UPMC Pursues ‘Lean’ Quality Approach in Italy to Better Care for Patients

By: Wendy Zellner

UPMC-managed ISMETT is hosting its second international quality symposium in Palermo, Italy, on Oct. 30, with a focus on the “Lean Six Sigma approach to improve efficiency and quality of care.” Featuring quality experts from around the world—including “executive sensei” Henry Otero, M.D., of Virginia Mason Institute—the symposium represents an important effort to share the kind of “lean” methodologies and practices that have transformed other industries. Barbara Ragonese, director of quality and patient safety for UPMC in Italy, shared her thoughts on how lean is changing health care at UPMC in Italy and beyond.

Q. What are “lean” practices, and why are they important to health care?

A. Lean Six Sigma principles are used in a wide range of industries to eliminate waste, decrease variation and reduce defects in every process, procedure and activity through an ongoing system of improvement and the use of a well-defined set of tools and techniques. When applied correctly, these methodologies can lead to higher patient and employee satisfaction and fewer errors. Lean Six Sigma has long been used in manufacturing and made famous by auto companies like Toyota.

At UPMC in Pittsburgh, this approach has been used for over a decade to improve operations, and thousands of people have been trained across the system. Now we are bringing that level of competency to our operations in Italy, starting at UPMC Salvator Mundi International Hospital in Rome. What we are trying to do is shape a culture of quality improvement. We aim to train 60 of the 200 employees at UPMC Salvator Mundi, including unit coordinators, nurses and managers.

Q. Is this unusual in health care, especially in Italy?

A. I’ve personally done this kind of training in Italy, but usually with engineers and manufacturing workers. You don’t typically have clinical people doing this kind of job. If you give this methodology and tools to the people who know the clinical work the best, we believe it will make a big difference. Our goal at UPMC Salvator Mundi is to be recognized as a “lean hospital,” with a deeply embedded culture of constant quality improvement. We hope to be the first facility of any kind in Italy to achieve ISO 18404 certification for Lean and Six Sigma from the Royal Statistical Society.

Q. Is “lean” new to UPMC in Italy?

A. No. For years, ISMETT has used some “lean” approaches, and we’ve celebrated those who have made significant achievements with this methodology—whether that’s reducing waiting times for patients, improving schedule efficiencies or reducing false positives in certain kinds of diagnostic tests. The Lean Six Sigma effort is meant to take this approach to the next level to achieve even better outcomes and higher patient satisfaction.

Q. What would the ISO certification you mentioned mean to patients?

A. The goal is for every single staff member and clinician to focus on the patient perspective, to listen to the “voice of the customer.” Our pursuit of this certification will mean that we are doing everything possible to reduce variation in our processes, which will reduce the risk of adverse events, reduce waste, enhance quality and improve patient satisfaction. It would be a huge achievement and one that we expect would take several years to accomplish. UPMC Salvator Mundi will also set the stage for expanding these efforts throughout our growing Italian operations.

Q. What does this process mean for your employees?

A. In this approach, our employees are the experts; their ideas, their input are central to the work. Staff should feel more confident identifying a broken process or a potential safety issue. It’s extremely empowering for our people. This is where health care has to go.