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Improvement in Post Operative Visual Outcome Following Cataract Surgeries (Phaco-emulsification with Intraocular Lens Implantation) by Reducing the Average Residual Spherical Error
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(May 17, 2020)

Lean Six Sigma (LSS) in healthcare was conceived as National Demonstration Project (NDP) by Quality Council of India to launch and manage their continuous Quality Improvement Programs. This case study aims at exploring the potential benefits of applying Lean Six Sigma principles to explore Clinical Performance Indicators in the Clinical domain and to enhance patient satisfaction. Through SIPOC (Supplier, Inputs, Process, Outputs and Customers) analysis, customers were identified. Surgical Coordinators, Surgeon, Optometrists and Medical Store were considered as suppliers. The patient selects lens based on estimate, IOL and refraction and Biometry as analyzed by optometrist and all this characterizes the process and the input. The DMAIC (Define, Measure, Analyze, Improve and Control) approach of Six Sigma Quality Management along with Lean philosophy was synthesized and deployed as the strategy for quality improvement. As a result of this the residual refractive error was reduced from 0.35D to 0.33D and eventually to 0.2D (3-Sigma). Project helped the hospital in terms of tangible and intangible benefits as post this project, the number of cataract surgeries surged by 17.75%, giving rise to substantial increase in financial accrual. A control plan was deployed through visual display of the process flow in OPD and monthly review of visual outcomes during Clinical Audit using Average, Standard Deviation and Sigma Value presented as Key Performance Indicators, to ensure no driftin performance post the closure of the project.

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