Gap Analysis using Literature Review

Presented by: Maria Ashraf

MSIEM32F18
Research Process
The eight-step model for carrying out research
PHASE I DECIDING WHAT TO RESEARCH
• Step I Formulating a research problem
PHASE II PLANNING A RESEARCH STUDY
• Step II Conceptualizing a research design
• Step III Constructing an instrument for data collection
• Step IV Selecting a sample
• Step V Writing a research proposal
PHASE III CONDUCTING A RESEARCH STUDY
• Step VI Collecting data
• Step VII Processing and displaying data
• Step VIII Writing a research report
Phase 1
The main task of phase 1 is to:
DECIDE
Research questions to answer?
Literature Review
Broder area off interest is LEAN SIX SIGMA.
Four Steps of literature review.
1 Searching for the existing literature in your area of study.
2 Reviewing the selected literature.
3 Developing a theoretical framework.
4 Developing a conceptual framework
1- Searching for the existing
literature
Some idea of the broad subject area.
The problem we wish to investigate.
Compiling a bibliography for this broad area
Electronic database
2-Reviewing the selected
literature
Lean six sigma methodology.
Findings: Lean Six Sigma use DMAIC approach to improve the performance by eliminating the
defects
Lean Six Sigma Implementation in manufacturing sector.
Findings: Lean implementations in manufacturing sector targets:
(1)increased profits and financial savings
(2) increased customer satisfaction
(3) reduced cost
(Cont.)
Cont.
(4) reduced cycle time
(5) improved key performance metrics
(6) reduced defects
(7) reduction in machine breakdown time
(8) reduced inventory
(9) improved quality;
(10) increased production capacity.
Cont.
Lean Six Sigma implementation in service industry:
Finding: Customer satisfaction, wait time reduction, cost reduction, quality improvement,
increasing profits.
Lean Six Sigma implementation in health care sector.
Databases:
Web of Science, Medline, Emerald Insight, ASQ and ProQuest databases.
Cont.
The most common benefits of Six Sigma implementation in healthcare are improvement:
In patient safety, improvement in process speed (i.e., increased productivity) and revenue
enhancement (i.e., bottom-line savings).
Lean Six Sigma and radiology department: Area of Interest.
 Literature
Article Details Methodology / Approach / Key Findings
(Authors, Years, Title) Respondents / Analysis
Antony, J. (2014). Readiness factors for the Lean Six • Readiness factors (RFs)
Sigma journey in the higher education sector. • Secondary data from literature to justify
International Journal of Productivity and
• LSS is a very powerful methodology that can
the need for RFs process efficiency problem in Higher education
Performance Management, 63(2), 257–264.
• theoretical paper review industry.
Readiness factors for the Lean • LSS (VSM, SIPOC, Cause and effect
Six Sigma journey in the higher analysis)
education sector (1)

Alsyouf, I., Kumar, U., Al-Ashi, L., & Al-Hammadi, • UAE airline • Low system reliability and high number of
M. (2018). Improving baggage flow in the baggage
handling system at a UAE-based airline using lean • (DMAIC) bags passing through MES (Manual Encoding
Six Sigma tools. Quality Engineering, 30(3), 432– • SIPOC, histograms, FMEA Station) will have an impact on both the
452. • Improved BHS system and the organization from different
perspectives
Improving baggage flow in the
baggage handling system at a
UAE-based airline using lean Six
Sigma tools. (2)
 Literature
Article Details Methodology / Approach / Key Findings
(Authors, Years, Title) Respondents / Analysis
Mohsen F. Mohamed Isa, & Mumtaz Usmen.
(2015). Improving university facilities services • Facilities management (FM) departments Non-value-added general improvement review form
using Lean Six Sigma: a case study. Journal of at universities (GIRF) process add in time delays, cost increases and
Facilities Management, 13(1), 70–84.
• DMAIC quality deficiencies and render cost estimates unreliable;
• survey questionnaire these are unnecessary and should be minimized or
Improving university • 205 responses eliminated.
facilities services using Lean • process mapping, Pareto analysis, CE
Six Sigma: a case study (3) matrix and FMEA

