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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 15  |  Issue : 1  |  Page : 91-93

Knowledge and attitude of nurses toward the implementation of quality management systems with special reference to Six Sigma


Faculty of Health Sciences, Symbiosis International University, Symbiosis College of Nursing, Pune, Maharashtra, India

Date of Submission07-Aug-2019
Date of Decision07-Aug-2019
Date of Acceptance12-Feb-2020
Date of Web Publication13-Oct-2020

Correspondence Address:
Prof. Deepak Sethi
#P9/2 New Mandela Line Range Hills, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_120_19

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  Abstract 


Background: Health care delivery system is one of the most dynamic areas where the professional growth takes place on an everyday basis. In the country's present scenario, where health services is made available to the community in a variety of forms, by way of government health centers, trust hospitals, religious sponsored small and big hospitals, and private and corporate hospitals, the expectations of the patient have increased toward the quality of health services offered. Aim: The aim of the study was to assess the knowledge and attitude of the employees toward the implementation of quality management system with special reference to Six Sigma. Objectives: 1. To assess the current status of the waiting period at various departments of the selected hospitals. 2. To assess the knowledge regarding Six Sigma. 3. To assess the attitude regarding Six Sigma. 4. To compare the knowledge and attitude of private and government health care organization. Methodology: Research approach: Quantitative approach. Research design: Pre-experimental. Sampling technique: Convenience sampling. Sample size: 60 (calculated by power analysis). Sampling criteria. Inclusive criteria. 1. Those who are involved in hospital administrative work. 2. Those who are available at the time of data collection. 3. Those who can understand English. Exclusive criteria. 1. Who have already done Six Sigma citification. Results: The results showed that the maximum time spent by the patient at the outpatient department (OPD) for registration was 16–20 min. According to the reviews, this is the appropriate time taken by any health care organization to do OPD registration. Very few respond to took more than 25 min, i.e., 3%. Maximum patients spent 21–25 min at the laboratory and only 5% spent <20 min. Time taken by the individual in pharmacy indicates that maximum participants, i.e., 37%, took 16–20 min to get the drugs and 23% of participants took more than 25 min. Regarding the knowledge toward Six Sigma, 22% health care workers in private sector have good knowledge score as compared to government organization, i.e., 10%. Seven percent of health care workers have average knowledge score in private organization and 8% of participants have average knowledge score in government health sector. Regarding the attitude toward Six Sigma, private health care organization workers (53%) have a good attitude score as compared to government organization (18%). Conclusion: Six Sigma principles are well suited to the health care sector due to its zero tolerance for mistakes and Six Sigma's potential for reducing medical errors. Lean Six Sigma projects in healthcare have largely focused on direct care delivery, administrative support, and financial administration. The aim has been to improve clinical processes, to identify and eliminate waste from patient pathways, to enable staff to examine their own workplace, and to increase quality, safety, and efficiency. The concept of Six Sigma is purely corporate in nature. There is a lot of difference between the knowledge and attitude regarding Six Sigma among private and government organizations, and this study proves the same..

Keywords: Attitude, knowledge, quality management process and Six Sigma


How to cite this article:
Sethi D, Joshi S G. Knowledge and attitude of nurses toward the implementation of quality management systems with special reference to Six Sigma. J Datta Meghe Inst Med Sci Univ 2020;15:91-3

How to cite this URL:
Sethi D, Joshi S G. Knowledge and attitude of nurses toward the implementation of quality management systems with special reference to Six Sigma. J Datta Meghe Inst Med Sci Univ [serial online] 2020 [cited 2020 Oct 27];15:91-3. Available from: http://www.journaldmims.com/text.asp?2020/15/1/91/297963




  Introduction Top


Patients have expectations which include the immediate attention to the health needs, care they are getting from nurses. less waiting time in OPD's, less time period for lab investigation etc. This is a well-known fact that one of the most important indexes of the health-care quality is patient's satisfaction and it takes place only when there is a process based on management, especially the one like management of waiting time process. Managing healthcare based on the effective use of Six Sigma concepts using the define, measure, analysis, improve, and control approach could result in a decrease in the patient's waiting time, especially at the OPDs. The techniques from the lean Six Sigma play an important role in assisting healthcare to deliver high-quality service within its current budget constraints.

