Journal of Healthcare Engineering

Journal of Healthcare Engineering / 2015 / Article

Research Article | Open Access

Volume 6 |Article ID 517429 |

Sheng-Hui Hung, Pa-Chun Wang, Hung-Chun Lin, Hung-Ying Chen, Chao-Ton Su, "Integration of Value Stream Map and Healthcare Failure Mode and Effect Analysis into Six Sigma Methodology to Improve Process of Surgical Specimen Handling", Journal of Healthcare Engineering, vol. 6, Article ID 517429, 22 pages, 2015.

Integration of Value Stream Map and Healthcare Failure Mode and Effect Analysis into Six Sigma Methodology to Improve Process of Surgical Specimen Handling

Received01 Mar 2015
Accepted01 Jun 2015


Specimen handling is a critical patient safety issue. Problematic handling process, such as misidentification (of patients, surgical site, and specimen counts), specimen loss, or improper specimen preparation can lead to serious patient harms and lawsuits. Value stream map (VSM) is a tool used to find out non-value-added works, enhance the quality, and reduce the cost of the studied process. On the other hand, healthcare failure mode and effect analysis (HFMEA) is now frequently employed to avoid possible medication errors in healthcare process. Both of them have a goal similar to Six Sigma methodology for process improvement. This study proposes a model that integrates VSM and HFMEA into the framework, which mainly consists of define, measure, analyze, improve, and control (DMAIC), of Six Sigma. A Six Sigma project for improving the process of surgical specimen handling in a hospital was conducted to demonstrate the effectiveness of the proposed model.


