Assessing the Impact of Lean Six Sigma (LSS) Methodology Implementation on Day Care Surgical Services at Saint Joseph Hospital in Jerusalem رسالة ماجستير

Abstract

Hospitals increasingly seek methods to enhance quality of care while optimizing its resources. Lean Six Sigma (LSS) has emerged as an effective framework to reduce inefficiencies (waste and variation) and improve patients’ outcomes. At Saint Joseph Hospital in Jerusalem, day care surgical services were affected by such inefficiencies like high no-shows and surgery cancellation rates, prolonged waiting times, and patient dissatisfaction. This study aimed to evaluate and improve these key performance indicators (KPIs) through a structured LSS intervention over a 16 months period (January 2024 - April 2025). This includes application of Define, Measure, Analyze, Improve, and Control (DMAIC) phases, Value Stream Mapping, Failure Mode and Effects Analysis (FMEA), Pareto analysis, 5S methodologies and others. A quasi-experimental nonequivalent-groups mixed-methods pre–post design was used, incorporating both qualitative and quantitative data. All day care surgery patients were included (N = 4,080). Quantitative and qualitative data were collected from hospital information systems, surgery schedules, patient satisfaction surveys, and staff inputs. Analyses involved descriptive statistics, control charts, and hypothesis testing using Minitab. LSS implementation included digital workflow enhancements and standardized patient-education processes, which led to substantial improvements; No show rates of patients who were scheduled for day surgery decreased from 21.4% to 16.3% (SD from 0.0398 to 0.0388), surgical cancellation rates declined from 2.5% to 0.7% (SD from 0.0126 to 0.00754), waiting times improved across major service intervals with total admission-to-operating-room time reduced from 183 to 114 minutes (SD from 34.6 to 27.7), and patient satisfaction increased from 91.6% to 94.1% (SD from 0.0141 to 0.0113) ). However, variability analysis using Levene’s and Bonett’s tests showed inconsistent reductions in processes variations, indicating opportunities for further standardization. The study concludes that LSS is an effective methodology for driving operational improvements in day care surgical services in hospitals. Recommendations include continuous monitoring through control charts, LSS staff training, future research incorporating longer timelines, and qualitative staff feedback. These outcomes contribute to improving healthcare quality, and support LSS integration as a sustainable model in hospital settings.