Lean six sigma and stroke in rural hospital – The case of Baruch Padeh Medical Center

Batsheva Tzadok, Oran Ben Tov, Vladimir Vaispapir, Lev Shornikov, Olga Marik, Leon Martens, Eran Tal Or

Research output: Contribution to journalArticlepeer-review


Purpose: This case study aims to demonstrate the strengths of the Lean Six Sigma (LSS) methodology to improve the acute ischemic stroke (AIS) treatment rates and reduce process lead time at Baruch Padeh Medical Center (BPMC), a rural hospital in the Galilee region of Northern Israel. The LSS project redefined the BPMC stroke care pathway and increased its efficacy. Design/methodology/approach: The LSS methodology was implemented in September 2017 by integrating lean principles and the Six Sigma DMAIC (Define–Measure–Analyze–Improve–Control). Existing procedures, field observation, ad hoc measurement and in-depth interviews were utilized, and the GEMBA method was implemented to identify root cause and improve actions optimizing the stroke pathway. Findings: The presented case shows the usefulness of the LSS methodology in improving quality performance in a rural hospital. The intervention allowed the BPMC to improve the intravenous tissue plasminogen activator (IV-tPA) administration rate (+15.2%), reducing the process lead time. The lead time of door-to-computer tomography decreased from 52 to 26 min, and the door-to-needle time decreased from 94 to 75 min. Originality/value: The present case study shows the implementation of the LSS methodology aimed to improve the IV-tPA administration rate and reduce the stroke pathway lead time in a rural hospital. The case demonstrates the potential for the LSS methodology to support the AIS pathway optimization and represents a guide for healthcare organizations located in rural areas.

Original languageEnglish
Pages (from-to)21-37
Number of pages17
JournalInternational Journal of Health Care Quality Assurance
Issue number1
StatePublished - 13 Sep 2022
Externally publishedYes

Bibliographical note

Funding Information:
Research Funding : The author(s) received no specific funding for this work. Author contributions : Conceived and designed the study: B.Z, O.B. Performed the data/evidence collection: O.B, L.M. Analyzed the data: O.B, L.M. Wrote the paper: B.Z, O.B. Critical revision of the manuscript: V.V, L.S, O.M, E.T. Approval of the final version of the manuscript: B.Z, O.B. Conflicts of interest : One author received consultancy fees paid by MOH to execute the improvement project.

Publisher Copyright:
© 2021, Emerald Publishing Limited.


  • Acute ischemic stroke
  • Healthcare quality improvement
  • Lean six sigma
  • Rural hospital
  • Stroke care pathway


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