Guest Post: Emergency Blood Product Release: Using the “6-3” to Work Smarter


Many thanks to the staff of Barnes-Jewish Hospital for providing this for publication. You might also be interested in my podcast with Dr. David Jaques from the same hospital.

By: Rebekah Johnson, BS, David Jaques, MD, and Colleen Becker, MSN, RN, CCRN

A large Midwestern hospital with a Level I Trauma Center and a surgical volume of 35,000 cases per year addressed the urgent need to provide a standardized process for the emergent release of blood products to patients with acute hemorrhagic blood loss. Any difficulty in obtaining critical blood products for emergency massive transfusion situations can lead to a patient's death. We used Lean-based tools and methodologies to move from event pre-work to solution implementation in eight weeks.

The traditional Lean Rapid Improvement Event (RIE) takes place over the course of five days and requires a full-time commitment, roughly 35 hours, from all team members. Considering the urgent need for a resolution of this problem and the need to have critical stakeholders present through all steps of the solution process, we chose to use an innovative “6-3” event to alleviate scheduling concerns for team members and to more rapidly address the crucial issue of emergent blood product release.

The “6-3” event, a unique concept created by our organization, uses the fundamentals of the Lean RIE in a refined event structure. A “6-3” is chartered using the standard RIE format, but focuses on a narrower scope. The event consists of one 6-hour and one 3-hour workday, with several days between for follow-up items. The flexible schedule of the “6-3” event for this project allowed all critical stakeholders to serve as full-time team members and provide the requisite approvals to move forward with solutions immediately.

The project team consisted of administration, process owners and end users from the operating rooms, the blood bank, the emergency department, anesthesiology, and trauma services. Target deliverables included the development of standard definitions and standard work, to be combined in a complete Massive Transfusion Protocol as an organizational policy.


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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. Interesting article and nice to see a successful breaking out of the traditional RIE paradigm. This goes to show that the TPS truly works best when people/organizations think for themselves and do what works best as opposed to blindly copying what maybe works for others.

    At my hospital we're becoming much more flexible with our approach, with projects sometimes going days, weeks, or even months if necessary. However, I sometimes feel we lose continuity when we accommodate our schedules more than we do the need to solve problems. It's something we have to decide for ourselves…

  2. We totally agree. Scoping becomes the challenge with shorter duration efforts, but success is more likely with tightly scoped objectives as well. I think healthcare, being young at this, is being encumbered by the RIE. It has its role, no doubt, but it is definitely not sized to meet the needs of most healthcare professionals.

  3. […] The classic “Kaizen event” (aka Rapid Improvement Event or Rapid Process Improvement Workshop) is a full week. That poses a real challenge to many organizations. How do we dedicate staff time to that? How do we backfill staff to keep things running normally? These are solvable problems and many organizations figure this out, even if it’s not easy or painless. Some organizations get creative and solve the problem by doing shorter, more focused events (or an innovative “6-3” schedule as discussed here). […]


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