Define
The Define phase is where every successful improvement project begins. Before data is collected or solutions are proposed, the team must clearly understand what problem they are solving and why it matters.
Many improvement efforts fail because they begin with vague goals such as:
- "We need to improve efficiency."
- "The department needs to work better."
- "Patients are unhappy."
While these concerns may be valid, they are too broad to solve effectively.
The Define phase transforms general concerns into clear, focused improvement projects. It helps teams answer critical questions:
- What specific problem are we trying to solve?
- Who is affected by the problem?
- How will we measure improvement?
- Who should be involved in the project?
When done correctly, the Define phase ensures that improvement efforts are purposeful, aligned, and achievable.
Identifying Improvement Opportunities
Improvement projects often begin with observations from people who work directly with a process every day.
Frontline staff frequently notice inefficiencies that others overlook.
Common triggers for Lean Six Sigma projects include:
- Increasing delays
- Frequent errors
- Staff frustration
- Patient complaints
- Rising operational costs
- Regulatory or compliance concerns
Healthcare Example: Delayed Patient Discharges
An infirmary notices that many patients who are medically ready to leave remain in their beds for much longer than they need to upon discharge.
This creates several problems:
- Beds remain unavailable for incoming patients
- Patient wait times increase
- Staff experience unnecessary workload
Rather than simply saying "discharges take too long," the Define phase helps frame the issue more precisely.
Understanding the Voice of the Customer
One of the most important concepts in Lean Six Sigma is the Voice of the Customer (VOC).
The customer is anyone who receives the output of a process.
In healthcare, customers may include:
- Patients
- Physicians
- Nurses
- Administrators
- Insurance providers
- Regulatory bodies
Understanding the Voice of the Customer means identifying what matters most to the people affected by the process.
Healthcare Example: Laboratory Turnaround Time
Patients and physicians often care about how quickly lab results become available.
If lab results take too long:
- Physicians cannot make treatment decisions
- Patients wait longer for diagnosis
- Medical requests may increase unnecessarily
Gathering Voice of the Customer information may involve:
- Patient surveys
- Staff interviews
- Grievance reports
- Operational data
The goal is to translate customer needs into clear performance expectations.
Writing a Problem Statement
Once the team understands the issue, they must define the problem clearly.
A good problem statement is:
- Specific
- Measurable
- Objective
- Focused on the current problem, not the solution
Poor example
"Patient wait times are terrible and need to improve."
Better example
"Patients in the sick-call line wait an average of 70 minutes before being seen by a nurse, exceeding the expected target of 30 minutes."
The second statement is much more useful because it:
- Identifies the process (sick-call intake)
- Quantifies the current condition (70 minutes)
- Provides a target (30 minutes)
Clear problem statements help teams stay focused throughout the project.
Defining the Project Goal
After defining the problem, the team establishes a goal statement that describes the desired outcome.
A well-written goal should follow the SMART principle:
| Criteria | Meaning |
|---|---|
| Specific | Clearly describes the objective |
| Measurable | Uses quantifiable metrics |
| Achievable | Realistic within the project scope |
| Relevant | Important to the organization |
| Time-bound | Includes a timeline |
Healthcare Example: Reducing Lab Result Delays
Problem Statement: Average lab result turnaround time for routine blood tests is 120 minutes, exceeding the clinic's target of 60 minutes.
Goal Statement: Reduce average lab turnaround time from 120 minutes to 60 minutes within six months.
The goal now provides a clear target for improvement.
Defining the Project Scope
One common mistake in improvement projects is attempting to fix too much at once.
Processes in healthcare are often complex and interconnected, making it easy for projects to expand beyond manageable limits.
Defining scope helps answer:
- What part of the process will be studied?
- What is outside the scope of this project?
Healthcare Example: Medication Administration
A clinic's wants to reduce medication errors.
A project that tries to address every possible cause, prescribing, pharmacy verification, medication preparation, and bedside administration, may become overwhelming.
Instead, the team might narrow the focus to: "Medication administration errors occurring during bedside barcode scanning."
This keeps the project manageable and increases the likelihood of success.
Creating a Project Charter
The project charter is one of the most important outputs of the Define phase.
It is a document that formally outlines the improvement project and aligns the team around a common purpose.
A typical project charter includes:
| Section | Description |
|---|---|
| Problem Statement | Description of the issue being addressed |
| Goal Statement | Desired improvement outcome |
| Project Scope | What is included and excluded |
| Business Impact | Why the project matters |
| Timeline | Expected project milestones |
| Team Members | Individuals involved in the project |
Healthcare Example: Project Charter Summary
Project: Reduce Emergency Department Intake Delays
Problem: Patients wait an average of 70 minutes before provider evaluation.
Goal: Reduce average wait time to 30 minutes within four months.
Impact: Improved patient care, reduced crowding, and faster treatment initiation.
Team: Emergency physician, triage nurse, intake nurse, quality improvement analyst.
The project charter serves as a roadmap for the entire improvement effort.
Identifying Key Stakeholders
Stakeholders are individuals or groups who are affected by the process or the improvement effort.
Including the right stakeholders early is essential because they often:
- Provide important insights
- Help identify root causes
- Support implementation of improvements
Healthcare stakeholders might include:
- Physicians
- Nurses
- Department managers
- Laboratory staff
- Information technology teams
- Quality improvement personnel
High-Level Process Mapping
Before collecting detailed data, teams often create a high-level process map.
This map shows the main steps in a process from beginning to end.