Ghoul, S., Nashawati, D. M. K., Hamaly, M. A., Mutlaq, S.,

Mansour, A., & Nofal, A. (2019). Streamlining the • Six sigma DMAIC methodology • The counter measures were
Interventional Breast Imaging Workflow by Lean
Methodology Implementation. Proceedings - 2018 1st • affinity diagrams implemented and that resulted in
International Conference on Cancer Care Informatics, CCI
• root cause analysis reduced wait time for the breast
2018, (Cci), 41–46.
https://doi.org/10.1109/CANCERCARE.2018.8618178 diagnostic patients and improved patient
Streamlining the Interventional satisfactions.
mammography Imaging Workflow
by Lean Methodology (4)
 Literature
Article Details Methodology / Approach / Key Findings
(Authors, Years, Title) Respondents / Analysis
Journal, I., & Volume, G. S. (2014). Utilization • DMAIC • By applying DMAIC approach the rejection has
of six sigma ( DMAIC ) Approach for Reducing • Observation of machine reduced from 6.98% to 3.10% and saving of cost Rs
• ISHIKIWA Diagram
Casting Defects. 2(6), 1065–1075. 2.35 lac approximately

Utilization of six sigma(DMAIC)

Approach for Reducing Casting
Defects (5)

Shirey, W. T., Sullivan, K. T., Lines, B., &
Smithwick, J. (2017). Case Study
Application of Lean Six Sigma to Improve
Service in Healthcare Facilities
Management : A Case Study. 1(1), 9–18.
Application of Lean Six Sigma to
Improve Service in Healthcare
Facilities Management: A Case
Study (6)
• Facilities management (FM)
services
• DMAIC
• Qualitative data analysis
• Pre- and post-intervention
surveys.
• The average wait time during the post-LSS
application period measured 9.50 hours,
which was a 75% improvement from the
baseline. The standard deviation improved
by 88% dropping from 70.03 hours down to
just 8.42 hours.
 Literature
Article Details Methodology / Approach / Key Findings
(Authors, Years, Title) Respondents / Analysis
Ahmed, S., Abd Manaf, N. H., & Islam, R. (2019). • Simple random sampling • Work force involvement for streamline
Effects of Six Sigma initiatives in Malaysian • Interviews and questioners process and improved six sigma
private hospitals. International Journal of Lean • AMOS software outcomes was found to be crucial.
Six Sigma, 10(1), 44–57.
https://doi.org/10.1108/IJLSS-08-2017-0099

Effects of Six Sigma initiatives in

Malaysian private hospitals(7)

Gul, M., & Guneri, A. F. (2015). A comprehensive

review of emergency department simulation
applications for normal and disaster conditions.
Computers and Industrial Engineering, 83, 327–
344. https://doi.org/10.1016/j.cie.2015.02.018
A comprehensive review of emergency
department simulation applications for
normal and disaster conditions(8)
• Simulations of HED
• Model of Emergency
department
• DMAIC on model
• The goal should be to reduce the process
problems not the people problems.
• In improvement phase of DMAIC the
process capability enhancement was found
to be crucial factor to enhance the patent
satisfaction levels.
 Literature Review
Article Details Methodology / Approach / Key Findings
(Authors, Years, Title) Respondents / Analysis
Basu, P. A., Ruiz-Wibbelsmann, J. A., Spielman, S. • Improving the process of • Waste reduction has helped in process improvement
B., Van Dalsem, V. F., Rosenberg, J. K., & Glazer, G. Myocardial infraction treatments and process efficiency improved from 32.27 to
M. (2011). Creating a patient-centered service:
using DMAIC process. 51.81%.
Lean Six Sigma approach. American Journal of • Non-value adding activities • Average stay time of patient in hospital was also
eliminations.
Roentgenology, 196(3), 605–610. reduced from a week to 3 days.
https://doi.org/10.2214/AJR.10.5333 • Saving net total of 4.422 million dollar’s resources

Creating a patient-centered service:

Lean Six Sigma approach. (9)

