Hospitals in pursuit of excellence

Decreasing Evidence-Based Medicine Order Set Review and Approval Cycle Time through Lean-Six Sigma Methodology

The problem faced by the health system was the lack of a coordinated approach for the review and approval of order sets, including standing orders and protocols, across the division's four community hospitals. They were not consistently taken through formal review, and there was wide variability in how they were utilized, creating opportunities for errors and misalignment with regulatory compliance. The goals were: to create and implement one standardized, improved process for the review and approval of order sets in all four hospitals; to have 100 percent of new order sets compliant with the new process going forward; to decrease process cycle time from baseline 77 days to 60 days or less; and to increase staff understanding of related terminology.

Change/implementation strategies included utilizing the Define, Measure, Analyze, Improve, Control (DMAIC) process and Lean-Six Sigma tools, physician and leadership approval of the new process, a three-phase go-live of new processes, utilization of computer-based learning for colleague education on terminology and continued monitoring of process compliance and cycle time. Results included a more than 75 percent decrease in process cycle time to 18 days and many operational benefits.

This case study is part of the Illinois Health and Hospital Association's annual Quality Excellence Achievement Awards. Each year, IHA recognizes and celebrates the achievements of Illinois hospitals and health systems in continually improving and transforming health care in the state. These organizations are improving health by striving to achieve the Triple Aim—improving the patient experience of care (including quality and satisfaction), improving the health of populations, and reducing the per capita cost of health care—and the Institute of Medicine’s six aims for improvement—safe, effective, patient centered, timely, efficient, and equitable. To learn more, visit https://www.ihaqualityawards.org/javascript-ui/IHAQualityAward/