It perhaps goes without saying that the healthcare sector is one of the most complicated industries when it comes to incorporating quality systems. Because of this, most Lean Six Sigma Black Belts fail in healthcare, having initially thought that all sectors are the same. Although this is the case in truth, these Six Sigma Black Belts are quickly frustrated by the confusing roles played by medical practitioners. Even worse, in compiling a simple process chart, placing medical practitioners in their right roles can cause a number of major headaches. Yet, only a handful of process modifications can be fully optimised without medical practitioners being involved, so the active management of the roles of medical practitioners should therefore be one of the most important tasks when it comes to implementing Lean Six Sigma into healthcare institutes. How do you involve medical practitioners in Lean Six Sigma projects?
Reasons for resistance to Lean Six Sigma among medical practitioners
Although medical practitioners play a major role in many processes carried out in hospitals, this fact is often not admitted by the doctors themselves. Some doctors even insist that their actions do not influence other system processes, such as nursing, dispensing, medical dossier control or invoicing and payment. On the other hand, many medical practitioners are aware of the effect of their processes on hospital processes, but choose to ignore this effect. A significant reason for doctors resisting change is in the fact that changes often make their processes more difficult. They take more time, become more complicated and reduce service provision to patients. Hospital administrators often do not fully understand the processes used by medical practitioners before they consider potential changes.
As an initial step, administrators can reduce resistance by simply “gaining in-depth knowledge” – quoting Deming – of doctors’ processes during the analytical phase (DMAIC) before they initiate the improvement phase.
However, the lack of doctor involvement in improvement attempts throughout an entire hospital can mainly be attributed to relatively minor causes. The most important of these are listed below:
- No interest in the intended results of Lean Six Sigma projects;
- No understanding of what systems thinking or process analysis involve;
- A preconception that more resources and more staff are the best solution and that detailed analysis is a waste of time;
- Changes to processes, which improve the hospital, have a negative effect on the processes of medical practitioners;
- Believing that they should be paid for any activities that benefit the hospital;
- Believing that priority should be given to the improvement of processes that benefit their hospital activities, even before the hospital has profited from improvements in cost-efficiency;
- Little mutual agreement among doctors when it comes to emphasis on specific areas or the relevant solutions;
- A lack of teamwork among doctors, even when individual practices fall within the same medical department.
The improvement process
How can healthcare managers ensure the effective cooperation and involvement of medical practitioners during improvement processes? The most effective approach for getting doctors on board involves:
- Striving towards a full understanding of the wishes of medical practitioners and gaining insight into the help required within the specific processes to be improved.
- Trying to build trust. This may sound simple, but trust between hospital administrators and doctors has drastically decreased over the past ten years. The reasons for this can be either complicated or simple. In many cases, hospital management teams have acted against the interests and wishes of medical practitioners in their attempts to limit financial losses. As a result, a model of cooperation has changed into one of conflict.
- Training medical practitioners in all aspects of healthcare, including financial management and environmental legislation. And clearly illustrating the pressure resulting from competition. This all for the purpose of creating a joint venture with a collective future vision. This is somewhat different to rushed staff meetings attended by just half of the doctors.
- Looking for win-win projects. In other words, finding projects that make medical practitioners happy, which often include improvement of the efficiency of processes that involve doctor-hospital interaction. For instance, a significant long-term surgery goal would be an increase in the ratio between the number of surgery hours per week and the number of nursing hours per week. In most surgery units, these ‘scalpel to nurture’ hours only form 50% of the total number of nursing hours per week. By increasing this ratio, the nursing hours can be used more efficiently. This can be achieved by e.g. observing operation start times more strictly, reducing operating times and increasing the precision of the process used by surgeons when selecting instruments required in theatre.
- Finding people with an influence on medical practitioners (referring care providers, other highly trustworthy doctors) to accelerate changes, instead of leaving it up to hospital administrators and management.
- Consider incentives. But please note: incentives are often only effective in the short term. Having been rewarded once, a pattern of entitlement can emerge. A lack of incentive can then become a demotivating factor.
Find care providers who are not medical practitioners to initiate changes among doctors or to guide them towards change. An example: because being mobile the day after hip surgery is statistically a significant motivation for patients, physiotherapists can be called on to phone surgeons on operation days to schedule physiotherapy sessions.
