Introduction to Lean Six Sigma
Lean Six Sigma combines two process improvement methodologies: Lean, which focuses on eliminating waste and improving flow, and Six Sigma, which focuses on reducing variation and defects using statistical analysis. RHIA candidates should understand how these combined tools apply to HIM operations such as coding productivity, release of information turnaround, and chart completion workflows.
The DMAIC Framework
Six Sigma projects typically follow the DMAIC cycle: Define the problem and project goals, Measure current performance using baseline data, Analyze the data to identify root causes of defects or delays, Improve the process by implementing targeted changes, and Control the improved process through ongoing monitoring to sustain gains over time.
Lean Concepts Applied to HIM
Lean identifies eight categories of waste, often remembered with the acronym DOWNTIME, standing for defects, overproduction, waiting, non-utilized talent, transportation, inventory, motion, and extra processing. In a coding department, waiting waste might appear as coders idle while awaiting physician query responses, while extra processing waste might appear as redundant documentation review steps that do not add value.
Common HIM Applications
- Reducing discharged-not-final-billed days by streamlining coding queue management
- Improving release of information turnaround time by mapping and simplifying the request fulfillment process
- Reducing physician query volume through targeted clinical documentation improvement education
- Standardizing chart completion workflows to reduce delinquent record rates
Value Stream Mapping
Value stream mapping visually documents every step in a process, distinguishing value-added steps from non-value-added steps, helping teams identify where bottlenecks and redundant handoffs occur before redesigning the workflow for greater efficiency.
Sustaining Improvement
The control phase is often the most overlooked step, but sustaining improvement requires visual management tools, standard work documentation, and periodic audits to ensure the improved process does not regress to prior, less efficient patterns.
Exam Tip
Memorize the five DMAIC phases in order, as exam questions frequently ask you to identify which phase a described activity, such as root cause analysis or baseline data collection, belongs to.