Speaker 1: I am in conversation with Professor Vijaya Sundar M, Clinical Assistant Professor in the Operations Management area and an affiliate faculty with the Max Institute of Healthcare Management at the Indian School of Business. Research interest spans operational excellence, quality management and industry 4.0. His areas of expertise include GLEAN, Six Sigma, Robotic Process Automation, Continuous and Breakthrough Process Improvements and Business Transformation across services. He has published several research articles in globally recognised peer reviewed academic journals as well as practice based journals and magazines. In this video we will be talking to him about GLEAN Six Sigma and its application to healthcare. Professor Sundar, thank you for your time. I would like to start this conversation by asking why is process improvement important in healthcare? Thank you very much Soumya for inviting me

Speaker 2: for this discussion today. In my opinion process improvement is important in healthcare because wherever there is a process there is an opportunity for improvement. And in healthcare process improvement becomes more critical compared to any other services because even a small error in healthcare could lead to a significant impact both on the service provider as well as on the beneficiary. Now let us take an example. Let us assume that we have a patient visiting a hospital. Now the patient will interact with lot of departments in the hospital, lot of people in the hospital and this interactions will change from patient to patient depending on the need, depending on why the patient is actually approaching a hospital and so on. Now what a patient will feel is the overall service experience that the patient receives in the hospital. There are several departments. There is a registration desk, there is a reception, there are doctors, nurses, ward boys, we have diagnostic labs, pharmacies. Now patient will not feel any of these departments in isolation. What patient experiences is a holistic experience of the hospital. And that is why it is important to change the paradigm from looking at individual departments in isolation towards a healthcare process which cuts across all these departments and different people. And that is why process improvement becomes very important in the healthcare concept.

Speaker 1: So I will come to your work in Lean Six Sigma now. So Lean and Six Sigma are two concepts. So what is Lean Six Sigma?

Speaker 2: So as you rightly pointed Lean Six Sigma is actually an amalgamation of Lean and Six Sigma. But it is actually not just Lean and Six Sigma but their synergies as well. Now first let me talk about what is Lean. So Lean has been a tested process improvement approach both in manufacturing as well as in services across different services sector including healthcare. It is more than two decades now that healthcare industry have adopted Lean. So it is not an experiment to look at Lean in healthcare, but it has been a tested practice. Now what is Lean? Lean actually focuses on reducing waste in the process so that the value that is delivered out of a process could be improved. So it is a very simple approach and a very effective process improvement approach when it is adopted in a right way. On the other side Six Sigma is a data driven approach. So Six Sigma is more driven by professionals who are wearing the process lens and the data lens and look at every healthcare process from a different perspective. So Six Sigma focuses dominantly on two things. One to reduce the number of defects in a process and also to reduce the variation that exists in the process. Now Lean is more tuned for rapid improvements. It is a bottom up approach that everybody in the healthcare organization can learn and practice Lean. On the other side Six Sigma is a data driven and very robust approach for process improvements. Now what happens when both these approaches come together as Lean Six Sigma? The rapidness of Lean and the robustness of Six Sigma come hand in hand and that is where the synergies will be built for process improvement.

Speaker 1: So Lean and Six Sigma both are concepts that have been developed in manufacturing and then we are talking about healthcare which is a service. So how does that relate or how is Lean and Six Sigma, Lean Six Sigma applied in healthcare?

Speaker 2: That is a very interesting question in fact. In my research and in practice for the past one decade I found Lean Six Sigma is very much applicable in healthcare. Again coming back to the original point of wherever there is a process there is an opportunity for process improvement and healthcare is full of processes. Every process that we are talking about cuts across different departments in the healthcare firm towards creating value to the patient or a beneficiary. So there is a good applicability of Lean Six Sigma in healthcare. I can give you some examples from my experience. I had an opportunity to work on improving the patient satisfaction in a mobile hospital in an intensive care unit. There are other opportunities how can the discharge time of a patient be reduced when they get hospitalized and also in the outpatient department, in the health insurance claims error reduction. So all these are examples of how Lean Six Sigma can play a significant role in improving the healthcare processes. So there is a great opportunity and it is not an experiment it has worked pretty well. There are several case studies, there are several research evidence that is found both in academic as well as in practitioner magazines about how Lean Six Sigma can improve the processes in healthcare.

Speaker 1: So healthcare is fast evolving as we know. It is more digital, we have like digital platforms that are coming up and being adopted rapidly across the board. So how is Lean Six Sigma still a relevant concept in this kind of new age healthcare that we are looking at?

Speaker 2: Very good question. In fact, I would say Lean Six Sigma is more important for the current digital era. Imagine a process which is bad and a healthcare firm goes ahead to automate the process. Just by automating a process it does not become an effective process. A bad process is a bad process even if it is automated. So what is important even before automating a process is to look for a process improvement there and that is where Lean Six Sigma plays an important role. At the end of the day what is automation? It is garbage in garbage out. We automate a bad process still it is a bad process which is automated. So my recommendation to the healthcare firms would be to look at processes, to lean them out, to apply the data driven Six Sigma methodology on it and reap the benefit of improving the capability of the process first. That is when the process automation can give us a good harvest. So the healthcare firms cannot reap the complete expected benefit or the returns or their technical investments that they put on digital transformations unless the processes are first improved and that is why Lean Six Sigma has a big role to play in the current digital era in the healthcare sector.

Speaker 1: So one last question Professor Sundar. So what would be your advice to the new age technology driven healthcare professionals? What are the three things that they should be focusing on in their firms?

Speaker 2: So in the current era I think we should first break the silos of our departments and this is applicable even outside healthcare as well but in the healthcare it is more important. If I am a doctor, if I feel that prescribing right medicines to my patient alone is my job then I am not thinking in the right direction for processing. This holds good even for a pharmacist, this holds good for a diagnostic lab technician. So what is important firstly is to break the silos of our workplace and think from the big picture. We work for a healthcare organization and improving the process is everybody's responsibility. So I think this is the first thing we should be mindful about. Secondly once these processes are broken what emerges out of this is called process thinking. Now what is process thinking? Process thinking is to look from a customer perspective. What is the experience that customer gets throughout the step by step procedures that we have clearly articulated in our processes? Now how can we improve that? So the second important thing is the customer centricity and in healthcare when I mean customers it is not just patients. The dependence of the patients, the other beneficiaries who are interested in the healthcare sector, the research and development sector which is involved in identifying and coming up with the new products related to healthcare, the new equipment related to healthcare. So every player is a customer here. So the second important thing is the customer centricity and thirdly is looking at processes as processes. That is when we get a clear picture of the as is state of where we are today. I mean if people get attached towards a process saying this is my process so it is obviously a good process then we are not on the right game. So looking at processes critically assessing them from the process lens and the data lens towards improving them to take it to the next level so that it is not just about automation it could be a solution which could be non-automation as well. But eventually what are we looking at is more important that is the capability of the process to deliver best in class services to our patients. So three things if I have to put it in the order. First is total employee involvement, number two is customer centricity and number three is process capability. This should be the focus for today's healthcare sector.

Speaker 1: Thank you so much. On that note we will end this conversation. Thank you for your time and we look forward to working with you more on the Lean Six Sigma in healthcare work stream. Thank you.

Speaker 2: Thank you very much Sowmya.