Almorsy, L., & Khalifa, M. (2016). Lean six sigma in

health care: Improving utilization and reducing
waste. Studies in Health Technology and
Informatics, 226(July), 194–197.
https://doi.org/10.3233/978-1-61499-664-4-194
Lean six sigma in health care:
Improving utilization and reducing
waste.(10)
• DMAIC (Define, Measure, • Reduced amount of quality checks and
Analyze, Improve and Control) Quality Control (QC) rounds from 13% to
method. 4% and thus saving of resources.
• to Update the internal
procedures and train the staff for
effective use of resources
 Literature Review
Article Details
(Authors, Years, Title)
Shanin, D., Ulrich, A., Robinson, C., Venkatesh, A.,
& Parwani, V. (2017). 18 Scan, Admit, or Both? Is
There a Correlation Between Admission Rate and
Computed Tomography Utilization? Annals of
Emergency Medicine, 70(4), S8–S9.
https://doi.org/10.1016/j.annemergmed.2017.07.
042
Scan, Admit, or Both? Is There a
Correlation Between Admission Rate
and Computed Tomography
Utilization?
Al-Bashir, (11) A., & Abdul Jawwad, A. •
A., Al-Tawarah,
(2017). Downtime reduction on medical
equipment maintenance at the directorate of
biomedical engineering in the Jordanian MOH.
International Journal of Online Engineering, 13(2),
4–17. https://doi.org/10.3991/ijoe.v13i02.6422
Downtime reduction on medical
equipment maintenance at the
directorate of biomedical engineering
in the Jordanian MOH. (12)
Methodology / Approach / Key Findings
Respondents / Analysis
• Retrospective observational • Increased provider CT utilization does not correlate
study. with a decreased admission rate. The opposite is true;
• Admission and CT utilization data those physicians who order the most CTs also admit
• The overall admission the most patients.
percentage was 33.2% with a
standard deviation of 8.6%. The
total CT utilization was 16.3%
with a standard deviation of
5.5%
Process improvement study • Downtime reduced by 35% by
• Six Sigma methodology- DMAIC- introducing a new procedure to the
(Define, Measure, Analyze, clinical engineer to used when dealing
Improve and Control). with any medical equipment for
maintenance work.
• A multiple regression model of
the downtime was developed.
 Literature Review
Article Details Methodology / Approach / Key Findings
(Authors, Years, Title) Respondents / Analysis
Tekes, A., Jackson, E. M., Ogborn, J., Liang, S., Bledsoe, M., • DMAIC methodology to assist • The improved MRI workflow bring about a
Durand, D. J., … Huisman, T. A. G. M. (2016). How to the team of radiologist 75% reduction in the usage of
reduce head CT orders in children with hydrocephalus • The existing baseline imaging hydrocephalus imaging done by CT scan.
using the lean six sigma methodology: Experience at a
practice for hydrocephalus was
outlined in a Kaizen session
major quaternary care academic children’s center.
American Journal of Neuroradiology, 37(6), 990–996.
• An improved radiation-free
workflow with ultrafast
https://doi.org/10.3174/ajnr.A4658 MR(Magnetic resonance)
How to reduce head CT orders in imaging was created.
children with hydrocephalus using
the lean six sigma methodology:
Experience at a major quaternary
care academic children’s center. (13)
• The aim was to improve the
Cheung, Y. Y., Goodman, E. M., & Osunkoya, T. O.
(2016). No more waits and delays: Streamlining • Significantly reduced wait times
process quality, reduce the wait
workflow to decrease patient time of stay for image- (P<.0019)
guided musculoskeletal procedures. Radiographics,
36(3), 856–871.
https://doi.org/10.1148/rg.2016150174
times and increasing the patient • registration time improvement from 17
satisfaction score. to 99%
No more waits and delays:
Streamlining workflow to decrease • Lean Six Sigma DMAIC (Define, • treatment tme improvement from 19 to
patient time of stay for image-guided Measure, Analyze, Improve and 60 %.
musculoskeletal procedures. (14)
Control framework
 Literature Review
Article Details Methodology / Approach / Key Findings
(Authors, Years, Title) Respondents / Analysis
Basu, P. A., Ruiz-Wibbelsmann, J. A., Spielman, S. • Improving the process of • Waste reduction has helped in process
B., Van Dalsem, V. F., Rosenberg, J. K., & Glazer, G. Myocardial infraction treatments improvement and process efficiency
M. (2011). Creating a patient-centered imaging
using DMAIC process. improved from 32.27 to 51.81%.
service: Determining what patients want. • Non-value adding activities • Average stay time of patient in hospital
eliminations. was also reduced from a week to 3 days.
American Journal of Roentgenology, 196(3), 605–
610. https://doi.org/10.2214/AJR.10.5333 • Saving net total of 4.422 million dollar’s
resources
Creating a patient-centered imaging
service: Determining what patients
want. (15)
Mohsen F. Mohamed Isa, & Mumtaz Usmen. • Facilities management (FM) departments • Non-value-added general improvement review form
(2015). Improving university facilities services (GIRF) process add n time delays, cost increases
using Lean Six Sigma: a case study. Journal of at universities
and quality deficiencies and render cost estimates
Facilities Management, 13(1), 70–84.
• DMAIC unreliable; these are unnecessary and should be
• survey questionnaire minimized or eliminated.
Improving university facilities services
using Lean Six Sigma: a case study(16) • 205 responses
• process mapping, Pareto analysis, CE
matrix and FMEA

