Applying health-six-sigma principles helps reducing the variability of length of stay in the emergency department

Ayala Kobo-Greenhut, Keren Holzman, Osnat Raviv, Jakov Arad, Izhar Ben Shlomo

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Reducing length of stay (LOS) is one of the urgent problems in healthcare systems worldwide. Popular methods that are used to reduce LOS are the Lean and the 6 Sigma, which in practice result in limited improvements. In this paper, we introduce and test a tailored method for implementing the 6 Sigma principles in healthcare (we call H-6S). Objective: To reduce the variability in the time between admission and discharge of patients in the emergency department. Methods: The study took place within the emergency department (ED) of Josephtal Medical Center in Eilat, Israel. Our analysis focused on the processes of examining and treating patients from admission to ED until discharge home. The analysis was done during the second quarter of 2018. The implementation of the recommendations took place during Q3 2018. The reported results are from Q3 2018 to Q2 2019, compared to the corresponding period in 2017 (experienced team). Results: In Q2 2017, LOS was 2.42 ± 2.07 h (experienced team, n = 9928). In Q2 2018, the LOS was 2.62 ± 7.04 h (before the H-6S, inexperienced team, n = 9484). In Q2 2019 following the intervention, it reached 2.3 ± 1.74 h (n = 7647). The differences between the standard deviations of the three periods are significant. Conclusion: Implementing H-6S dropped the variance of LOS within 3 months and remained low for the whole year. Each new team of physicians who enter the ED should be thoroughly instructed as to the routines and expectations of the system from them, which should narrow the differences of previous education between them.

Original languageEnglish
Article numbermzab086
JournalInternational Journal for Quality in Health Care
Issue number2
StatePublished - 23 Jun 2021
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2021 The Author(s) 2021. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved.


  • Emergency department workflow
  • Length of stay variability
  • health 6-sinma


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