Improving performances of the knee replacement surgery process by applying DMAIC principles

Giovanni Improta, Giovanni Balato, Maria Romano, Alfonso Maria Ponsiglione, Eliana Raiola, Mario Alessandro Russo, Patrizia Cuccaro, Liberatina Carmela Santillo, Mario Cesarelli

Research output: Contribution to journalArticlepeer-review


RATIONALE, AIMS, AND OBJECTIVES: The work is a part of a project about the application of the Lean Six Sigma to improve health care processes. A previously published work regarding the hip replacement surgery has shown promising results. Here, we propose an application of the DMAIC (Define, Measure, Analyse, Improve, and Control) cycle to improve quality and reduce costs related to the prosthetic knee replacement surgery by decreasing patients' length of hospital stay (LOS) METHODS: The DMAIC cycle has been adopted to decrease the patients' LOS. The University Hospital "Federico II" of Naples, one of the most important university hospitals in Southern Italy, participated in this study. Data on 148 patients who underwent prosthetic knee replacement between 2010 and 2013 were used. Process mapping, statistical measures, brainstorming activities, and comparative analysis were performed to identify factors influencing LOS and improvement strategies.

RESULTS: The study allowed the identification of variables influencing the prolongation of the LOS and the implementation of corrective actions to improve the process of care. The adopted actions reduced the LOS by 42%, from a mean value of 14.2 to 8.3 days (standard deviation also decreased from 5.2 to 2.3 days).

CONCLUSIONS: The DMAIC approach has proven to be a helpful strategy ensuring a significant decreasing of the LOS. Furthermore, through its implementation, a significant reduction of the average costs of hospital stay can be achieved. Such a versatile approach could be applied to improve a wide range of health care processes.

Original languageEnglish
Pages (from-to)1401-1407
Number of pages7
JournalJournal of Evaluation in Clinical Practice
Issue number6
Publication statusPublished - Dec 2017


  • Journal Article


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