing delays in timely discharge of its patients. Any delay in discharge affects the patients' total length of stay, thereby contributing to overcrowding in ED. The main objective of this study is to reduce the time gap between discharge orders and a patient physically leaving the ED through the implementation of LSS, i.e. DMAIC methodology (Define, Measure, Analyse, Improve and Control). Data collection for a period of one month revealed that the average time between discharge orders and patient physically leaving the ED as 76 minutes in the current process. The root causes of delay in the process were identified and improvement ideas were figured out. A new process map was designed based on the finalized improvement ideas and validated using ARENA simulation software. The simulation results show a significant reduction in the time gap between discharge orders and patient physically leaving ED from 76 minutes to 22 minutes. Hence, discharge process waiting time is reduced by 71%. Therefore, LSS methodology can be implemented by the Indian healthcare sector to improve the overall efficiency of healthcare processes.