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Therefore, reducing waste in health facilities could generate substantial cost savings. The objective of this study is to show that <jats:styled-content style=\"fixed-case\">L<\/jats:styled-content>ean <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>ix <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>igma represents an appropriate methodology for the development of a clinical pathway which allows to improve quality and to reduce costs in prosthetic hip replacement surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The methodology used for the development of a new clinical pathway was <jats:styled-content style=\"fixed-case\">L<\/jats:styled-content>ean <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>ix <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>igma. Problem solving in <jats:styled-content style=\"fixed-case\">L<\/jats:styled-content>ean <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>ix <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>igma is the <jats:styled-content style=\"fixed-case\">DMAIC<\/jats:styled-content> (<jats:italic>Define, Measure, Analyse, Improve, Control<\/jats:italic>) roadmap, characterized by five operational phases which make possible to reach fixed goals through a rigorous process of defining, measuring, analysing, improving and controlling business problems.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The following project indicated several variables influencing the inappropriate prolongation of the length of stay for inpatient treatment and corrective actions were performed to improve the effectiveness and efficiency of the process of care. The average length of stay was reduced from 18.9 to 10.6 days (\u221244%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This article shows there is no trade\u2010off between quality and costs: Lean Six Sigma improves quality and, at the same time, reduces costs.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jep.12361","type":"journal-article","created":{"date-parts":[[2015,5,11]],"date-time":"2015-05-11T08:58:17Z","timestamp":1431334697000},"page":"662-672","source":"Crossref","is-referenced-by-count":76,"title":["<scp>L<\/scp>ean <scp>S<\/scp>ix <scp>S<\/scp>igma: a new approach to the management of patients undergoing prosthetic hip replacement surgery"],"prefix":"10.1111","volume":"21","author":[{"given":"Giovanni","family":"Improta","sequence":"first","affiliation":[{"name":"Department of Public Health of the University Hospital University of Naples \u2018Federico II\u2019  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Balato","sequence":"additional","affiliation":[{"name":"Orthopaedy and Ortho\u2010traumatology Department of Public Health of the University Hospital University of Naples \u2018Federico II\u2019  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Romano","sequence":"additional","affiliation":[{"name":"DSMC Department University \u2018Magna Graecia\u2019 of Catanzaro  Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Carpentieri","sequence":"additional","affiliation":[{"name":"DIETI University of Naples \u2018Federico II\u2019  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Bifulco","sequence":"additional","affiliation":[{"name":"DIETI University of Naples \u2018Federico II\u2019  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Alessandro Russo","sequence":"additional","affiliation":[{"name":"Department of Public Health of the University Hospital University of Naples \u2018Federico II\u2019  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donato","family":"Rosa","sequence":"additional","affiliation":[{"name":"Orthopaedy and Ortho\u2010traumatology Department of Public Health of the University Hospital University of Naples \u2018Federico II\u2019  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Triassi","sequence":"additional","affiliation":[{"name":"Department of Public Health of the University Hospital University of Naples \u2018Federico II\u2019  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Cesarelli","sequence":"additional","affiliation":[{"name":"DIETI University of Naples \u2018Federico II\u2019  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,5,11]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"d\u2032Imporzano M.&Peretti G.(2009)Societ\u00e0 Italiana di Ortopedia e Traumatologia. 94\u00b0 Congresso Nazionale SIOT(2009). 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