  1. J. Heuvel, R. J. Does, and J. P. S. Verver, “Six Sigma in healthcare: lessons learned from a hospital,” International Journal of Six Sigma and Competitive Advantage, vol. 1, no. 4, pp. 380–388, 2005. View at: Google Scholar
  2. F. Van der Meulen, T. Vermaat, and P. Willems, “Case study: an application of logistic regression in a Six Sigma project in health care,” Quality Engineering, vol. 23, no. 2, pp. 113–124, 2011. View at: Google Scholar
  3. I. R. Lazarus and B. Stamps, “The promise of Six Sigma: getting better faster,” Extra Ordinary Sense, vol. 3, pp. 3–29, 2002. View at: Google Scholar
  4. M. Murugappan and G. Keeni, “Quality Improvement-The Six Sigma Way,” in First Asia-Pacific Conference on Quality Software Proceedings, pp. 248–257, 2000. View at: Google Scholar
  5. Q. Feng and J. Antony, “Integrating DEA into Six Sigma methodology for measuring health service efficiency,” Journal of the Operational Research Society, vol. 61, pp. 1112–1121, 2010. View at: Google Scholar
  6. L. C. Tang, T. N. Goh, S. W. Lam, and C. W. Zhang, “Fortification of Six Sigma: Expanding the DMAIC toolset,” Quality and Reliability Engineering International, vol. 23, no. 1, pp. 3–18, 2007. View at: Google Scholar
  7. U. K. Teichgräber and M. de Bucourt, “Applying value stream mapping techniques to eliminate non-value-added waste for the procurement of endovascular stents,” European Journal of Radiology, vol. 81, no. 1, pp. e47–e52, 2011. View at: Google Scholar
  8. R. Dehnavieh, H. Ebrahimipour, Y. Molavi-Taleghani, A. Vafaee-Najar, S. Noori Hekmat, and H. Esmailzdeh, “Proactive risk assessment of blood transfusion process, in pediatric emergency, using the Health Care Failure Mode and Effects Analysis (HFMEA),” Global Journal of Health Science, vol. 7, no. 1, pp. 322–331, 2014. View at: Google Scholar
  9. E. D. Arnheiter and J. Maleyeff, “The integration of lean management and Six Sigma,” The TQM Magazine, vol. 17, no. 1, pp. 5–18, 2005. View at: Google Scholar
  10. David G, Hicks, “Standardization of Tissue Handling from the OR to the laboratory,” AORN Journal, vol. 99, no. 6, pp. 810–813, 2014. View at: Google Scholar
  11. H. Minato, M. Fukushima, T. Nojima, and M. Nakano, “Specimen misidentification in pathology laboratory: trends and measures,” Journal of Clinical Pathology, vol. 8, pp. 751–759, 2013. View at: Google Scholar
  12. E. A. Wagar, “Specimen labeling errors: A Q-probes analysis of 147 clinical laboratories,” Arch Pathol Lab Med, vol. 132, p. 1617, 2008. View at: Google Scholar
  13. Raouf E, Nakhleh, “Patient Safety and Error Reduction in Surgical Pathology,” Arch Pathol Lab Med, vol. 132, pp. 181–185, 2008. View at: Google Scholar
  14. D. Graybill and P. Ercole, “RP implementation: specimen management,” AORN Journal, pp. 625–633, 2014. View at: Google Scholar
  15. L. Trask and E. Tourmas, “Barcode Specimen Collection Improves Patient Safety,” Medical Laboratory Observer, vol. 44, no. 4, pp. 44–45, 2012. View at: Google Scholar
  16. L. Trask, “Barcode specimen collection. It’s fast. It’s easy. It can stops errors for good,” Medical Laboratory Observer, vol. 46, no. 12, pp. 20–21, 2014. View at: Google Scholar
  17. S. C. Hellensead, W. B. Lockwood, and R. J. Elin, “Errors in Pathology and Laboratory Medicine: Consequences and Prevention,” Journal of Surgical Oncology, vol. 88, no. 3, pp. 161–181, 2004. View at: Google Scholar
  18. J. T. Bart, “Clinical Laboratory Utilization: Rationale,” in Principles of Clinical Laboratory Utilization and Consultation, B. Davis, D. Mass, and Bishop, Eds., 6, Saunders, Philadelphia, PA, 1999. View at: Google Scholar
  19. V. Wiwanitkit, “Types and Frequency of Pre-analytical Mistakes in the First Thai ISO, 9002:1994 Certified Clinical Laboratory, a 6-month Monitoring,” BMC Clinical Pathology, vol. 1, no. 5, pp. 5–9, 2001. View at: Google Scholar
  20. M. J. Alsina, V. Álvarez, N. Barba et al., “Preanalytical Quality Control Program - an Overview of Results (2001-2005 summary),” Clinical Chemistry and Laboratory Medicine2008, vol. 46, no. 6, pp. 849–854. View at: Google Scholar
  21. P. Pande, R. Neuman, and R. Cavanagh, The Six Sigma Way: How GE, Motorola and Other Top Companies Are Honing Their Performance, McGraw-Hill, New York, 2000.
  22. M. Harry and R. Schroeder, Six Sigma: the Breakthrough Management Strategy Revolutionizing the World’S Top Corporations, Doubleday, New York, 1999.
