Lean/Six Sigma
Lean and Six Sigma are complementary quality‑improvement (QI) methodologies widely used in healthcare to reduce waste, improve flow and minimise variation.
Combined, they provide a structured, data‑driven approach to making ED processes faster, safer and more predictable.
Use RCEM’s QI guidance as the primary ED‑focused reference for definitions, DMAIC steps and practical tools (RCEM QI Guide, 2022).
Use NICE “Into practice” implementation materials for measurement planning and linking projects to national quality standards (NICE Into Practice).
Organisational responsibilities for embedding QI are described by the National Quality Board/GOV.UK guidance (NQB/GOV.UK).
Overview and when to choose Lean/Six Sigma
- Best suited to defined, repeatable clinical or operational processes with measurable outcomes (for example: triage, analgesia delivery, imaging workflow, discharge).
- Appropriate where inefficiency, waste or unwarranted variation are the primary problems and baseline data are available.
- Not ideal for ill‑defined, highly adaptive system problems with no clear process map; alternative approaches (for example: system redesign, workforce modelling) or rapid PDSA cycles may be preferable.
- Ensure frontline engagement and organisational support before starting a Lean/Six Sigma project (see Governance & prerequisites).
Core concepts
- Lean: maximises value for patients by identifying and eliminating waste (activities that consume resources without adding patient value). Common wastes include defects, waiting, unnecessary motion/transportation, excess inventory, overprocessing and underused staff. Typical tools: value‑stream mapping (VSM), gemba/waste walks, 5S,...