Background

Lean thinking is a bundle of concepts, methods and tools for organizing human activities in organizations. It attempts to eliminate the underlying unnecessary waste in order to deliver more benefits. The methodology of Lean Six Sigma combines these principles with a statistical approach (“six sigma”) and lean management. Here we deployed for the first time Lean Six Sigma methodology for the evaluation and improvement of a transplant administration process. We focused on kidney waitlist management and the duration between first contact to our center and final listing to the Eurotransplant waiting list.

Methods

The structure of this work is following the DMAIC improvement cycle as the core tool for six sigma Projects. This cycle includes the five consecutive steps “Define”, “Measure”, “Analyze”, “Improve” and “Control”. First we stated the current process for kidney waitlist management in our hospital. Next we defined measurements for the administration process. The primary metric was document cycle time. Then we collected historical data from patients listed for kidney transplantation in 2014. A random sample was taken according to sample size calculation. All available data for randomized 64 health records were analyzed by using MiniTab®. Based on our analysis we implemented several improvements into the process. Later we tracked metrics for on-going listing processes in 2015 over six month.

Results

Based on the created process map of kidney transplant waitlist management we could generate a value stream map. Calculations revealed an initial total lead time (processing time in our office) about 30.4 days. The impact of different factors on our output was evaluated by Pareto-Chart-Analysis. After implementing reasonable improvements the lead time decreased from 30.4 to 10.1 days (equals a decrease of 67%) and the number of new listings in our hospital increased dramatically. Additionally we identified even much more potential time savings, which could be implemented in future improvement projects.

Conclusion

The described Lean Six Sigma project demonstrates that the methodology could be successfully applied to improve the kidney waitlist management at our university hospital. So far the approach could deliver the essential data to track the work flow and make the process of kidney waitlist management transparent for all process owners.

CITATION INFORMATION: Arelin V, Schaefer J, Haller H, Ackermann I, Schrem H. Kidney Waitlist Management with Lean Six Sigma. Am J Transplant. 2016;16 (suppl 3).

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