Although containing many supremacies and exhibiting outstanding advances in technology and management, the health-care sector is widespread with inabilities and errors.[1] Over the past decade, the world financial pressures on health-care system raised throughout the world. While an aging population and increased cost of medical treatments with new and advance technology are the most common culprits for these financial pressures,[2] managing healthcare and effective use of Six Sigma concepts could result in a decreased proportion of citizens in industrialized societies being able to afford high-quality healthcare.[2]

One way to improve this situation is the health-care sector to continue the evaluation of quality processes and to deliver healthcare more efficiently and effectively within available budgets. The techniques from the Lean Six Sigma play an important role in assisting healthcare to deliver high-quality service within its current budget constraints.

Six Sigma is a data-driven process improvement methodology used to achieve stable and predictable process results, reducing process variation and defects. Snee (1999) defined it as: “a business strategy that seeks to identify and eliminate causes of errors or defects or failures in business processes by focusing on outputs that are critical to customers.” While both Lean and Six Sigma have been used for many years, they were not integrated until the late 1990s and early 2000s,[3] and today, Lean Six Sigma is recognized as: “a business strategy and methodology that increases process performance resulting in enhanced customer satisfaction and improved bottom line results.”[4] Lean Six Sigma uses tools from both toolboxes to get the best from the two methodologies, increasing speed while also increasing accuracy.

Lean Six Sigma is a process which improves business methodology and aims to maximize shareholder value by improving quality, speed, customer satisfaction, and costs.[8] It has been widely adopted in health-care delivery system and service industries. Six Sigma principles are well suited to the health-care sector due to its zero tolerance for errors and focused on potentially reducing medical errors.[5] On the same hand, Six Sigma tools are applicable to an endless variety of processes in healthcare, addressing critical challenges such as medical errors, escalating costs, and staffing shortages.[6] Lean and Six Sigma have the potential to contribute to the health-care industry as much as they have contributed to the automotive industry.[7]

In the Indian scenario, any multispecialty hospital with a bed capacity of 200 and above has a tendency to get a continuous inflow of patients despite whatever is the time of the day. One way to improve this situation is the health-care sector to examine its processes and to deliver care more efficiently and effectively within the available time and budget. The philosophy of continuous improvement and the techniques, which is the motto of every hospital, from the lean Six Sigma stable has a role to play in assisting healthcare to deliver high-quality service within its current budget constraints.

Lean and Six Sigma have followed independent paths since the 1980s when the terms were first hard-coded and defined: the first applications of lean were recorded in the Michigan plants of Ford in 1913 and were then developed to mastery in Japan (within the Toyota Production System), while Six Sigma saw the light in the United States (within the Motorola Research Centre). Lean is a process improvement methodology used to deliver products and services better, faster, and at a lower cost.

For this study, the source of idea and motivation came in from the personal experience of the researcher. During the clinical postings at a corporation hospital in Pune, a clinical supervisor for the undergraduate and postgraduate students of the nursing college, the investigator/researcher identified that the workload of the hospital OPD was immense due to the continuous inflow of patients by way of referrals, both from urban as well rural community, as it was one of the largest multispecialty hospitals offering services of expert doctors and nurses.

The observations made on everyday basis and an informal interaction with the patients who were waiting at the OPDs made the researcher to rethink about this as an area to be pondered upon and researched with a view to identify the existence of the problem as experienced by the patients and perceived by the staff and concerned management members and the attitude toward bringing in modifications to reduce the waiting period of patients at the OPDs.

Research statement

Research statement consists of employees' knowledge and attitude toward the implementation of quality management systems with special reference to Six Sigma.

Aim

The aim of the study was to assess the knowledge and attitude of the employees toward the implementation of quality management system with special reference to Six Sigma.

Objectives

  1. To assess the current status of the waiting period at various departments of the selected hospitals
  2. To assess the knowledge regarding Six Sigma
  3. To assess the attitude regarding Six Sigma
  4. To compare the knowledge and attitude of private and government health-care organization.



