The DOI matches its Crossref record; 10 of the 10 references it cites were found in a registry or an index.
Adaptation of Lean Six Sigma Methodologies for the Evaluation of Veterans Choice Program at 3 Urban Veterans Affairs Medical Centers
Abstract
Objective: The Veterans Health Administration (VHA) is adapting to meet the changing needs of our Veterans. VHA leaders are promoting quality improvement strategies including Lean Six Sigma (LSS). This study used LSS tools to evaluate the Veterans Choice Program (VCP), a program that aims to improve access to health care services for eligible Veterans by expanding health care options to non-VHA providers. Research Design: LSS was utilized to assess the current process and efficiency patterns of the VCP at 3 VHA Medical Centers. LSS techniques were used to assess data obtained through semistructured interviews with Veterans, staff, and providers to describe and evaluate the VCP process by identifying wastes and defects. Results: The LSS methodology facilitated the process of targeting priorities for improvement and constructing suggestions to close identified gaps and inefficiencies. Identified key process wastes included inefficient exchange of clinical information between stakeholders in and outside of the VHA; poor dissemination of VCP programmatic information; shortages of VCP-participating providers; duplication of appointments; declines in care coordination; and lack of program adaptability to local processes. Recommendations for improvement were formulated using LSS. Conclusions: This evaluation illustrates how LSS can be utilized to assess a nationally mandated health care program. By focusing on stakeholder, staff, and Veteran perspectives, process defects in the VCP were identified and improvement recommendations were made. However, the current LSS language used is not intuitive in health care and similar applications of LSS may consider using new language and goals adapted specifically for health care.
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In the citing paper
“results such as increased time for patient care, restructuring of the physical structure, visual management, reduction of lead time and improvement financial performance were also achieved [21,22,41,56,59].”
From Lean Healthcare Tools for Processes Evaluation: An Integrative Review. (2021) · cites this paper as [22]
In the citing paper
“A single article that aimed to evaluate the current process of a service did not present any type of intervention [22].”
From Lean Healthcare Tools for Processes Evaluation: An Integrative Review. (2021) · cites this paper as [22]
In the citing paper
“four (12.1%) did not clearly describe the place of study [20,21,22,23]”
From Lean Healthcare Tools for Processes Evaluation: An Integrative Review. (2021) · cites this paper as [22]
Citations
Cites
Matrix Analysis as a Complementary Analytic Strategy in Qualitative Inquiry
Averill, J. B. (2002) · Qualitative Health Research · doi:10.1177/10432302012006011 · Cited by 839
The evolution of lean Six Sigma
Pepper, M., & Spedding, T. A. (2010) · International Journal of Quality & Reliability Management · doi:10.1108/02656711011014276 · Cited by 545
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The Current State of Lean Implementation in Health Care
Poksinska, B. B. (2010) · Quality Management in Health Care · doi:10.1097/qmh.0b013e3181fa07bb · Cited by 366
Assessing the Evidence of Six Sigma and Lean in the Health Care Industry
DelliFraine, J. L., Langabeer, J. R., & Nembhard, I. M. (2010) · Quality Management in Health Care · doi:10.1097/qmh.0b013e3181eb140e · Cited by 295
Effects of Lean Six Sigma application in healthcare services: a literature review
Ahmed, S., Manaf, N. H. A., & Islam, R. (2013) · Reviews on Environmental Health · doi:10.1515/reveh-2013-0015 · Cited by 106
Pocha, C. (2010) · Quality Management in Health Care · doi:10.1097/qmh.0b013e3181fa0783 · Cited by 50
Lee, E., Grooms, R., Mamidala, S., & Nagy, P. G. (2014) · Journal of the American College of Radiology · doi:10.1016/j.jacr.2014.08.031 · Cited by 31
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Voice of the customer---a roadmap for service improvement.
