Optimizing Chemotherapy Waiting Time in the Day Care Unit for Gastrointestinal Cancer Patients: A Lean Six Sigma Approach.

BACKGROUND: Delays in chemotherapy waiting in a day care unit (DCU) can lead to heightened patient anxiety, and reduced satisfaction, and unnecessary delays for the staff. PURPOSE: This study aimed to optimize chemotherapy initiation times for cancer patients by addressing inefficiencies and enhancing process reliability. METHODS: The study was conducted in a DCU at a dedicated cancer center. Patients attending the gastrointestinal cancer program were selected. A pre-and post-one group design was employed to compare metrics before and after the intervention.  Implementing the Lean Six Sigma (LSS), principles, and using the DMAIC (Define, Measure, Analyze, Improve, Control) approach, we collected baseline data, identified bottlenecks, and implemented targeted solutions. A multidisciplinary team of nursing staff, physicians, and administrators collaborated on the project. The study was approved by the institutional research and ethics committee. RESULTS: Key interventions included the introduction of fast-track and normal-track pathways based on lab readiness, transitioning from round-based to clinic-based evaluations, optimizing patient and staff workflows, standardizing diagnostic processes, and addressing systemic issues such as network outages and resource shortages. The mean time for chemotherapy waiting decreased from 188.4 minutes to 128 minutes, reflecting a substantial improvement in process efficiency. Variability and outliers were notably reduced, as evidenced by improvements in process capability indices. The Process Potential Index (Pp) increased from 0.76 to 0.86, indicating better overall consistency in the process, while the Process Performance Index (Ppk) rose from -0.05 to 0.52, reflecting improved alignment with specification limits and reduced variability. Additionally, the percentage of cases outside the specification limits dropped significantly from 60.6% to 7.3%, demonstrating enhanced process reliability. The Defects Per Million Opportunities (DPMO) decreased dramatically from 606,060.6 to 72,727.3, highlighting a considerable reduction in defects and inefficiencies. CONCLUSION: Implementing LSS principles successfully reduced chemotherapy waiting times and enhanced process efficiency in the DCU. These findings demonstrate the potential of LSS to address systemic inefficiencies and improve patient-centered outcomes in healthcare. Future efforts should focus on expanding these methodologies to other areas and incorporating advanced technologies to sustain improvements.