Two Complementary Improvement Philosophies
Lean and Six Sigma are the two most widely tested performance improvement methodologies on the RHIA exam. While they share a goal of improving quality and efficiency, they approach the problem differently. Lean focuses on eliminating waste, while Six Sigma focuses on reducing variation and defects.
Lean Principles
Lean methodology originated in manufacturing and identifies eight types of waste, often remembered with the acronym DOWNTIME: defects, overproduction, waiting, non-utilized talent, transportation, inventory, motion, and extra processing. In an HIM department, waiting time for physician signatures or unnecessary duplicate data entry are common examples of waste.
Value Stream Mapping
A core Lean tool is value stream mapping, which visually documents every step in a process to identify non-value-added activities. Mapping the release of information process, for instance, might reveal redundant approval steps that can be eliminated.
Six Sigma and DMAIC
Six Sigma uses statistical methods to reduce process variation to near-zero defect levels. The DMAIC cycle, standing for Define, Measure, Analyze, Improve, and Control, structures Six Sigma projects.
- Define the problem and project goals
- Measure current process performance with data
- Analyze root causes of defects
- Improve the process through targeted changes
- Control the new process to sustain gains
Lean Six Sigma Hybrid
Many healthcare organizations combine both approaches into Lean Six Sigma, using Lean tools to streamline workflow while applying Six Sigma statistical rigor to reduce errors, such as coding inaccuracies or missing documentation elements.
Kaizen Events
A kaizen event is a short, focused improvement workshop where a cross-functional team rapidly analyzes a process and implements changes. HIM departments use kaizen events to tackle specific problems like chart deficiency backlogs.
Applying These Tools
RHIA candidates should be able to distinguish when to apply Lean versus Six Sigma. A process with obvious wasted steps benefits from Lean, while a process with inconsistent quality outcomes benefits from Six Sigma statistical analysis.
Exam Tip
Memorize the DMAIC steps in order and know that Lean targets waste while Six Sigma targets variation and defects. Scenario questions often ask which methodology fits a described problem.