From classroom to clinic: What Lean Six Sigma looks like in practice
by Elizabeth Backus, senior operational excellence analyst and Lean Six Sigma instructor, NEOMED Executive Education
When we talk about Lean Six Sigma (LSS), it's easy to focus on the tools, the phases and the tollgates. At its core, LSS is a structured methodology that gives professionals the strategies and tools to analyze problems, eliminate waste and drive measurable change through efficient and effective solutiosn to problems. What those conversations sometimes miss is what it actually feels like to use those tools in real workflows with real stakes and real outcomes, and the moment when the data starts to tell the story you suspected was there all along.
The NEOMED Executive Education team recently followed up with two University Hospitals Green Belt cohorts to learn more about their projects, the impact they are seeing and the lessons they learned along their quality improvement journeys. Their experiences are different in scope and setting, but the thread running through both is the same: structured problem solving, honest data and a commitment to better patient outcomes.
Reducing Variation, Restoring Confidence: The Pre-Visit Chart Review
When Angel Velotta, CPC, CRC, CDEO, CPMA, set out to improve the pre-visit chart review process, the problem wasn't immediately obvious. She knew there was inconsistency in review times, variation in decision-making and uneven query quality that was increasing variability, the potential for defects and overall time spent on the chart review process, but understanding the full picture required getting closer to the work.
The DMAIC roadmap gave Velotta the foundation to do that. Through the Define and Measure phases, she identified that review time standard deviation sat at 11.7 minutes across reviewers, a significant spread for a process that needs to be both efficient and accurate. Rather than making assumptions about why, Velotta took the time to talk with reviewers about the pain points they faced and how they experienced the chart review flow day to day.
Combining her quantitative data with the experiences of her team, the Analyze phase revealed root causes tied to a lack of standardized decision tools and no formal quality audit process. That's where the real work began.
The Improve phase produced standardized SOPs, decision supports and a quality audit framework that supported the team in what they felt they needed most: a shared definition of what "good" looks like. Among SOP-aligned reviewers, standard deviation in chart review time dropped from 11.7 minutes to approximately 3 minutes. Quality audit performance improved by 17 percentage points, and the number of queries meeting the defined high-quality threshold more than doubled.
And those numbers, as impressive as they are, only describe one workflow. Here's how Velotta described the broader impact:
"The impact of this project extends beyond one workflow. It created a more standardized, measurable and sustainable process that supports documentation integrity, risk adjustment accuracy, team training and compliance across the UH system."
That's the compounding effect of trusting the Lean Six Sigma process. A single well-executed DMAIC project doesn't just fix the problem it was aimed at — it builds the infrastructure for better work to happen consistently going forward.
What made that possible, she explained, was a willingness to slow down before speeding up.
"The experience changed the way I approach problems. Instead of jumping to solutions, I now know how to measure the current state, look for root causes and use data to guide improvement. It helped me to see that effective change is not just about fixing a problem, it's about designing a process that is clear, sustainable, and meaningful for the people who use it."
For anyone wondering whether the Green Belt program is worth the commitment, here's what Velotta had to say about what it actually takes and what it gives back:
"My advice would be to commit to the process, believe in yourself and keep going. There were times when I doubted myself, felt frustrated or faced challenges that seemed almost impossible to overcome. But by trusting the LSS framework and continuing to move forward one step at a time, I was able to produce work I did not even know I was capable of. Quality improvement work can be challenging, but it is also deeply rewarding. The process helps you see problems differently, build confidence and create solutions that can make a real impact."
A Ripple Effect in the ED: The Urine Collection Cycle Time Project
Shifting to the clinical side of improvement, Christine Giardino, Thomas Grano, Andria Paster and Elizabeth Powers set out to reduce urine collection times in the emergency department (ED). Urine tests are frequently the rate-limiting diagnostic step for some of the most common ED presentations, including abdominal pain, fever and suspected UTIs. When that step is slow, everything downstream slows with it.
Their problem statement put it plainly: patients in the emergency department were experiencing delays in the collection and processing of urinalysis, contributing to prolonged lead times and overall length of stay. In evaluating the current state, the team found that collection time was sitting at 179 minutes.
What they found when they went to Gemba changed the direction of the project. In some cases, incorrect urine specimen cups were being used in the triage area because of their easy accessibility and excess supply; in other cases, patients weren’t receiving them at all. These small process gaps were creating significant downstream effects. Giardino described it this way: "The Gemba Walks were really the 'Aha' moment for me. You cannot effectively understand the process without going to Gemba, the place where the work happens."
Root cause analysis confirmed that inadequate supply management and a lack of standardization were driving the delays and the variability in processing times. Once the team could see the waste clearly, they went after it directly. Through a 6S of triage supply carts to correct par levels and reduce unnecessary items, visual management to prompt staff to grab the right collection kit, and structured training to reinforce standard work, the team-built solutions that addressed the root causes rather than the symptoms.
Elizabeth Powers, B.S.N., M.B.A., RN, noted the importance of the multi-dimensional approach to solving their problem. While the team found multiple approaches to solving the problem, the improvements they selected were the ones they believed were the most important for improving quality.
As Giardino put it, "Going through the Green Belt class, you really learn to see inefficiencies. Suddenly you can't unsee the waste in daily workflows." Standardization for sustainability, she added, is the thing that makes improvement part of the culture rather than just a one-time fix.
Lessons Worth Sharing
After sitting down with both teams, a few themes stood out that are worth passing along to anyone considering a quality improvement journey of their own.
- The DMAIC framework isn't a shortcut — it's a compass. Both teams were clear that skipping phases, particularly jumping straight to Improve, is a path to solutions that don't stick. The discipline of measuring the current state and confirming root causes before designing improvements is what separates lasting change from a temporary fix.
- Data changes how you see problems. Once you've built the habit of looking for where a process fails rather than who failed it, that lens doesn't turn off. When you first get started, it's easy to try to boil the ocean. As Giardino shared, "Start small and learn how to successfully navigate a DMAIC cycle." The data will be your North Star throughout.
- The Control phase is not an afterthought. Standardization for sustainability came up in both projects as the thing that ensures improvements outlast the project itself. Building in the audit, the SOP, the visual management, and checking them regularly is what protects the work.
For anyone standing at the beginning of their first project, or deciding whether to take the first step into quality improvement training at all, both teams landed on the same advice: start small, don't skip steps and trust the framework enough to follow it all the way through. Both teams were also quick to add that you won't be doing it alone. As Velotta shared, "I am especially grateful for the guidance and support from the NEOMED staff, who were with me every step of the way." Giardino echoed that sentiment: "The entire NEOMED team will guide you along the whole process and they are incredible!"
So for those wondering what a manufacturing philosophy has to do with healthcare, these are two clear examples of what happens when Lean Six Sigma meets real work and real commitment to drive real change.
Lean Six Sigma equips healthcare professionals with the tools and problem-solving mindset needed to analyze, improve and lead in clinical, operational and healthcare settings. By integrating traditional Lean and Six Sigma principles with healthcare-specific process science, the program builds capability to enhance workflows, improve care quality and strengthen system performance. If exploring Lean Six Sigma certification is something that you or your team are interested in, we would love to connect! To learn more about our Lean Six Sigma programming, as well as other Executive Education offerings, visit us at neomed.edu/Executive-Education.