| Case Studies

Hospital HR Dept Performance Measurement

Lean Six Sigma in Healthcare

The next few months’ newsletters will look at Lean Six Sigma applications in Hospitals. We all have a vested interest in seeing our hospitals continuously improve productivity and quality. These case studies will show how we used Lean Six Sigma tools to improve various aspects of administration and patient care.


In hospitals, one of the key performance issues is recruiting and retaining nurses. There is a national nurse shortage. As we being our review of Lean Six Sigma in Healthcare, we are therefore starting with an administrative area, Human Resources.

HR at this VA Medical Center was not meeting it’s goals in recruiting timeliness. In the past they blamed slowdowns on the government bureaucracy and internal customers not providing complete information. Instead we focused on the HR department’s own inefficiencies.

Lean Six Sigma Tools

Performance Measurement

Implementation Details – Scorecard Creation

1) Lean Six Sigma begins by measuring performance. HR created a simple performance scorecard and a complete performance measurement system.

2) A Performance Measurement System includes the departments:

  • Goals
  • Monthly updates on actual performance
  • Department Action Plan

3) Perhaps the most important part of the Performance Measurement System is the Action Plan. This is a list of projects that are happening in the department. This action plan has action item owners and expected completion dates. We try to limit the number of action items/projects to 5 or fewer. The fewer actions the department is working on at one time the more likely they are to get them done. (see the HR Action Items worksheet)

4) To handle more ideas we made a list of projects-in-waiting that the HR department will tackle when they finish current projects.

5) Scorecard results are reviewed with all HR employees monthly at a 15 minute performance review meeting. This meeting is quick and effective. It reviews actual performance and an update on action items. It gives the entire HR department status and performance update. No one is in the Dark!

Details – Executive Management

1) A very important part of making Performance Measurement effective, is to get buy-in from Executives of the Medical Center.

2) We needed their agreement that these measures and goals were correct and their promise not to add new measures.

3) We also needed their agreement that they would not add new projects to the HR department without making sure that the current list wasn’t getting closed-out. This also ensured that any new projects directly improve the Key Performance Measures.

4) This is easy to say, but hard to do in most organizations. The Performance Measurement System creates focus, both for the employees of the HR department and for the top management of the Medical Center.

Impact on People

1) The HR staff enjoys knowing what is going on and how the department is doing.

2) Initially, all measures were in the Red. This grounded everyone in the reality that they weren’t meeting their goals. Immediately, however, they began improving a little each month


The “Recruiting completed within 90 days of application” measure increased from 33% to 56% within 6 months. This is still below our minimum expectation of performance, but definitely better. More work continues to improve this measure and the trend is upward. This demonstrates the philosophy of slow continuous and sustainable improvement.

Next month we will look deeper at this department’s processes and show how we streamlined their critical work.