Structured Quality Improvement: Fable

In my earlier Quality Capsules, I had shared the four steps for Structured Quality Improvement:

I would now like to share a Quality Fable (#26) to inject life into the Quality Improvement methodology.

Red Bags. Green Bags.

The head of finance at a hospital in Thailand realized it was spending far too much on replacement linen. It was a chronic problem.

As a result the senior management appointed a cross-functional project team to solve the mystery of the disappearing linen.

During the problem diagnosis phase, the team brainstormed about possible hypotheses for the vanishing linen. Since the problem was very focused, it entailed convergent thinking. The ideas that emerged were few: the supplier of linen was possibly delivering sub-standard products; the ambulance vans were inadvertently driving off with the linen; linen was hoarded by staff; demand for linen was greater than supply. On analysis, none of these hypotheses could be validated.

The true root cause emerged when the team mapped a detailed flow diagram of the linen distribution process start-to-end.

Without a doubt, the linen was disappearing in the operation theatre. Hospital procedures dictated that any linen coming in contact with blood be placed in plastic bags of a specific thickness. Therefore the linen in the operation theatre was dutifully placed in plastic bags of the specified thickness.

It turned out that the only plastic bags of the specified thickness, at this hospital, were red in color. Red colored bags were used for bio-hazardous waste.

The hospital procedures clearly stated that all bio-hazardous waste must be destroyed. Inadvertently, the linen was going up in smoke!

As remedial action, the hospital purchased green plastic bags, of the right thickness, for bloody linen. In the first year itself, the hospital saved US$ 500,000.

Lessons Learned

  • Chronic problems do not have an alarm system
  • The only alarm for chronic problems is when we proactively translate it into the language of upper management – money
  • All hypotheses need to be validated with data
  • An as-is flow diagram is an excellent tool for diagnosis
  • Documented procedures must be specific and detailed
  • The solution to a problem does not have to be complex


Please refer to the question I had asked last week in Quality Capsule 8 What is the greatest pitfall in problem solving? My response is: Confusing ideas for data.

My questions this week are:

  • Can you map the four steps in this Quality Fable?
  • What quality tool provided the clue for the mystery of the disappearing linen?
  • Do you think Finance and Quality should work hand in hand?

Please share a similar example from your hospital / organization?

In my next edu-blog, on Wednesday 9 September, I will introduce a quality tool.

Additional References
Problem Solving Pro
Quality Fables – Volumes 1/2/3

  • Author :

    Suresh Lulla

  • Resource Link :


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