  Methodology Top


  • Research approach: Quantitative approach
  • Research design: Preexperimental
  • Sampling technique: Convenience sampling
  • Sample size: 60 (calculated by power analysis)
  • Sampling criteria.
  • Inclusive criteria


    1. Those who are involved in hospital administrative work
    2. Those who are available at the time of data collection
    3. Those who can understand English.


  • Exclusive criteria


  1. Who have already done Six Sigma citification


Ethical clearance

Ethical clearance was obtained from the Institutional Ethical Committee of Symbiosis College of Nursing, Pune, Maharashtra on 8th July 2019. With ethical clearance no SCN/IEC/2019-20/82.

Data collection procedure: The data collection was done in three phases

  1. Section I: Sociodemographical data and time duration taken up by various departments of hospital such as ICU nursing department
  2. Section II: Knowledge regarding Lean Six Sigma among the health-care workers
  3. Section III: Attitude toward lean Six Sigma among the health-care workers.



  Discussion Top


Study was conducted by Admin et all reveled that the nurses knowledge and attitude towards six sigma process in order to maintain drug records and minimizing the medication errors were very poor. It can be improved by continuing education services during the tenure of service.

Similar study conducted showed that nurses can improve the quality management process with the used of DMAIC approach of six sigma.


  Results Top


The results showed that the maximum time spent by the patient at the outpatient department (OPD) for registration was 16–20 min. According to the reviews, this is the appropriate time taken by any health-care organization to do OPD registration. Very few respond to took more than 25 min, i.e., 3%. Maximum patients spent 21–25 min at the laboratory and only 5% spent <20 min. Time taken by the individual in pharmacy indicates that maximum participants, i.e., 37%, took 16–20 min to get the drugs and 23% of participants took more than 25 min. Regarding the knowledge toward Six Sigma, 22% health-care workers in private sector have good knowledge score as compared to government organization, i.e., 10%. Seven percent of health-care workers have average knowledge score in private organization and 8% of participants have average knowledge score in government health sector. Regarding the attitude toward Six Sigma, private health-care organization workers (53%) have a good attitude score as compared to government organization (18%).


  Conclusion Top


Six Sigma principles are well suited to the health-care sector due to its zero tolerance for mistakes and Six Sigma's potential for reducing medical errors. Lean Six Sigma projects in healthcare have largely focused on direct care delivery, administrative support, and financial administration. The aim has been to improve clinical processes, to identify and eliminate waste from patient pathways, to enable staff to examine their own workplace, and to increase quality, safety, and efficiency. The concept of Six Sigma is purely corporate in nature. There is a lot of difference between the knowledge and attitude regarding Six Sigma among private and government organizations, and this study proves the same.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Adams C, Gupta P, Wilson C. Six Sigma Deployment. Burlington, MA: Butterworth-Heinemann; 2003.  Back to cited text no. 1
    
2.
Antony J. Assessing the Status of Six Sigma in the UK Service Organizations. Proceedings of the Second National Conference on Six Sigma Wroclaw; 2005a. p. 1-12.  Back to cited text no. 2
    
3.
Antony J. Six sigma for service processes. Bus Process Manage J 2005b; 12:234-48.  Back to cited text no. 3
    
4.
Antony J, Kumar M, Madu CN. Six sigma in small and medium sized UK manufacturing enterprises: Some empirical observations. Int J Qual Reliab Manage 2005c; 22:860-74.  Back to cited text no. 4
    
5.
Antony J, Kumar M, Tiwari MK. An application of six sigma methodology to reduce the engine overheating problem in an automotive company. IMechE - Part B 2005d; 219(B8):633-46.  Back to cited text no. 5
    
6.
Antony J, Antony F, Taner T. The secret of success. Public Serv Rev Trade Ind 2006;10:12-14.  Back to cited text no. 6
    
7.
Antony J, Kumar M, Cho BR. Six sigma in services organizations: Benefits, challenges and difficulties, common myths, empirical observations success factors. Int J Qual Reliab Manage 2007;24:294-311.  Back to cited text no. 7
    
8.
Benedetto AR. Adapting manufacturing-based six sigma methodology to the service environment of a radiology flim library. J Healthcare Manage 2003;48:263-80.  Back to cited text no. 8
    




 

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