How We Serve You : White Papers
Six Sigma: An Effective Tool for Healthcare
By Norma S. Simons
Introduction:
The Institute of Medicine defines quality in healthcare as “ ..the extent to which services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (Institute Of Medicine 1990). This concept is widely accepted and it has seen the healthcare industry use a large variety of quality initiatives and metrics to track and respond to issues that impact patient care. Most of these initiatives have provided incremental improvement over the last several years. However the Institute of Medicine reports that medical errors may cause 98,000 deaths annually which results in the financial toll of $17 to $29 billion per year. With these and other challenges facing the industry there is a need for a more revolutionary approach to improving the quality of patient care. Six Sigma is a business model that has demonstrated in several industries that when properly used has enabled companies to achieve considerable reduction in defects and waste resulting in impact to the bottom-line.
Six Sigma |
Traditional Quality Initiatives |
Clear definition of customer satisfaction is linked to variation of the process output |
Focus is primarily on averages |
Initiatives are aligned with the customer needs |
Initiatives are identified internally |
Emphasizes cross-functional process management |
Focuses on departmental activity |
Uses a robust problem solving methodology which is driven by the use of statistical methods |
Some statistical tools are applied with less rigor |
Promotes alignment of initiatives with business goals and yields bottom-line results |
Project selection may not pertain to the business goals |
Why Six Sigma?
- Defines Customer Satisfaction In general, the patient and patient families are considered to be the ultimate customer and all activities are geared towards satisfying their needs. From the perspective of the patient, any aspect of dissatisfaction of a service is regarded as a defect. Therefore patient satisfaction is linked to the variation of the process. For example, if the Length of Stay in a hospital is expected to be five days, patients and their families will be dissatisfied if the hospital stay is too short or too long. The measurements used in Six Sigma enables the hospital environment to identify the defect rate, the major drivers that impact the length of stay and the corrective actions or policies that need to be established in order to ensure customer satisfaction.
- Identifies and Optimizes the needs of Third Party Organizations Meeting the requirements of Inspection, Regulatory and Peer Review bodies is very critical to the healthcare environment. However, the focus needs to move away from conformance to regulations to enhanced performance. This can occur, through the application of the Six Sigma methodology as it seeks to focus on requirements of all customers and provides the means to optimize the needs of each group without compromising patient care.
- Enables a Strong Focus on Processes The healthcare industry has long been known to have highly qualified and skilled professionals whose activities are monitored by accreditation bodies and various forms of peer reviews. The high caliber of professionals along with sophisticated technology is not sufficient to provide adequate patient care. The Six Sigma approach helps organizations develop a strong focus on processes and moves away from blaming individuals. Errors and mistakes are the result of broken processes and systems that no longer serve the need of the patient of the healthcare professional. Well qualified people will be constrained by dysfunctional processes which will result in high costs driven by medical errors, poor patient care, waste and inefficiencies.
- Promotes Decision Making based on Data The metrics used in Six Sigma are linked to customer satisfaction. This provides the means to ensure a common understanding, use and interpretation of performance measures across the facility.
Defect – Failure to deliver customer requirement
DPMO – Defects per Million Opportunities
Variation - Deviation from predictable output
For example, patients and family members may be expecting the Length of Stay for a certain illness to be 4 to 6 days in the hospital. If the patient is discharged outside this window, then this may be considered a defect. The number of times this occurs can be defined as defects per million opportunities (DPMO)
The use of the Six Sigma metric allows for the accurate measurement of process outputs before and after process improvement initiatives to evaluate their effectiveness.
- Provides a Structured Methodology for Problem Solving Six Sigma uses a problem solving methodology (DMAIC) that has resulted in cost reduction and increased customer satisfaction.
The application of the DMAIC model for healthcare provides a robust approach to problem solving with the use of statistical tools that has already demonstrated improvement in patient care, reduction of waste, and improvement in operational efficiencies. The challenges that now face the industry cannot be addressed with the current quality improvement methodologies and need an approach that is revolutionary and can be applied to cross-functional processes.
- Aligns Process Improvement with Bottom-line Results Six Sigma is a business model that allows for the alignment of customer satisfaction, waste reduction, and cost improvement with bottom-line results. The Six Sigma model has been used in a wide range of industries and has demonstrated considerable improvements in processes and the bottom-line. The ability of the healthcare industry to embrace these concepts will allow for the quick application of management concepts that have been tried and tested in other industries.
Diagram showing alignment of customer requirements to bottom-line results
Summary
Six Sigma is a business management model that aligns strategies to outcomes. It does not seek to replace the strong scientific knowledge that already exists, but seeks to provide a framework that will enable the healthcare professional to focus more on patient care and overall performance. Six Sigma forces a change in behavior, the extensive use of metrics and the application of a robust problem solving methodology that emphasizes the need develop and manage processes across departments. The strong scientific approach to problem solving will support the scientific principles that are incorporated into the thinking and knowledge base of healthcare professionals. The move to adopt Six Sigma will not happen overnight, and will require strong commitment for all levels of management. The way to begin the journey to Six Sigma is to begin a project at a time – always selecting projects that can show measurable results. This will enable the gradual learning and dissemination of the concepts of Six Sigma throughout the healthcare facility.
