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Case Study


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Define the Problem

To assist focus the team, the project lead began with a project to define the problem they were attempting to solve and the objective they aimed at achieving.

Business Case:

Improving the quality of the patients’ meals is the primary case in that by catering services in-house, design of new menus by top chefs and the Lloyd Grossman initiatives for Better Hospital Food, we are effectively reducing food issues facing the patients in the hospital. The National Health Service (NHS) spends nearly £500 million to serve 300 million meals in at most 1, 200 hospitals annually. It is estimated that the food wastage in hospital is £144 million yearly, which is thrice the Department of Health estimate of £45 million. The outsourcing of the catering processes to the food manufacturing company situated 20 miles away will improve food nutrition because of the high nutritional value, decrease food waste, and ultimately improve food quality.

Problem Statement:

The hospital has received 375 hospitals in the previous years about the quality of the meals of the patients. It is an actual cause of concern considering the rising number of patients that are left malnourished, and the quantity of food wastage is increasing. The rising quantity of food wastage has forced the hospital and NHS to evaluate the likely alternatives to enhance the delivery of meals spanning from the kitchen to the patient. If the alternatives are not effective, the hospital will continue to deliver low-quality meals to its patients.

Objective Statement:

The objective of the hospital was to improve the food quality that is served to its patients, particularly those on long stay. Additionally, by outsourcing food catering processes to a food manufacturing company will improve the nutritional value in the food consumed by the patients and cut down food wastage.

SIPOC map:

Before planning to begin any process management, it is vital to have an in-depth understanding of the process. A SIPOC (supplier, inputs, process, output, customer) analysis was used in the define stage to acknowledge the customer base. It was developed to assist the process owner and individuals working on the process to agree on the project scope. It offers a way to discuss the process and reach an understanding of what it entails before drawing the process maps (Sibanda & Ramanathan 2019; Brown 2019). The SIPOC analysis in Figure 1 recognized the main outcome metric, the base of the customer, and a great-level assess of the present state of the process.

Food Manufacturing Process that is situated 20 miles from the Riverside HospitalMoney




The manufacturing organization will be responsible for cooking and chilling the food before plating and loading it on trolleys before transporting it to the hospital. In the hospital, the food trolleys will be conveyed by the porters by the delivery can straight to the kitchen where a ‘Reheating Unit’ will heat them. The food will be reheated for 40 minutes. The heated food will be taken on trolleys down to a lift.Food and DrinksPatient


Pareto analysis:

The Pareto Principle is an overall rule-of-thumb that reflects that 80% of the effects have their roots from 20% of the causes. Vilfredo Pareto initially observed in Italy whereby 80% of the land was owned by 0.2 of the people. Dr Joseph M. Juran applied this principle to quality control and preferred the use of the phrase ‘ the important few and significant’ to define the 80-20 rule. Even though the real numbers might be distinct from case-to-case,’ the Pareto Principe offers guidance on the hospital practitioners on the frequency of the causes.

Y = F (X) + E


The simple-looking equation is highlighted as the crux of the Six Sigma philosophy. The parts of the equation are as follows:

  • Y = Outputs also known as Dependent Variables
  • X = Inputs also known as independent Variables
  • F = Function of

The equation implies that the outputs we obtain are the function of the inputs that we deliver to the process. Therefore, if we are capable of controlling the inputs with precision, the outputs would also be regulated accurately.

The variables that are critical to the patients are variety, the texture of meat and vegetables, flavour, and, the perception of selecting a healthy meal. On the other hand, the variables that are vital to the caterers are access to materials and the number of consumers.

  • Build a House of Quality

The house of quality is a significant tool that the Six Sigma Black Belt that the healthcare practitioners use in the Define Phase of the DMAIC life cycle. It is a vigorous approach for translating the needs of the clients and wishes in chronological order for delivering high-quality food service to the patients. Whereas delivering better designs that are accustomed to the needs of the clients, the house of quality cuts the normal development cycle by half leading to increased access to the market for the patients requiring food.


            Value Stream

            In a patient satisfaction survey, the application of Value Stream Mapping (VSM) is driven with the motive of guaranteeing material and information flow in a manner that assists get rid of non-value added activities and decrease of waste. It depicts that the application of value stream mapping enables a critical assessment of the exiting process of a health care project and compares them with the anticipated or standard process of the similar industry (HO 1995). The value stream mapping acknowledges the studies and explores the difference between ‘what is’ and ‘what should be.’

Also, the value mapping demonstrates the flow of materials and information in a process in a graph. It shows the liaising of many organizational functions and ancillary functions. It highlights the problem areas, defects, and bottlenecks in an efficient manner as it combines and maps the details the flow of material and information alongside the sequence of tasks. It even demonstrates the cycle-times and lag-times between the distinct tasks. In addition, it engages the stakeholders in every phase of the process and therefore become easy to develop and enforce the countermeasures to enable the change of culture in the company (Doughlas et al. 2017). Continuous enhancement is enabled as the direction can be concentrated on lean transformation teams and upper management.

Food Delivery Cycle Time;

Cycle time is the measure of Throughput, which is the reverse of Cycle Time. The unit for measuring Throughput is units in every period. This association is analogous to Takt Time which is the reciprocal of demand rate of client. The units of measuring Takt Time and demand rate of the client is the amount of time per unit and units per period of time, respectively. From a definition standpoint, Cycle Time (or Takt Time) is a mean value.