Uberoi, R. S., Nayak, Y., Sachdeva, P., & Sibal, A. (2013) · PubMed · Cited by 3
Research works printed but not linked: 1
- Hagedorn, 2006, Lessons learned about implementing research evidence into clinical practice: experiences from VA QUERI, J Gen Intern Med, 21, S21
Cited by
Quality improvement in healthcare: Six Sigma systematic review
Niñerola, À., Rebull, M. V. S., & Hernández‐Lara, A. B. (2020) · Health Policy · doi:10.1016/j.healthpol.2020.01.002 · Cited by 161
Lean Healthcare Tools for Processes Evaluation: An Integrative Review.
de Barros, L. B., Bassi, L. D. C., Caldas, L. P., Sarantopoulos, A., Zeferino, E. B. B., Minatogawa, V., & Gasparino, R. C. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18147389 · Cited by 90
“2% of the articles that also used the VSM and results such as increased time for patient care, restructuring of the physical structure, visual management, reduction of lead time and improvement financial performance were also achieved [21,22,41,56,59].”
BackgroundMattocks, K. M., Cunningham, K. G., Elwy, A. R., Finley, E. P., Greenstone, C. L., Mengeling, M. A., Pizer, S. D., Vanneman, M. E., Weiner, M., & Bastian, L. A. (2019) · Journal of General Internal Medicine · doi:10.1007/s11606-019-04972-1 · Cited by 53
A Social Ecological Model for Military Women's Health
Trego, L. L., & Wilson, C. (2021) · Women s Health Issues · doi:10.1016/j.whi.2020.12.006 · Cited by 43
A Qualitative Study of Primary Care Providers’ Experiences with the Veterans Choice Program
Nevedal, A., Wagner, T. H., Ellerbe, L. S., Asch, S. M., & Koenig, C. J. (2019) · Journal of General Internal Medicine · doi:10.1007/s11606-018-4810-2 · Cited by 39
Metadata
- Authors
- Ball, S. L., Stevenson, L. D., Ladebue, A. C., McCreight, M. S., Lawrence, E. C., Oestreich, T., & Lambert-Kerzner, A. C.
- Affiliations
- Veterans Health Administration (US)
- Louis Stokes Cleveland VA Medical Center (US)
- Cleveland VA Medical Center, Cleveland, OH
- Corresponding author
- Ball, Sherry L.
- Stevenson, Lauren D.
- Venue
- Medical Care
- Published
- 2017-07
- Volume
- 55
- Issue
- Suppl 1
- Pages
- S76-S83
- ISSN
- 0025-7079 (ISSN-L)
- OpenAlex
- W2607374001
- Cited by
- 31
- References
- 10
- Citations by year
- 2026: 1 · 2024: 1 · 2023: 3 · 2022: 15 · 2021: 4 · 2020: 3 · 2019: 2 · 2018: 1 · 2017: 1
- FWCI
- 2.63
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Medical Care (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Quality and Management
- Social Sciences › Business, Management and Accounting › Management Information Systems › Quality and Supply Management
- Social Sciences › Decision Sciences › Management Science and Operations Research › Healthcare Operations and Scheduling Optimization
- Keywords
- Lean Six Sigma, Veterans Choice Program, Veterans Health Administration, quality improvement, health care access, process waste, care coordination, clinical information exchange, program evaluation
- MeSH terms
- Choice Behavior, Hospitals, Urban, Hospitals, Veterans, United States, United States Department of Veterans Affairs, Program Evaluation, Total Quality Management, Quality Improvement
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- CoChat. (2026). Citation check: Adaptation of Lean Six Sigma Methodologies for the Evaluation of Veterans Choice Program at 3 Urban Veterans Affairs Medical Centers. https://app.cochat.ai/papers/10.1097/mlr.0000000000000721
- The paper
- Ball, S. L., Stevenson, L. D., Ladebue, A. C., McCreight, M. S., Lawrence, E. C., Oestreich, T., & Lambert-Kerzner, A. C. (2017). Adaptation of Lean Six Sigma Methodologies for the Evaluation of Veterans Choice Program at 3 Urban Veterans Affairs Medical Centers. Medical Care. https://doi.org/10.1097/mlr.0000000000000721
Data sources
Bibliographic data: Semantic Scholar, OpenAlex, Crossref.
Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.
