Case Study: Improving Healthcare Referrals with Lean Six Sigma at KAMC

This case study examines the implementation of Lean Six Sigma principles at King Abdullah Medical City (KAMC) in Makkah, Saudi Arabia, focusing on improving the hospital's referral process. The study identifies the inefficiencies in the existing referral system, which led to delays and patient dissatisfaction. The research utilizes the DMAIC (Define, Measure, Analyze, Improve, Control) methodology to analyze the problem and implement solutions. The Define phase identifies the problem, the Measure phase evaluates the current process using the SIPOC model, the Analyze phase employs a fishbone diagram to identify root causes, the Improve phase outlines short-term and long-term solutions, and the Control phase establishes a monitoring system using the PDCA cycle. The results demonstrate that the Lean Six Sigma model, through the DMAIC methodology, enhanced physician response rates for both normal and urgent referral cases, with a noticeable improvement in sigma levels and reduced delays. The study highlights the effectiveness of Lean Six Sigma in improving healthcare efficiency and patient satisfaction.

King Abdullah Medical City (KAMC) 1
Case Study on Lean and Six Sigma
associated to Hospitals

King Abdullah Medical City (KAMC) 2
Table of Contents
Summary for the problem statement and the project methodology.................................................3
Problem Statement.......................................................................................................................3
Research Methodology................................................................................................................3
Selection of Lean and Six Sigma Tool............................................................................................5
Customization of Lean and Six Sigma Tool....................................................................................5
Overall result of the Case Study....................................................................................................11
References......................................................................................................................................12

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Summary for the problem statement and the project methodology
Problem Statement
The case study based on King Abdullah Medical City (KAMC) a medical centre operating in
Makkah, Saudi Arabia reflects that the implementation of the referral process in both primary
healthcare units and specialty medical centers had become unwieldy in nature. The existence of a
disorganized referral process in the hospitals tends to potentially affect the level of efficiency and
also effectiveness of the medical system. It thereby affects the meeting of the healthcare needs of
the patients both in the short and long run periods. Further, the inefficiency of the referral system
also accounted to the delays in referral based responses and also affected the documentation
activity for registering and admitting patients in the hospital. Overall, the above facts accounted
for growth of dissatisfaction in the minds of the patients regards to the medical services provided
by KAMC (Alkinaidri & Alsulami, 2018).
Research Methodology
The DMAIC Methodology was incorporated by the researchers for understanding and reflecting
the manner in which the implementation of the lean six sigma model in KAMC would help in
reducing the level of delays in the response time of the physicians associated to the referral
system. Herein, DMAIC stands as the acronym for defining, measuring, analyzing, improving
and finally controlling (Sehgala, Kaushisha, & Rathia, 2015).

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(Sehgala, Kaushisha, & Rathia, 2015)
In the define phase, the methodology aims to identify the parameters that are most significant to
the business like the needs and expectations of the customers. Secondly, in the measuring phase
the methodology the efficiency of the current referral process is evaluated based on collection of
raw data and thereby comparing the same with standard and predicted figures. Thirdly, in the
analyzing phase, the methodology model based on evaluation of the datasets focuses on
analyzing the problem or issue being faced by the organization (Shaikh & Kazi, 2015). Fourthly,
in the improvement phase, the methodology model encourages the process of brainstorming of
ideas and solutions for effectively solving the problem and also in identifying variations if any.
Finally, the controlling phase of the DMAIC Model focuses on sustaining the performance or
progress gained in the long-run and in countering potential contingencies (Alkinaidri &
Alsulami, 2018).

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Selection of Lean and Six Sigma Tool
The lean six sigma tool is selected by the authors for solving the referral problem associated to
KAMC, Dubai in that the lean management tool undertakes a strategic approach in highlighting
the activities of staffs in hospitals that contribute in enhancing the quality of healthcare and
thereby in reducing the chances of existence of errors and also delays in clinical responses.
Again, the application of the lean and six sigma tool in hospital operations is also reflected to
help in reducing the emergence of waste products as that which tends to emerge owing to
hospital operations. It thereby helps in sustaining of effective storage and also the distribution
operations associated with the inflow of different types of medical items (Furterer, 2013, pp.
145-147). The application of Six Sigma in hospital environments is taken to help in enhancing
the expertise levels of the hospital staffs based on development of both training and
communication programs (Graban, 2018, pp. 1-2). Further, the selection of the lean and six
sigma tools is made by the authors in that the application of the tools regards to a service
organization is generating value to the potential customers. The application of the lean model in
business and service organizations is taken to help in enhancing the level of speed and efficiency
of the current operations. On the other hand, the application of the six sigma model regards to
business and service operations is taken to help in improving the service quality and also in
reducing the level of costs to be expended by consumers (Alkinaidri & Alsulami, 2018).
Customization of Lean and Six Sigma Tool
The customized use of the lean and six sigma tool regards to KAMC, Dubai is effectively
illustrated along the different phases of the DMAIC Model. The defining phase potentially
highlighted that the problem associated to delay regards to medical responses arouse from the

