RCHE Publications


Woodward-Hagg, H., El-Harit, J., Vanni, C., Scott, P., (2007). Application of Lean Six Sigma Techniques to Reduce Workload Impact During Implementation of Patient Care Bundles within Critical Care – A Case Study. Proceedings of the 2007 American Society for Engineering Education Indiana/Illinois Section Conference, Indianapolis, IN, March 2007.


Within healthcare, clinical practice bundles have been used to implement standardized, nursing driven protocols resulting in standardized patient care and improved patient outcomes. Examples of these types of bundles include clinical practices shown through evidence based medicine to reduce occurrences of Ventilator Associated Pneumonia – VAP bundle; those shown to reduce the occurrences of central line infections – CL bundle; and those shown to significantly improve the outcomes of patients presenting with sepsis – Sepsis Bundle.

Unfortunately, as critical care units cycle through the implementation of multiple bundles without adjustment in workflow practices the result is often increased staff fatigue and a more stressful work environment – a phenomenon appropriately termed by critical care staff members as being ‘All Bundled Out’.

This paper will describe the partnership between IUPUI faculty and Sisters of St. Francis Health Services (SSFHS) in application of Lean Six Sigma techniques. These techniques were adapted for use within healthcare and were applied to reduce the workflow impact and optimize implementation of nursing driven, clinical protocols used to implement intensive glucose control for ventilator patients within two critical care units. Additionally, this paper will discuss the strategies and methodologies used to sustain initial results during the 9 months following the initial protocol implementation.


clinical practice implementation, VAP, glycemic control, spread adoption, sustainability

Date of this Version

March 2007