Working together to achieve greater quality and safety in healthcare; interweaving Quality Improvement, Lean Six Sigma and Human Factors Ergonomics: a viewpoint paper

Purpose Many efforts to improve patient safety across the healthcare system over the last 20 years have not met their desired objectives. Transformational and courageous leadership is needed to encourage thinking at the macro, meso and micro system levels to identify what are the best approaches to change at different system levels that will ultimately enable improvements in patient safety. In this viewpoint we explore Quality Improvement (QI), Lean Six Sigma (LSS) and Human Factors Ergonomics (HFE), as approaches to change and improvement. Design/methodology/approach As authors we are experts in QI, LSS and HFE and this paper has arisen out of much dialogue between us aimed at developing a shared understanding and appreciation of QI, LSS and HFE and how these approaches could work together towards the goal of improved quality of care and patient safety. We draw on the literature and case studies that we have authored using these three approaches. Findings The findings are presented along a number of key areas including: defining the approaches and understanding their theoretical underpinnings; outlining what type of changes are suited to each approach including giving some case study examples; outlining how each approach tackles key issues in change and improvement including understanding context, developing, implementing and evaluating change. Practical implications We believe that QI, LSS and HFE approaches to change are complementary and synergistic and that they do not contradict each other. Through prioritising the well-being of both patients and staff, and fostering cultures that promote collaboration, innovation and resilience, they can enable healthcare organisations to more effectively achieve their goals of improved safety, efficiency and human well-being. In this viewpoint we propose that there is room for the three approaches to be adopted in healthcare for different purposes and at different system levels depending on existing capability and capacity. Originality/value Sharing understanding of QI, LSS and HFE and what each approach can offer, respecting the complementarity between them and the possibility of achieving more by working together and interweaving these approaches, can help us all to reap greater benefits for patient safety and care quality.