Graduate School of Business


Doctor of Business Administration (DBA)


Connie Ostwald


High Reliability, Lean Six Sigma, Medication Error


Business | Medicine and Health Sciences


This research was designed to test the theory of Robust Process Improvement (RPI) as it has been applied to the problem of medication error at Navy medical treatment facilities (MTFs). Medication error is the greatest cause of patient injury in America. In an effort to duplicate the success of High Reliability Organizations (HROs), leaders of the Joint Commission advocated the application of Lean Six Sigma (LSS) as the key elements of RPI and the best way to increase safety and improve the quality of healthcare. The specific problem was that very little empirical evidence existed supporting the theory. The research question asked if the application of LSS could reduce medication error rates. To answer that question, the researcher used a quantitative pre-post design which measured the number of medication related Patient Safety Reports (PSRs) before and after the LSS studies performed at Navy MTFs. Navy Medicine was used as a test bed because it has developed a formidable LSS program. The researcher examined all Navy LSS studies that were directed toward reducing medication error. There were five studies conducted at three different MTFs. The research hypothesis H1 stated that the medication PSR rate prior to the LSS study would be greater than the PSR rate after the study. The five studies combined, showed a total reduction of PSRs from 462 to 407 but the reduction in PSR rate was not statistically significant. One of the LSS studies did show a statistically significant reduction of the PSR rate. Although the results did not give a decisive answer to the research question, it did provide credible evidence that LSS, if applied correctly, may reduce medication error. The findings also produced inquisitive insight into how the principles of HRO should be intertwined with the interventions of process improvement initiatives to create more long-term success.