The surgical services is playing a vital role in the present day of medical field saving a large number of lives with low cost and less time. The surgical services is not a new word, it is an ancient word but many changes have been done to the procedures and the equipment and tools used has changed a lot that even without the helping staff one can do the process very easily. Such advancements not only just allowed disease to be detected and treated earlier but also made life-saving possibilities for patients. The treatment is also done with great accuracy. The consumer demand has grown to a very great extent and also with this growth the need to recruit and maintain qualified technologists has also grown.


In this study DMAIC (Define, Measure, Analyze, Improve, and Control) is used to enhance the Surgical services in hospitals. The need for surgical services is growing rapidly, especially with ambulatory and cosmetic procedures. When workflow is encumbered by inefficiencies, the benefit to the organization – and ultimately the patients – may not be fully realized. Even with the latest equipment installed, many organizations are facing delays in report-turnaround time and a backlog of patients waiting for appointments. The problems faced because of this delays are delay in diagnosis and treatment, emergency department bottlenecks, increased length of stay, patient dissatisfaction, referring physician dissatisfaction, potential loss of outpatient business, loss of revenue and so on.From the last ten years, the volume of ambulatory surgery in U.S. hospitals increased by 2.9 million procedures, according to data from the American Hospital Association. The surgical services are the busiest areas in hospitals and the main cause of more annual revenue. It contributes more than 40 percent of annual revenue to the hospitals. As the clinical and technical advances are transforming the way of surgery is performed. To attract both the patients and physician most of the hospitals are introducing digital operating rooms, tele-surgery and robotic assistance. With this the patients have to stay shorter period in the hospital and fewer procedural complications.

A recent study from the Healthcare Financial Management Associations (HFMA) and Health Care Advisory Board (HCAB) found that the average operating room runs only at 68% of the hospital capacity. The report indicates that improvements targeting even one procedure per day per operation room (OR) will additional increase of $4 million to $7 million in annual revenue for average sized organization.

Six-Sigma is a useful tool for improving the quality, throughput and bottom line of the operation room.  

Six-Sigma projects in operation room have targeted area such as: 

  • Improving first case start times
  • Optimizing technologies
  • Improving room turnover times
  • Ensuring appropriate scheduling
  • Improving admissions/registration processes
  • Assessing OR charging mechanism

Delay in first case is the major problem in the most of the health care organization and delay in the rest of the schedule in the day. Optimizing the technology like reducing the more number of doctors or helpers in one surgery. Admitting procedure, scheduling conflicts and procedures for patient preparation are well example that can influence the OR utilization and throughput. Most of the hospitals and surgical units, process variability may contribute to inefficiency and waste. Room improvement can be identified in every setting academic medical center, small/rural hospital or large hospital system. For surgical suite to consistent deliver safe, cost effective and profitable service, attention must be paid to both the technical and cultural improvement that can be maintained long term. 

Quality is one of the constant concerns. While hospital try to take reasonable precautions to avoid mistakes. The very nature of surgical suite makes it a unique system to susceptible variations and error.  Six-Sigma process will help us to reduce this variability and ensure the safest service and deliver the safest possible manner. From the perspective of patient and patient entering the hospital, surgery (either same day or overnight stay) is a stressful ordeal. Sensitive, response staff and appearance of calm, well-organized atmosphere can help to put them at ease. 

Examples of the core operation room performance indicators provided by the Healthcare Financial Management Association (HFMA).

  • In-patient workload
  • Out-patient workload
  • Cancellation rates on day of surgery
  • Day of surgery add-on rates
  • Start time accuracy – first case of the day
  • Start time accuracy – subsequent cases
  • Estimated case duration
  • Turnover time in-patient
  • Turnover time out-patient
  • Total case time in-patient
  • Total case time out-patient
  • Room utilization: 7:30 a.m.-3:15 p.m.
  • Surgeon satisfaction
  • Employee satisfaction
  • Cost per case (labor)
  • Cost per case (materials)
  • Cost per case (total)
  • Gross revenue per case

Making the perioperative environment safer, more efficient and cost effective for both the patients will identify the best opportunities for improvement.  A project team may decide to apply lean tools with the Six-Sigma DMAIC Approach (Define, Measure, Analyze, Improve, and Control).


Next to the team and champion involvement the main cause of project failure is not understanding the voice of customer and focusing on wrong CTQ’s. So it is very important to clearly identify critical elements and obtain voice of the customer (VOC) information through stakeholder interviews. Having clear and measurable CTQ’s are the foundations of the success of any project. In this phase, the voice of customer (VOC) data needs to collect the surveying. The customer may be stakeholder relevant to the project, surgeons, nurses, anesthesiologists, patients, technicians, support staff and administrators. The survey questions are based on Lichert Scale. The collected data become the part of the analysis driven and focus area for the project.It is important that all the customer who should provide input and how they related to the survey. This may include the radiology, laboratory, cardiopulmonary, ambulatory surgery, admitting, recovery, medical/surgical units, intensive care units and discharge.

