Table 1.

Lean Six Sigma Steps (DMAIC Cycle)

DMAIC Phase	Description
Define	The project team identified delays in the chemotherapy initiation process as the primary issue. A problem statement was developed focusing on workflow inefficiencies and their impact on patient waiting times and resource utilization. Key performance indicators (KPIs) included patient wait times from arrival to chemotherapy initiation, staff coordination efficiency, and overall patient satisfaction.
Measure	Data on the current chemotherapy initiation process was collected using time-tracking logs, direct observations, staff interviews, and a review of patient records. Baseline metrics included average patient wait times. These measurements highlighted bottlenecks in various workflow stages, such as lab testing, drug preparation, and communication between departments.
Analyze	Root cause analysis techniques, such as fishbone diagrams, were applied to identify contributing factors to delays. Process mapping revealed inefficiencies in communication, scheduling, and workflow sequencing. Feedback from staff provided qualitative insights into operational challenges, such as resource limitations and unclear role definitions.
Improve	Targeted interventions included streamlining lab result reporting, implementing pre-mixing protocols for chemotherapy drugs, enhancing communication through real-time tracking systems, and cross-training staff to improve flexibility. Pilot testing of these solutions was conducted to ensure feasibility and effectiveness before full-scale implementation.
Control	Standard Operating Procedures (SOPs) were revised to sustain improvements, and monitoring tools such as dashboards were introduced to track real-time KPIs. Regular audits were scheduled, and staff were engaged in feedback sessions to identify emerging issues and ensure continued compliance with optimized workflows.
Source: [7-11]