Implementing Lean Six Sigma in a Kuwaiti private hospital.

PURPOSE: The purpose of this paper is to use Lean Six Sigma (LSS) to reduce patient waiting time in a Kuwaiti private hospital obstetrics and gynaecology clinic. APPROACH: The define, measure, analyse, improve and control methodology was used. The "define" stage involved identifying patients' needs, system capabilities and project objectives. The "measure" stage assessed the system's current state through data collection on waiting times. Dunnett's test, control charts and process capability analysis were used to ensure data accuracy. In the "analyse" stage, an Ishikawa diagram and Pareto chart were constructed, showing that overbooking appointments, doctors' unscheduled breaks and doctors not arriving on time were the root causes of the problem. The "improve" stage used an Arena simulation model to represent current and improved system status. The proposed solutions were implemented and monitored in the "control" stage. FINDINGS: A sigma-level improvement of 300 per cent (0.5-2.0) was realized for appointment patients on Saturdays, with a 67 per cent reduction in waiting time. For walk-ins, the sigma level improved by 288 per cent (0.8-3.1), with a 55 per cent reduction in waiting time. For weekday appointments, the sigma level improved by 111 per cent (0.9-1.9), with a 63 per cent reduction in waiting time. For walk-ins, the sigma level improved by 69 per cent (1.6-2.7), with a 46 per cent reduction in waiting time. A cost-benefit analysis estimated the present project value at $656,459, leading to a total of $5,820,319 in savings by 2025. ORIGINALITY/VALUE: This paper fulfils the need for process improvement, increasing patients' satisfaction and hospitals' profitability using LSS.

Corrosion behavior, in vitro and in vivo biocompatibility of a newly developed Ti-16Nb-3Mo-1Sn superelastic alloy.

The biocompatibility of a recently developed Ni-free Ti-16Nb-3Mo-1Sn (at.%) superelastic alloy was investigated both in vitro and in vivo. In addition, static water contact angle (WCA) and electrochemical tests were carried out. Commercial purity Ti (cp-Ti), which is already being used as a clinical material, was used as the control material. The alloy showed a stable corrosion behavior similar to that of the cp-Ti. The WCA measurements showed that the alloy exhibited hydrophilic properties that contributed to cell attachment to implants, as evident by the cytocompatibility tests. According to the in vivo implantation tests conducted on 30 adult BALB/c rats for periods up to 12 weeks, the tissue reaction around the implants was similar for both the cp-Ti and the alloy, and no significant difference was found in almost all parameters analyzed. Due to its stable superelastic properties accompanied with excellent biocompatibility and high corrosion resistance, we believe that this alloy is considered as a promising substitute for the biomedical materials containing Ni or other toxic elements.