Minimizing Waste & Maximizing Value for Nurses, Patients

By Jannise T. Baclig, PHD, RN, Clinical Content Director, AMN Healthcare
& Bette Case di Leonardi, PhD, RN-BC, Contributor

Minimizing Waste & Maximizing Value for Nurses, Patients

When administering breast milk to a new patient for the first time, the nurse noticed the patient’s armband identification did not match the patient identification label on the breast milk bottle. The patient was given breast milk bottles during the last shift, so the discrepancy puzzled the nurse.

The nurse verified the patient’s mother’s armband identification with the patient’s. Then the nurse notified the mother of this near miss and checked the remaining breast milk bottles. After discovering the breast milk bottles were all mislabeled, the nurse discarded them and reported the incident to the manager.

What happened next gives an example of the power of Lean Six Sigma. The manager called an organization-wide Patient Safety Alert. That same day, the organization introduced a new procedure that included a double verification by two licensed personnel when labeling breast milk bottles. By the following morning, the chief nursing officer (CNO) and the chief medical and safety officer had already facilitated a hospital-wide change in the breast milk verification process.

Six Sigma, Lean, and Lean Six Sigma developed from quality improvement strategies used in the Japanese manufacturing industry. When a problem occurs that creates a defect in a Lean Six Sigma manufacturing company, the equipment is stopped immediately (“stop the line”) and will not resume production until the problem is solved. Similarly, when the mislabeled breast milk was discovered, it was immediately discarded and immediate corrective action was taken.

The term "Six Sigma" refers to the acceptable target for defects in a production process (Six Sigma = 3.4 defects per million). The term "Lean" focuses on optimizing performance by streamlining processes. In order for Lean Six Sigma to succeed in any organization, leadership must enthusiastically adopt, coach, and consistently be active in the pursuit of improved processes, quality, efficiency and safety.

Lean Six Sigma also demands active involvement of staff at all levels. Staff members are best equipped to analyze the processes they use in their work, identify problems, and make practical suggestions for improvement. All employees feel empowered and encouraged to recognize a need and make a change immediately.
Additional characteristics of the Lean Six Sigma approach include:

  • Rapid response
  • Simple, standardized checklists
  • Teamwork across departments
  • Commitment to "everyday lean ideas," sometimes referred to as "a way to remove rocks from your shoes" (Scoville & Little, 2014)
  • Vision/slogan for the quality improvement effort, such as "Protect Me."

If your organization is practicing Lean Six Sigma, use your empowerment to identify opportunities to improve and work with others toward acting on them. If your organization has not formally adopted Lean Six Sigma or another organization-wide improvement process, do not let that prevent you from identifying opportunities to improve safety and quality and recommending ideas through proper channels.

For more information related to quality control, check out Medical Error Reduction - A Key to Quality Care at RN.com.   


Scoville, R. & Little, K. (2014). Comparing Lean and Quality Improvement. IHI white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement.  Retrieved from here

© 2015. AMN Healthcare, Inc. All Rights Reserved. 


Bette Case Di Leonardi has worked in nursing, education and healthcare administration for more than 40 years and was among the first group of nurses certified in Nursing Professional Development. Today, Di Leonardi is an independent consultant who publishes and presents on a variety of professional and educational topics.