title: Lean Six Sigma: a new approach to the management of patients undergoing prosthetic hip replacement surgery.
abstract: OBJECTIVE
  In 2012, health care spending in Italy reached €114.5 billion, accounting for 7.2% of the Gross Domestic Product (GDP) and 14.2% of total public spending. Therefore, reducing waste in health facilities could generate substantial cost savings. The objective of this study is to show that Lean Six Sigma represents an appropriate methodology for the development of a clinical pathway which allows to improve quality and to reduce costs in prosthetic hip replacement surgery.
  
  
  METHODS
  The methodology used for the development of a new clinical pathway was Lean Six Sigma. Problem solving in Lean Six Sigma is the DMAIC (Define, Measure, Analyse, Improve, Control) roadmap, characterized by five operational phases which make possible to reach fixed goals through a rigorous process of defining, measuring, analysing, improving and controlling business problems.
  
  
  RESULTS
  The following project indicated several variables influencing the inappropriate prolongation of the length of stay for inpatient treatment and corrective actions were performed to improve the effectiveness and efficiency of the process of care. The average length of stay was reduced from 18.9 to 10.6 days (-44%).
  
  
  CONCLUSIONS
  This article shows there is no trade-off between quality and costs: Lean Six Sigma improves quality and, at the same time, reduces costs.
authors.affiliation: Department of Public Health of the University Hospital, University of Naples 'Federico II', Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Improta
authors.affiliation: Orthopaedy and Ortho-traumatology, Department of Public Health of the University Hospital, University of Naples 'Federico II', Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Balato
authors.affiliation: DSMC Department, University 'Magna Graecia' of Catanzaro, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Romano
authors.affiliation: DIETI, University of Naples 'Federico II', Naples, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Carpentieri
authors.affiliation: DIETI, University of Naples 'Federico II', Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Bifulco
authors.affiliation: Department of Public Health of the University Hospital, University of Naples 'Federico II', Naples, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Alessandro Russo
authors.affiliation: Orthopaedy and Ortho-traumatology, Department of Public Health of the University Hospital, University of Naples 'Federico II', Naples, Italy.
authors.forename: Donato
authors.initials: D
authors.lastname: Rosa
authors.affiliation: Department of Public Health of the University Hospital, University of Naples 'Federico II', Naples, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Triassi
authors.affiliation: DIETI, University of Naples 'Federico II', Naples, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Cesarelli
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000191:economics; D019091:Critical Pathways / Q000458:organization & administration*; D017598:Efficiency, Organizational; D005260:Female; D017048:Health Care Costs; D006302:Health Services Research; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D058996:Quality Improvement; D012189:Retrospective Studies
keywords: Lean Six Sigma; efficiency of care; health care management; health economics; health services research; public health; reducing length of stay