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category of physicians employed in the hospital. The objective was set to set the response rate of
physicians at 95 percent in case of urgent requests and at 90 percent in cases of normal requests.
The measurement phase initiates with the application of the SIPOC model that identifies both
value and also non-value added activities regards to different entities like suppliers, inputs,
processes, outputs and finally the customers (Levinson, 2016, p. 43). The application of the
SIPOC model regards to the case of referral system for KAMC is reflected as follows.

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(Alkinaidri & Alsulami, 2018)

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The application of the SIPOC Model reflected around 68 percent of the normal periods the
response time of the physicians got duly met for normal cases while the response time of the
physicians for urgent requests were met around 79 percent of the times (Alkinaidri & Alsulami,
2018). Further down the analysis phase requires the application of the fish-bone diagram that
outlines the causes or factors that prompted the emergence of the effect associated with the
delayed responses from the physicians in the case of referrals. The same is reflected below.

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(Alkinaidri & Alsulami, 2018)
Subsequently, the improvement phase reflects on the different types of short and long-term plans
that are undertaken for reducing the delays in responses of the physicians and also in minimizing
the level of wastage of clinical resources. The different short-term plans include assigning a
referral number for each of the different departments, sending of SMS to the

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physicians/consultants as and when the referral is incorporated in the system, direct calling of
consultants in cases of urgency, informing the head of system in cases of delays and
subsequently reaching the medical director and thereby asking the consultant to highlight the
reason for delays with the objectives of the referral. The long-term actions to be undertaken
include developing an acceptance procedure for the referrals and thereby in delegating proper
authorities to implement the plan, developing a standing committee for both accepting and also
reviewing the referrals, developing a mobile app for assisting the referral program and also in
designing an auto-escalation system in case of delays in referrals (Alkinaidri & Alsulami, 2018).
Finally, the control phase reflected the designing of a coordination office that monitored the
performances of the actions undertaken based on the use of the PDCA (Plan-Do-Check-Act)
Cycle (Bauer, 2017, Ch. 9).
(Bauer, 2017, Ch. 9)

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The performance metrics were evaluated based on set standards based on which monthly reports
were generated and also presented before the medical boards. The PDCA Cycle was also used
for checking of trends such that in cases of unusual trends the concerned department head is
summoned and discussions are made for resolving issues if any. Finally, awareness sessions
were also called for review of the findings and also in taking of further actions (Alkinaidri &
Alsulami, 2018).
Overall result of the Case Study
The overall results of the case study reflected that for KAMC Dubai the application of the Lean
Six Sigma model through the use of the DMAIC Methodology contributed in enhancing the
response rates of the physicians for both normal and urgent referral cases compared to previous
situations. The development of sigma from 2.05 to 2.20 was also noticeable. In urgent referral
cases the delay in the response rates of the consultants were reduced by 2 percent while in
normal cases the same recorded a reduction by around 5 percent (Alkinaidri & Alsulami, 2018).

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References
Alkinaidri, A., & Alsulami, H. (2018). Improving Healthcare Referral System Using Lean Six
Sigma. American Journal of Industrial and Business Management , 8, 193-206.
Bauer, E. (2017). Risk Thinking for Cloud-Based Application Services. United Kingdom : CRC
Press. Ch. 9
Furterer, S. L. (2013). Lean Six Sigma Case Studies in the Healthcare Enterprise. United
Kingdom : Springer Science & Business Media. pp. 145-147
Graban, M. (2018). Lean Hospitals: Improving Quality, Patient Safety, and Employee
Engagement, Third Edition. United Kingdom : CRC Press. pp. 1-2
Levinson, W. A. (2016). Lean Management System LMS:2012: A Framework for Continual
Lean Improvement. United Kingdom : CRC Press. p. 43
Sehgala, S., Kaushisha, D., & Rathia, V. (2015). Qualitative Analysis of Foundry Industry: A
DMAIC Approach. Journal of Business Management & Social Sciences Research
(JBM&SSR) , 4 (9), 573-577.
Shaikh, S. A., & Kazi, J. (2015). A Review on Six Sigma (DMAIC) Methodology. Interrnational
Journal of Modern Enigineering Research , 5 (2), 1-5.