Development of a Rational Laboratory Use (RLU) operating model in Chiang Saen Hospital by using Six Sigma.
Keywords:
Rational Laboratory Use, Six Sigma, DMAIC, Community Hospital, Paradoxical OutcomeAbstract
Abstract
This research and development study aimed to (1) assess the baseline situation of rational laboratory use (RLU), (2) develop an RLU operational model using the Six Sigma DMAIC process, and (3) evaluate implementation outcomes at Chiang Saen Hospital, Chiang Rai Province. The study was conducted from January to December 2025. A purposive sample of 46 medical personnel from the RLU committee participated. Data were collected from HIS/LIS systems and questionnaires, analyzed using Sigma Level, DPMO, Pareto Analysis, Chi-square test, Paired t-test, and Linear Regression.
Results revealed a baseline Sigma Level of 2.0 (DPMO = 305,495, Yield = 69.45%), with an Inappropriate Laboratory Test Request Rate (ILTR) of 32.84% among target test groups. The LFT group exhibited critical underperformance (Sigma = 0.6). Following full DMAIC implementation, a Paradoxical Outcome emerged: ILTR increased to 79,767 episodes and Sigma Level declined to 1.1, primarily attributable to an unintended 12,287.32% surge in Electrolyte Profile orders triggered by HIS menu restructuring. Notably, staff satisfaction and positive attitudes toward RLU improved significantly across all dimensions (p < 0.001). The developed DMAIC model provides a replicable framework for community hospitals, emphasizing the critical importance of HIS pilot testing prior to menu restructuring and continuous performance monitoring.
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