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Journal of Healthcare Engineering
Volume 6, Issue 3, Pages 377-398
Research Article

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

Sheng-Hui Hung,1 Pa-Chun Wang,2 Hung-Chun Lin,3 Hung-Ying Chen,3 and Chao-Ton Su3

1Institute of health policy and management, National Taiwan University, Taipei, Taiwan
2Department of Quality Management Center, Cathay General Hospital, Taipei, Taiwan
3Department of Industrial Engineering and Engineering Management, National Tsing Hua University, Hsinchu, Taiwan

Received 1 March 2015; Accepted 1 June 2015

Copyright © 2015 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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.