Research Article | Open Access
Integration of Value Stream Map and Healthcare Failure Mode and Effect Analysis into Six Sigma Methodology to Improve Process of Surgical Specimen Handling
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.
- 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.
- 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.
- I. R. Lazarus and B. Stamps, “The promise of Six Sigma: getting better faster,” Extra Ordinary Sense, vol. 3, pp. 3–29, 2002.
- M. Murugappan and G. Keeni, “Quality Improvement-The Six Sigma Way,” in First Asia-Pacific Conference on Quality Software Proceedings, pp. 248–257, 2000.
- 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.
- 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.
- 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.
- 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.
- 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.
- David G, Hicks, “Standardization of Tissue Handling from the OR to the laboratory,” AORN Journal, vol. 99, no. 6, pp. 810–813, 2014.
- 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.
- E. A. Wagar, “Specimen labeling errors: A Q-probes analysis of 147 clinical laboratories,” Arch Pathol Lab Med, vol. 132, p. 1617, 2008.
- Raouf E, Nakhleh, “Patient Safety and Error Reduction in Surgical Pathology,” Arch Pathol Lab Med, vol. 132, pp. 181–185, 2008.
- D. Graybill and P. Ercole, “RP implementation: specimen management,” AORN Journal, pp. 625–633, 2014.
- L. Trask and E. Tourmas, “Barcode Specimen Collection Improves Patient Safety,” Medical Laboratory Observer, vol. 44, no. 4, pp. 44–45, 2012.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- M. Harry and R. Schroeder, Six Sigma: the Breakthrough Management Strategy Revolutionizing the World’S Top Corporations, Doubleday, New York, 1999.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Taiwan Joint Commission on Hospital Accreditation, “Hospital laboratory test and pathology biopsy event,” Taiwan Patient-safety Reporting system Annual Report, Taiwan, 2013, 63-68.
- “Compensation for medical malpractice,” 2004, Accessed June 1, 2015, http://health.gov.taipei/Default.aspx?tabid=417&mid=537&itemid=15318.
- “Medical dispute with surgical specimen misplace,” 2015, Accessed June 1, 2015, , http://news.ltn.com.tw/news/life/paper/859318http://news.ltn.com.tw/news/focus/paper/503123.
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