Article Details
(Authors, Years, Title)
Creating a Radiology Quality • Root Cause Analysis
and Safety Program: • SMART goals
Principles and Pitfalls (17) • PDCA cycle
Jennifer C. Broder, MD Scott F. Cameron, MD
RadioGraphics 2018; 38:1786–
1798https://doi.org/10.1148/rg.2018180032
Literature Review
Methodology / Approach /
Respondents / Analysis
Key Findings
• It was identified that Radiology QS need constant
monitoring from the leadership.
• Using resources offered by professional societies
and participating in QS community networks can
provide ongoing support for program leaders

Decreasing Wait Times and
Increasing Patient Satisfaction (18)
A Lean Six Sigma Approach Mary
Godley, DNP, MSN, RN, NE-BC;
Jeanne B. Jenkins, PhD, MBA, RN
• Lean Six Sigma define, measure,
analyze, improve, and control
(DMAIC) framework
• There was a statistically significant decrease in
wait times and an increase in patient satisfaction
scores in 3 areas: registration wait times (from
17 to 99 percentiles), test/treatment (from 19 to
60 percentiles), and likelihood to recommend
(from 6 to 97 percentiles).
• Lean Six Sigma was an effective framework for
use in decreasing wait times and improving
patient satisfaction.
 Literature Review
Article Details Methodology / Approach / Key Findings
(Authors, Years, Title) Respondents / Analysis
Vilert A. Loving, MD, MMMa , • Process improvement • Wait times heavily influence patient satisfaction
Richard L. Ellis, MDb , Robert methodologies and their perception of service quality
Rippee, MBAc 2017 American
College of Radiology
• LEAN Six Sigma • Radiology practices can employ a four-step
• Value stream map approach to decrease patient wait times: (1)
Time Is Not on Our Side: How
Radiology Practices Should
• Fishbone analysis analyze factors contributing to queue formation;
(2) improve processes to reduce service times; (3)
Manage Customer Queues(19)
reduce variability; (4) address the psychology of
queues.
• Failure mode effect analysis
Janet Switi, Sudhakar Kantipadi, P Naveen • Number 490 is the maximum risk priority
number (RPN) for report approval and
Kumar Jp-Journal 10035 (FMEA) was used to identify preparation; 920 minutes was the average time
Improving Scan Reporting potential steps for failure, and taken for CT scan approval and 834 minutes was
Time using Lean and Six their effects the time for MRI scan approval.
Sigma (20) • The radiologists were pointing that lesser
number of monitors were available for report
preparation.
 Literature Review
Article Details Methodology / Approach / Key Findings
(Authors, Years, Title) Respondents / Analysis
Vilert A. Loving, MD, MMMa , • Process improvement • Wait times heavily influence patient satisfaction
Richard L. Ellis, MDb , Robert methodologies and their perception of service quality
Rippee, MBAc 2017 American
College of Radiology
• LEAN Six Sigma • Radiology practices can employ a four-step
• Value stream map approach to decrease patient wait times: (1)
Time Is Not on Our Side: How
Radiology Practices Should
• Fishbone analysis analyze factors contributing to queue formation;
(2) improve processes to reduce service times; (3)
Manage Customer Queues(21)
reduce variability; (4) address the psychology of
queues.
• Failure mode effect analysis
Janet Switi, Sudhakar Kantipadi, P Naveen • Number 490 is the maximum risk priority
number (RPN) for report approval and
Kumar Jp-Journal 10035 (FMEA) was used to identify preparation; 920 minutes was the average time
Improving Scan Reporting potential steps for failure, and taken for CT scan approval and 834 minutes was
Time using Lean and Six their effects the time for MRI scan approval.
Sigma(22) • The radiologists were pointing that lesser
number of monitors were available for report
preparation.
Key findings:
The findings of the systematic review reveal a growing interest in research on Six Sigma
adoption in healthcare.
I have observed that major focus of lean six sigma in radiological department of healthcare is
on patient wait time reduction, or improving the process parameters.
However, the aspect of radiological machines downtime on the overall process efficiency and
patient wait time is not properly investigated yet.
On basis of these observations I am going to formulate the problem that I’ll investigate .
Problem Formulation:
Impact of Lean Six Sigma in radiology department: To
reduce Radiological Equipment Downtime.
Methodology:
DMAIC
To observe CM(Corrective maintenance) & to schedule PM (Preventive maintenance).
FMEA
Preto-Chart Analysis.
Thank You.