Increases in number of patients arrive for same day surgery. To accommodate such trends the OR has evolved into a series of care areas. Every transaction point is important for and must be processed in orderly and consistent manner. All the collected data is analyzed to understand timing and area of variation.  The analysis the key to finding the addressing root causes and allow the project team to trace the every step in the process and discover where need to be improved. A project team does not want to be limited by what is available, but it wants to get what it needs. During the measure phase one should define how the data is to be gathered, factors for data acquisition plan.


In this phase, the parameters clearly delineated and appropriate data collected, and then the project moves to the analysis phase. The team uses a tool to narrow the focus and contribute the level of the process variation. Chart and graphs makes us the current process performance relative to the upper and lower specification that team can establish during the phase of the project. Analysis is performed to check the capability of the process as compared to the present standards. Adjustments are done if the goal is not meeting the expectations. Data is partitioned in order to find the causes of the problems. Update the prediction on how improvement can be achieved in the process. Having the right data ready for analysis puts a team half way through project success. During the Analyze phase, analyzing the critical drivers that are impacting the process are examined carefully. There may be issues like slow start-up times during the mornings or there may be conflicts with physicians. The information also may indicate that a high volume of patients failing to show up for appointments is consuming capacity, or that utilization fluctuates during the day due to bottlenecks in the system or variability in patient arrival patterns. With analysis complete, the team develops action plans like how to approach, what to do and what not to do.


During this improve phase, the team will proposes the solution based on the evidence of the data which is collected. Once the solution is developed the project moves to the control phase for ongoing monitoring and measurement. This ensures the results over time. Through methods such as Control charts and dashboard with key indicators, the team will know the process begins to show any strain and can take the corrective action before the problem escalate. The main role of Improve phase is to identify a solution to the problem that the project aims to address. This involves brainstorming potential solutions, selection solutions to test and evaluating the results of the implemented solutions. Often a pilot implementation is conducted prior to a full-scale rollout of improvements. The key steps involved in Improve Phase are selecting solutions to implement, implementing improvements, Evaluating improvements and wrapping up the improve phase. The Improve phase often is the most challenging one. But it is also the rewarding part of the project. As the process is changing long-standing issues will be finally addressed and better processes will be put in place – changes that will ultimately improve the overall effectiveness of the facility’s surgical services. 

Simple and Robust – if the team gets these two things right, it will have half won the control battle. The Control phase begins once process changes have been established and appear to be working. One cannot underestimate the importance of monitoring results during this phase. This plays a major role in long-term success and a differentiating element for Six Sigma. It also is important during the Control phase to “institutionalize” the wins, celebrate success and instill ongoing change management capabilities through change management tools.



The strategic imperative of this case is HIGH. The look into the future problems and solving them ahead is the key principle of an organization success. Each step the organization took for the future problems made the company to step into the success of project. The way the industry kept the confidentiality, security made us think that it has got the Link to Strategic Imperatives Criteria. The project has a very great impact on the key metrics for the organization. It is very important to maintain the grip over strategic drivers of business as it ensures that leadership remains engaged during the long run improvements. 



I will rank it MEDIUM because there is partial active sponsor engagement in this project to guide the project to the right direction to achieve major business goals. They have identified the issues earlier and stepping towards solving the problem


I will rank it HIGH.  Team members are proud of being part of the team and they see themselves as part of the team. The team has a clear understanding of the overall goal of the process. There has to be team participation for the successful project we can see that the team is maintaining a better understanding and each one playing their role effectively and actively.


The entire organization is aware of the project and they are all involved in the six sigma project. Every member of the organization is aware of the project and has a clear understanding of how it will impact their area of responsibility and plays an active role in communicating the project. I will rank it HIGH.


The project delivered the anticipated results. Everybody in the project is aware of the project changes, results and outcome. I will rank it HIGH, because the project delivered the anticipated results. 


The project was completed within the stipulated time. I will rank it HIGH. Completing the project within the specified time period indicates a sign of success. If a target has to be reached successfully there should be a time period to be set. Finishing a project within the time period is a signal for the starting of success. Short project duration boosts the morale of the team members and long duration projects make team members lose focus


I will rank it LOW. A process owner has not been identified. 


This is HIGH because the improvements attained has sustained over the period of time. The results have been sustained and showed that changes have been adopted by the organization. The performance during the process is far much better as compared to the project start date .The team has embraced the changes and the manager was efficient in managing the time and team efficiently. 


I will rank it HIGH. The team has developed a thorough plan to show how the improvement would be duplicated. Changed management has been put in place for successful continuation.


A project never gets finished it just takes another stage in a cycle called Improvement. It moves from one stage to another stage in a cycle. It enters into the stage called Improvement where changes are made to the plan and implemented again for better results. Improving the measurement system allows a Six Sigma team to focus on the right issue, increase its chances of project success or simply provide day-to-day operations with a tool that helps them in continuous improvement effort. What is measured gets done. Ensuring quality, efficiency and profitability in perioperative services requires a comprehensive approach and the right set of tools. Given current competitive pressures, hospitals must address inefficiencies at their source in order to optimize quality, throughput and the bottom line. The department of perioperative services must understand the linkages with the rest of the facility, and how to align its goals with organizational objectives. When processes can be tightened and delays avoided, the hospital achieves multiple and measurable benefits. Aiming for Six Sigma performance levels can help to improve cost and quality, maximize staff time and resource utilization, and raise satisfaction for both physicians and patients.