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Lean and Six Sigma are continuous improvement methodologies that have garnered international fame for improving manufacturing and service processes. Increasingly these methodologies are demonstrating their power to also improve healthcare processes. The purpose of this paper is to discuss a case study for the application of Lean and Six Sigma tools in the reduction of turnaround time (TAT) for Emergency Department (ED) specimens. This application of the scientific methodologies uncovered opportunities to improve the entire ED to lab system for the specimens.

This case study provides details on the completion of a Lean Six Sigma project in a 1,000 bed tertiary care teaching hospital. Six Sigma’s Define, Measure, Analyze, Improve, and Control methodology is very similar to good medical practice: first, relevant information is obtained and assembled; second, a careful and thorough diagnosis is completed; third, a treatment is proposed and implemented; and fourth, checks are made to determine if the treatment was effective. Lean’s primary goal is to do more with less work and waste. The Lean methodology was used to identify and eliminate waste through rapid implementation of change.

The initial focus of this project was the reduction of turn-around-times for ED specimens. However, the results led to better processes for both the internal and external customers of this and other processes. The project results included: a 50 percent decrease in vials used for testing, a 50 percent decrease in unused or extra specimens, a 90 percent decrease in ED specimens without orders, a 30 percent decrease in complete blood count analysis (CBCA) Median TAT, a 50 percent decrease in CBCA TAT Variation, a 10 percent decrease in Troponin TAT Variation, a 18.2 percent decrease in URPN TAT Variation, and a 2-5 minute decrease in ED registered nurses rainbow draw time.

This case study demonstrated how the quantitative power of Six Sigma and the speed of Lean worked in harmony to improve the blood draw process for a 1,000 bed tertiary care teaching hospital. The blood draw process is a standard process used in hospitals to collect blood chemistry and hematology information for clinicians. The methods used in this case study demonstrated valuable and practical applications of process improvement methodologies that can be used for any hospital process and/or service environment.

While this is not the first case study that has demonstrated the use of continuous process improvement methodologies to improve a hospital process, it is unique in the way in which it utilizes the strength of the project focussed approach that adheres more to the structure and rigor of Six Sigma and relied less on the speed of lean. Additionally, the application of these methodologies in healthcare is emerging research.

In this chapter, we examine the unique and heightened negative impacts of the COVID-19 pandemic through tracing how the preexisting social conditions of exclusion and precarity in which many disabled people live, effected access to safe, affordable, and accessible housing in Canada. We then illustrate the reverberating impacts housing choices have on how people with disabilities lived, lived well, and how they faced barriers to living well during the COVID-19 pandemic.

Using an intersectional livelihoods approach, we analyzed semi-structured interviews and focus groups with 32 diverse people with disabilities, 12 key informant semi-structured interviews, as well as academic and community literature and a social media scan of key disability advocacy organizations in Canada.

Pandemic-related policies in Canada often excluded people with disabilities, either overlooking barriers to access and safety, which exacerbated the already precarious livelihoods of people with disabilities or over-emphasized the usefulness of social adaptions such as work from home. These exclusions had more profound consequences for people with disabilities from historically marginalized groups, as they often faced increased barriers to livelihoods pre-pandemic, and disability- or care-specific policies failed to consider intersectional experiences of discrimination. People with disabilities formed communities of care to meet their needs and those of their loved ones.

To achieve a responsive policy response that addresses the cascading impacts of risk and care, it is necessary for governments to engage, early and often, with people with disabilities, disability leaders and organizations in emergency planning and beyond.