  23. C. T. Su, Y. H. Hsiao, and Y. L. Liu, “Enhancing the fracture resistance of medium/small-sized TFT-LCDs using the Six Sigma methodology,” IEEE Transactions on Components Packaging and Manufacturing Technology, vol. 2, no. 1, pp. 149–164, 2012. View at: Google Scholar
  24. M. L. George, D. Rowlands, M. Price, and J. Maxey, The Lean Six Sigma Pocket Toolbook: A Quick Reference Guide to 100 Tools for Improving Quality and Speed, McGraw-Hill, New York, 2004.
  25. A. L. Grove, J. O. Meredith, M. Macintyre, J. Angelis, and K. Neailey, “Lean implementation in primary care health visiting services in National Health Service UK,” Quality and Safety in Health Care, vol. 19, no. 5, Article ID e43, 2010. View at: Google Scholar
  26. L. M. Mazur and S. J. Chen, “Understanding and Reducing the Medication Delivery Waste via Systems Mapping and Analysis,” Health Care Management Science, vol. 11, no. 1, pp. 55–65, 2008. View at: Google Scholar
  27. P. M. Carter, J. S. Desmond, C. Akanbobnaab et al., “Optimizing Clinical Operations as Part of a Global Emergency Medicine Initiative in Kumasi, Ghana: Application of Lean Manufacturing Principals to Low-resource Health Systems,” Academic Emergency Medicine, vol. 19, no. 3, pp. 338–347, 2012. View at: Google Scholar
  28. J. DeRosier, E. Stalhandske, J. P. Bagian, and T. Nudell, “Using health care Failure Mode and Effect Analysis: the VA National Centre for Patient Safety’s prospective risk analysis system,” The Joint Commission Journal on Quality Improvement, vol. 28, no. 5, pp. 248–267, 2002. View at: Google Scholar
  29. J. S. Krouwe, “An improved failure mode effects analysis for hospitals,” Archives of Pathology and Laboratory Medicine, vol. 128, no. 6, pp. 663–667, 2004. View at: Google Scholar
  30. M. Gilchrist, B. D. Franklin, and J. P. Patel, “An outpatient parenteral antibiotic therapy (OPAT) map to identify risks associated with an OPAT service,” Journal of Antimicrobial Chemotherapy, vol. 62, no. 1, pp. 177–183, 2008. View at: Google Scholar
  31. Joint Commission on Accreditation on Healthcare Organization, “Revisions to Joint Commission standards in support of patient safety and medical/health care error reduction,” Joint Commission on Accreditation on Healthcare Organization, Oakbrook Terrace, 2002. View at: Google Scholar
  32. M. Hambleton, “Applying root cause analysis and failure mode and effect analysis to our compliance programs,” Journal of Health Care Compliance, vol. 7, no. 2, pp. 5–13, 2005. View at: Google Scholar
  33. D. L. Kunac and D. M. Reith, “Identification of priority for medication safety in neonatal intensive care,” Drug Safety, vol. 28, no. 3, pp. 251–261, 2005. View at: Google Scholar
  34. C. H. Cheng, C. J. Chou, P. C. Wang, H. Y. Lin, C. L. Kao, and C. T. Su, “Applying HFMEA to prevent chemotherapy errors,” Journal of Medical Systems, vol. 36, no. 3, pp. 1543–1551, 2012. View at: Google Scholar
  35. M. Vélez-Díaz-Pallarés, E. Delgado-Silveira, M. E. Carretero-Accame, and T. Bermejo-Vicedo, “Using Healthcare Failure Mode and Effect Analysis to reduce medication errors in the process of drug prescription, validation and dispensing in hospitalised patients,” BMJ Quality & Safety, 2012. View at: Publisher Site | Google Scholar
  36. R. J. Kuo, Y. H. Wu, and T. S. Hsu, “Integration of fuzzy set theory and TOPSIS into HFMEA to improve outpatient service for elderly patients in Taiwan,” Journal of the Chinese Medical Association, vol. 75, no. 7, pp. 341–348, 2012. View at: Google Scholar
  37. C. M. Collins and K. A. Elsaid, “Using an enhanced oral chemotherapy computerized provider order entry system to reduce prescribing errors and improve safety,” International Journal For Quality in Health Care, vol. 23, no. 1, pp. 35–43, 2011. View at: Google Scholar
  38. Taiwan Joint Commission on Hospital Accreditation, “Hospital laboratory test and pathology biopsy event,” Taiwan Patient-safety Reporting system Annual Report, Taiwan, 2013, 63-68. View at: Google Scholar
  39. “Compensation for medical malpractice,” 2004, Accessed June 1, 2015, View at: Google Scholar
  40. “Medical dispute with surgical specimen misplace,” 2015, Accessed June 1, 2015, , View at: Google Scholar

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