Process maps help teams:
- Visualize how work flows
- Identify potential bottlenecks
- Clarify responsibilities
Healthcare Example: Medical Department Intake Process
A simplified process map might include:
- Patient arrives at medical center
- Patient registers at front desk
- Triage nurse performs initial assessment
- Patient waits for available treatment room
- Provider evaluates patient
Even a simple map can reveal opportunities for improvement.
For example:
- Registration delays
- Limited triage staffing
- Room availability constraints
These insights will later guide the Measure and Analyze phases.
Avoiding Common Pitfalls in the Define Phase
Teams sometimes rush through the Define phase in their eagerness to solve problems quickly.
However, skipping this step often leads to wasted effort.
Common mistakes include:
- Jumping to solutions too early
- Defining the problem too broadly
- Failing to include key stakeholders
- Setting unrealistic project goals
A well-executed Define phase ensures that the team solves the right problem.
Define Phase Outputs in Practice
At the end of the Define phase, the team should have several important deliverables that guide the rest of the project. These outputs ensure the team has a clear direction, measurable objectives, and a shared understanding of the process being improved.
The three key outputs are:
- A completed Project Charter and Work Plan
- Clearly defined Measurable Customer Requirements
- A High-Level Process Map
To better understand how these elements work together, consider the following healthcare scenario.
Healthcare Example: Improving Emergency Department Triage Time
A facility leadership team has noticed increasing patient complaints about long wait times in the emergency department. Data from patient satisfaction surveys and operational reports suggests that patients often wait too long before being assessed by a triage nurse.
A Lean Six Sigma team is formed to investigate the issue. During the Define phase, the team produces several key outputs.
Output 1: Project Charter and Work Plan
The first major deliverable is the Project Charter, which formally defines the improvement project
and aligns the team around a shared goal.
Example Project Charter
Project Title
Reduce sick-call Triage Wait Times
Problem Statement
Patients arriving at the clinic currently wait an average of 28 minutes before triage, exceeding the clinic's's target of 10 minutes.
Goal Statement
Reduce average triage wait time from 28 minutes to 10 minutes within six months.
Business Impact
- Faster patient assessment
- Reduced triage area congestion
- Better compliance with emergency care guidelines
- Improved patient satisfaction
Scope
In Scope
- Patient arrival through triage assessment
Out of Scope
- Provider evaluation
- Diagnostic testing
- Discharge processes
Project Team
- Director of Nursing
- Triage Nurse
- Supervisor Nurse
- Quality Improvement Analyst
While the charter defines the project, the Work Plan describes the activities required to complete it.
A simple work plan might include:
| Task | Responsible | Timeline |
|---|---|---|
| Develop project charter | Project lead | Week 1 |
| Create high-level process map | Improvement team | Week 1 |
| Collect baseline wait-time data | Data analyst | Weeks 2-3 |
| Conduct root cause analysis | Improvement team | Weeks 4-5 |
| Develop improvement solutions | Team | Weeks 5-6 |
The work plan helps the team stay organized and ensures that the project progresses in a structured way.
Output 2: Measurable Customer Requirements
Another important outcome of the Define phase is translating the Voice of the Customer into measurable requirements.
In healthcare, the primary customer is often the patient, but other stakeholders also have important expectations.
For the triage process, the team identifies several customer needs.
Voice of the Customer
Patients want:
- To be assessed quickly when they arrive
- To feel confident their condition is taken seriously
- Clear communication about wait times
Physicians want:
- Accurate triage information
- Patients prioritized correctly based on severity
Facility's Medical leadership wants:
- Efficient patient flow
- Compliance with emergency care standards
These expectations are converted into measurable requirements.
| Customer Need | Measurable Requirement |
|---|---|
| Quick triage | Patient triaged within 10 minutes of arrival |
| Patient safety | Correct triage level assigned |
| Efficient flow | Minimal waiting before assessment |
By translating customer expectations into measurable metrics, the team ensures that improvement efforts focus on what truly matters to those receiving the service.
Output 3: High-Level Process Map
The final key output of the Define phase is a high-level process map, which visually shows how the process currently operates.
This map helps the team understand the major steps involved before diving into deeper analysis.
Emergency Department Intake Process (High-Level Map)
- Patient arrives at clinic
- Patient checks in at triage desk
- Does patient need to be seen?
- No: Patient is dismissed
- Yes: Patient directed to Provider line
Even this simple map can reveal potential problem areas.
For example, the team might ask:
- Does registration take too long?
- Are triage nurses always available?
- Are patients arriving faster than staff can process them?
These questions will guide the Measure phase, where the team begins collecting data to better understand the process.
Why These Outputs Matter
The Define phase outputs provide the foundation for the entire Lean Six Sigma project.
Without them, teams may struggle with:
- Unclear objectives
- Misaligned expectations
- Poor communication among stakeholders
- Inefficient improvement efforts
By completing the Project Charter, defining measurable customer requirements, and mapping the process at a high level, the team ensures that the project begins with clarity, structure, and alignment.
These deliverables also prepare the team for the next stage of the DMAIC cycle: Measure, where data is collected to understand how the current process actually performs.
Chapter Summary
The Define phase establishes the foundation for every Lean Six Sigma improvement project.
During this stage, teams:
- Identify improvement opportunities
- Gather the Voice of the Customer
- Develop clear problem statements
- Define measurable project goals
- Establish project scope
- Create a project charter
- Identify key stakeholders
- Map the high-level process
By carefully defining the problem and aligning the team, organizations ensure that improvement efforts begin with clarity, purpose, and direction.
The next chapter will focus on the Measure phase, where teams collect and analyze data to understand how the current process actually performs.