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Improvement in the postoperative visual outcome following cataract surgeries by reducing the average residual spherical error

Background and Context: Lean Six Sigma (LSS) in healthcare was conceived as a national demonstration project by Quality Council of India to launch and manage their continuous quality improvement programs. Aims and Objectives: To explore the potential benefits of applying LSS principles in the clinical domain to enhance patient satisfaction and as a clinical performance indicator. Materials and Methods: Through the supplier, inputs, process, outputs and customers (SIPOC) were identified. On the supplier side there were surgical coordinators, surgeon, optometrists and medical store. Input and process are important in that patient selects lens based on an estimate, intra ocular lens and refraction as analyzed by an optometrist. The define, measure, analyze, improve and control (DMAIC) cycle was used in taking the project further. Results: The residual refractive error was reduced from 0.35D to 0.33D and eventually to 0.25D (3 sigma). Project helped the hospital in terms of tangible and intangible benefits. Number of cataract surgeries surged by 17.75%, giving rise to an increase in financial accrual from rupees 11.5 Cr to 13.5 Cr. Conclusion: A control plan was deployed through visual display of the process flow in out-patient department and monthly review of visual outcomes during clinical audit using average, standard deviation and sigma presented as key performance indicators, to ensure no drift in performance post the closure of the project.