DPMO and Sigma level for the hospital meals process;

For a typical organization, a significant process might be highly, equally, or lowly valued comparatively to the other critical processes. This element might be easily visualized from the Baldrige benchmark, whereby the dimensions will be weighed distinctly and used to prioritize the process. Whenever the weights are similar, the DPMO values will be average. However, the overall sigma levels will not be the mean of corresponding sigma levels. When few processes (say, m < n) are higher-valued, then the weight presumed for every m such higher-valued processes is seemingly more than that of the personal lower-valued processes.

Table 3: Process Types, Weights and Possible Sigma Levels
Process TypeWeightSigma Level
Equally-Valued1/nHigher Sigma Level
(Above 5 Sigma)
Lower Sigma Level
(3 to 5 Sigma)
Higher-Valuedwi > wj *Higher Sigma LevelLower Sigma Level
Lower-Valuedwj < wi *Higher Sigma LevelLower Sigma Level

* wi is the weight of the i-th higher-valued process out of m such processes and wj is the weight of the j-th lower-valued process out of n – m such processes.

Process Control Charts;


Value and Non-Value Added Process Steps;

            To offer high-quality food service to the patients, resources such as labour, money, information, and time will be essential. The objective is to offer the greatest amount of value to clients, whereas using the least amount of the resources. The concept of including value to products and services is a significant notion of lean. It is described as anything that the client would be willing to pay (George 2003). The provision of low-quality food service will mean that the food manufacturing corporation is not offering value to the client. When analyzing the step, it is vital to look at every phase and evaluate whether it is contributing to the value of the desired output. Every phase can be classified as value-added or non-value added (waste).

Value-added steps are a process whereby things are included in the service for the client who would be more than willing to pay. These activities allow deriving most from expending the sources when offering high-quality food service to hospitals. There are many steps in the process for getting food, but the client is willing to pay for the service in which there is the delivery of the specific ordered food, enough portion size, highly nutritious, comfort food on the menu, protected mealtime, served at the right time, menu designed by celebrity chef, hot food present for each meal, easy to understand menu, food well-presented, food tastes good, and a diversity of the menu. In this scenario, only those steps in the process that lead to the actual development of the food that satisfies the patient will be taken into account as value-added steps.

Non-Value Added Process Steps is categorized under pure waste. In these procedures, the resources are expended, delays happen, and no value is included in the food service to Riverside hospital. The clients are not willing to pay a dime for these activities. These steps require to be gotten rid of from the process. Lean acknowledges types of waste. They entail food, not the correct temperature, delivery of wrong meal ordered, ·cultural or personal food preferences ignored, poor quality meal ingredients, poor quality cooking (over or undercooked), patient not hungry (maybe recovering from surgery), portion size too large, and the patient required assistance that was not available.

Cause and effect diagram

Why-Why and How-How analysis;

Problem Who What When Where WhichHow


Scatter Diagram and possible correlations;



This stage entails the development of a standard process that defines the ways of working and monitoring the process performance in the future. To monitor the outcomes, a couple of six sigma tools require to be effected. A control plan is essential to maintain track of an enhanced process at its present level. Statistical Process Control that scrutinizes the process behaviour by enhancing quality services through the decrease of process variation. Standardized work assists in attaining the optimum efficacy, efficiency and consistency when the work is levelled in the entire operations.

            The training of the health personnel in communication and interpersonal skills is perceived to be cost-effective than developing technical amenities in enhancing the contentment of patients. The training will solve issues linked with the perceptions and norms of the catering staff in offering food services. Frequent monitoring of the quality of nutritional care of hospitalized patients based on the major standards and the appraisal of the standards set for the foodservice such as the client satisfaction is significant to enhance the overall in-patient care. Such attempts will not enhance the effective use of present resources though will be cost-effective in the long run through decreasing the waste of food and impending food quality.

The dietary services can contribute to the success of a hospital food service. Their services span from the planning of the menu and the development of the recipe to the nutritional analysis of hospital meals that equate to the needs of the patients (Theurer 2011). The medical personnel that are qualified in human nutrition and dietetics must liaise with the food manufacturing company to guarantee that the nutritional standards of the meals offered at the hospital. Nutritional counselling and evaluation are essential during discharge.

Timing of meals highlights the reason behind the refusal of hospital food which is interfered by external aspects. When there is no designated dining area in the wards, the confined environment can inhibit any desire for consuming food. Protected meal moments can be launched with a setting for dining to make the meal times pleasant. The perception of food quality can rely on distinct attributes such as variety, the texture of meat and vegetables, flavour, and, the perception of selecting a healthy meal. The menu changes enforced to enhance food quality require illuminating a diversity of influences. Every hospital foodservice institution is exceptional, and interventions require to be customized to the needs and perceptions of the patient population (Muraal & Davas  2014).











Brown, C., 2019. Why and how to employ the SIPOC model. Journal of business continuity & emergency planning, 12(3), pp.198-210.

Sibanda, N. and Ramanathan, U., 2019. A holistic approach to quality: a case of UK chocolate manufacturing. International Journal of Quality & Reliability Management.

Muraal, S. and Davas, V., 2014. Assessment of acceptability and satisfaction of patients for government hospital diets. J Nurs Health Sci, pp.38-40.

Theurer, V.A., 2011. Improving patient satisfaction in a hospital foodservice system using low-cost interventions: Determining whether a room service system is the next step.

Ho, S.K., 1995. TQM: an integrated approach: implementing total quality through Japanese 5-S and ISO 9000. Kogan Page.

Douglas, J., Muturi, D., Douglas, A. and Ochieng, J., 2017. The role of organisational climate in readiness for change to Lean Six Sigma. The TQM Journal.

George, M.L., 2003. How to use Lean speed and Six Sigma quality to improve services and transactions.



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