Using Lean Six Sigma to Improve Performance in the Acute Care Setting

Purpose: To increase the percentage of appropriate referrals to the physical therapist (PT) and the occupational therapist (OT), decrease the amount of time spent on determining inappropriate referrals, and measure the perceived changes in work environment. The process used Lean Six Sigma principles. Methods: Twenty-three (11 OTs and 12 PTs) full-time, part-time, or per diem therapists in the hospital system were recruited. An algorithm was developed by therapists and used during educational sessions with referral sources. Appropriate and inappropriate referral data were collected for 4 weeks before and after the educational sessions. Inappropriate referrals were further categorized and tracked during the pre- and posteducation data collection periods. Consenting PTs and OTs were surveyed before and after using the Copenhagen Psychological Questionnaire (COPSOQ). Lean Six Sigma principles were used to facilitate the entire process. Results: Twenty-one therapists completed the presurveys and 15 completed the postsurveys. Appropriate referrals increased from 80% to 86%. Of the inappropriate referrals, the proportion of patients on bedrest decreased from 23% to 4%; the proportion of those on sedation decreased from 15% to 10%. Estimated time lost on inappropriate referrals decreased from 3 hours to 1.42 hours per day. Favorable changes measured by the COPSOQ were greater clarity of the role of the PT/OT, feeling less stress, greater sense of trust in management with conflicts being resolved fairly, and more opportunity for development. Also noted was a perceived increase in demand and work pace. Conclusions: Hospital therapy departments can educate referral sources on the types of patient best served by therapy services and increase time spent on appropriate referrals without negatively compromising the employee perceptions of the work environment.