Analysis of Lean Six Sigma as a method for developing and implementing a falls prevention programme in a geriatric rehabilitation setting

Abstract

Background: Accidental falls in hospitalised older adults are a significant issue for patients and for healthcare providers, with previous research revealing that a variety of hospital based falls prevention strategies have delivered only limited success. Recently, the utilisation of Lean Six Sigma as a problem solving tool in the healthcare setting has shown promising results, although research into its ability to generate acceptable solutions for clinical problems is still in its infancy. Aim: The aim of this research was to investigate the perceived utility of Lean Six Sigma as a tool for developing and implementing a falls prevention programme in a geriatric rehabilitation setting. The research utilises Rycroft-Malone’s PARIHS framework as a basis for the analysis of factors which may inhibit or facilitate successful implementation. Methods: Using a mixed methods design, participants of the project team utilising the Lean Six Sigma method to develop the falls prevention programme participated in two focus group interviews held at differing times during the programme’s development. The clinical staff members who were expected to implement the falls prevention programme completed two identical Likert Scale questionnaires based on the PARIHS framework, three months before and three months after implementation of the falls prevention programme. Likert Scale questionnaires were analysed using a Chi-Squared test for association. Findings: The results show a division between the utility of Lean Six Sigma in the development of a falls prevention programme and the implementation of it. Whereas project group members believed many aspects of the Lean Six Sigma method were useful in developing and implementation of the programme, this was not always congruent with the opinions of those expected to implement the programme in the study environment. Conclusion: The findings show that project group members felt that Lean Six Sigma provides a suitable structure for the development of solutions to clinical problems specifically relating to inpatient falls prevention. However, the on-going challenge of translating guidelines into practice for clinicians illuminates the need for a robust engagement and communication plan with staff expected to implement a change in their practice.