Mason S E, Nicolay C R, Darzi A
Division of Surgery, Imperial College London, St Mary's Campus, London W2 1NY, UK.
Division of Surgery, Imperial College London, St Mary's Campus, London W2 1NY, UK.
Surgeon. 2015 Apr;13(2):91-100. doi: 10.1016/j.surge.2014.08.002. Epub 2014 Sep 2.
Lean and Six Sigma are improvement methodologies developed in the manufacturing industry and have been applied to healthcare settings since the 1990 s. They use a systematic and reproducible approach to provide Quality Improvement (QI), with a flexible process that can be applied to a range of outcomes across different patient groups. This review assesses the literature with regard to the use and utility of Lean and Six Sigma methodologies in surgery.
MEDLINE, Embase, PsycINFO, Allied and Complementary Medicine Database, British Nursing Index, Cumulative Index to Nursing and Allied Health Literature, Health Business Elite and the Health Management Information Consortium were searched in January 2014. Experimental studies were included if they assessed the use of Lean or Six Sigma on the ability to improve specified outcomes in surgical patients.
Of the 124 studies returned, 23 were suitable for inclusion with 11 assessing Lean, 6 Six Sigma and 6 Lean Six Sigma. The broad range of outcomes can be collated into six common aims: to optimise outpatient efficiency, to improve operating theatre efficiency, to decrease operative complications, to reduce ward-based harms, to reduce mortality and to limit unnecessary cost and length of stay. The majority of studies (88%) demonstrate improvement; however high levels of systematic bias and imprecision were evident.
Lean and Six Sigma QI methodologies have the potential to produce clinically significant improvement for surgical patients. However there is a need to conduct high-quality studies with low risk of systematic bias in order to further understand their role.
精益和六西格玛是制造业中开发的改进方法，自20世纪90年代以来已应用于医疗保健领域。它们采用系统且可重复的方法来提供质量改进（QI），其流程灵活，可应用于不同患者群体的一系列结果。本综述评估了有关精益和六西格玛方法在手术中的应用及效用的文献。
2014年1月检索了MEDLINE、Embase、PsycINFO、联合与补充医学数据库、英国护理索引、护理及相关健康文献累积索引、健康商业精英数据库和健康管理信息联盟。如果实验研究评估了精益或六西格玛对改善手术患者特定结果能力的影响，则纳入研究。
在检索到的124项研究中，23项适合纳入，其中11项评估精益，6项评估六西格玛，6项评估精益六西格玛。广泛的结果可归纳为六个共同目标：优化门诊效率、提高手术室效率、减少手术并发症、减少病房相关伤害、降低死亡率以及限制不必要的成本和住院时间。大多数研究（88%）显示有改善；然而，明显存在高水平的系统偏倚和不精确性。
精益和六西格玛质量改进方法有可能为手术患者带来临床上的显著改善。然而，需要进行系统偏倚风险低的高质量研究，以进一步了解它们的作用。
