title: Applying Lean Six Sigma methodology to reduce cesarean section rate.
abstract: OBJECTIVE
  This study aims to reduce cesarean section rate and increase rate of vaginal delivery.
  
  
  METHODS
  By using Lean Six Sigma (LSS) methodology, the cesarean section rate was investigated and analyzed through a 5-phase roadmap consisting of Define, Measure, Analyze, Improve, and Control. The principal causes of cesarean section were identified, improvement measures were implemented, and the rate of cesarean section before and after intervention was compared.
  
  
  RESULTS
  After patients with a valid medical reason for cesarean were excluded, the main causes of cesarean section were maternal request, labor pain, parturient women assessment, and labor observation. A series of measures was implemented, including an improved parturient women assessment system, strengthened pregnancy nutrition guidance, implementation of painless labor techniques, enhanced midwifery team building, and promotion of childbirth-assist skills. Ten months after introduction of the improvement measures, the cesarean section rate decreased from 41.83% to 32.00%, and the Six Sigma score (ie, Z value) increased from 1.706 to 1.967 (P < .001).
  
  
  CONCLUSIONS
  LSS is an effective way to reduce the rate of cesarean section.
authors.affiliation: Department of Obstetrics and Gynecology, Taizhou Hospital of Zhejiang Province, Affiliated with Wenzhou Medical College, Linhai, Zhejiang Province, China.
authors.forename: Ze-Ying
authors.initials: ZY
authors.lastname: Chai
authors.affiliation: Department of Obstetrics and Gynecology, Taizhou Hospital of Zhejiang Province, Affiliated with Wenzhou Medical College, Linhai, Zhejiang Province, China.
authors.forename: Hua-Min
authors.initials: HM
authors.lastname: Hu
authors.affiliation: Department of Obstetrics and Gynecology, Taizhou Hospital of Zhejiang Province, Affiliated with Wenzhou Medical College, Linhai, Zhejiang Province, China.
authors.forename: Xiu-Ling
authors.initials: XL
authors.lastname: Ren
authors.affiliation: Department of Obstetrics and Gynecology, Taizhou Hospital of Zhejiang Province, Affiliated with Wenzhou Medical College, Linhai, Zhejiang Province, China.
authors.forename: Bao-Jin
authors.initials: BJ
authors.lastname: Zeng
authors.affiliation: Department of Obstetrics and Gynecology, Taizhou Hospital of Zhejiang Province, Affiliated with Wenzhou Medical College, Linhai, Zhejiang Province, China.
authors.forename: Ling-Zhi
authors.initials: LZ
authors.lastname: Zheng
authors.affiliation: Department of Obstetrics and Gynecology, Taizhou Hospital of Zhejiang Province, Affiliated with Wenzhou Medical College, Linhai, Zhejiang Province, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Qi
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data*; D004032:Diet; D004777:Environment; D005260:Female; D006801:Humans; D048949:Labor Pain / Q000523:psychology; D008880:Midwifery / Q000458:organization & administration; D011247:Pregnancy; D012307:Risk Factors; D012931:Social Environment; D017749:Total Quality Management / Q000458:organization & administration*
keywords: Lean Six Sigma; cesarean section rate