What Is Six Sigma in Health Care?

In my years of being involved in quality improvement in manufacturing, service industries and healthcare…

In my years of being involved in quality improvement in manufacturing, service industries and healthcare I have encountered many different quality programs: Total Quality Management, Six Sigma, plan-do-check-act, lean production, Baldrige, and Lean Six Sigma, the current favorite it seems. In the first few years of the 2000s Six Sigma was becoming the “flavor of the month.” Forrest Breyfogle had published his influential work on Six Sigma in 1999.
Which program is the best in the healthcare setting? Are there really any significant differences among them? Let me address the latter question with an illustration comparing Total Quality Management and Six Sigma.
Six Sigma and Total Quality Management (TQM) in the healthcare field are quite different in their approach to quality although they are complimentary. Six Sigma focuses on reducing the variability in a standard process whereas TQM focuses on a mindset. For instance, suppose you want to apply Six Sigma techniques to the amount of time it takes to prep a surgery room to get it ready for the next surgery. That is, you want to standardize the prepping of a surgery room so that the amount of time taken to do so is consistent from one prep time to the next. Using Six Sigma, you would write down in detail the process that all follow in prepping the surgery room. The details of the process should come from a representative team of staff who are very familiar with the process as it exists. If the process in not standardized, then the team should design what it believes would be the best process. After the standardized process is delineated, the Six Sigma project leader will take a sample of times it takes to ready the surgery room from a random sample of actual occurrences of prepping over several days or weeks and measure the variance (a statistical measure) of the prepping. The leader will plot the variances and check to see if they meet the mathematical standards prescribed in the Six Sigma process. This approach is repeated until the variability of the prep time meets required standards and is maintained in future applications of the prepping.
TQM is not as mathematically focused. It concentrates on the attitudes towards quality of all staff and managers at a healthcare site. Taking the prep time example above, all the personnel involved in the prepping would hopefully have a similar attitude about the quality of the prepping process. Rather than just participating in an improvement process as is done in Six Sigma because of the demands of a manager, they will be willing supporters of the improvement process and will be knowledgeable of the outcomes of being committed to the process-namely that there will less chance for errors that will have adverse effects on patients and that results will be positive for all. The hospital will be respected by the doctors who are using Prevention Definition Medical the facilities as they won’t have to endure long or irregular waits for using the surgery theater. The staff prepping the room will have more pride in the work since they are an active part in developing the standardized work. Too, they become active participants in the quality program as they continually look for ways to improve upon the prepping process. The patients, the ultimate customers, will benefit as there will be less chance for acquiring infections in the surgery process and less chance of other errors. Of course the management and leaders of the hospital, who are ultimately responsible for the TQM program, are satisfied as they improve the outcomes for their customers, the patients, while improving the bottom line.
As you can probably see, each has its strengths and weaknesses. Six Sigma focuses on one process at a time and TQM focuses on the overall picture without much mathematical analysis. If you were to adopt a Six Sigma approach, you might reach the 3.4 errors per million opportunities, the ultimate goal of Six Sigma, for a particular process; however, there will be many other processes that need improvement that are neglected because Six Sigma does not look at the whole picture at a site. Another process may even be negatively impacted by the improved Six Sigma process. I know that in manufacturing cost savings in one process realized through Six Sigma have increased waste and cost in another process sometimes.
With TQM employees and managers will continuously seek ways to improve all processes at a site, if the methodology is correctly deployed. However, there will be limitations as to improvement of any given process Fast Weight Loss Diet Plan Lose 5Kg In 5 Days if mathematical approaches such as employed in Six Sigma are not used. Variation will not be tamped down as much as it could be and there will still be opportunities for eliminating errors that could be missed.
To me it seems that no one approach is best. A blend of techniques from several methods can be used. For a healthcare provider with its own quality department, it would be possible to have staff employed who individually are competent in different quality fields and be able together to use the best approach for any quality improvement project. For instance, such an organization might want to have its staff certified in different areas by the American Society of Quality or have individuals with multiple certifications, which is quite common. In my opinion three desirable certifications would be certified quality manager, certified quality engineer (which I am) and certified six sigma black belt or green belt. You could also seek certification from other organizations in Lean Six Sigma Black Belt. It is not enough just to have the members of the quality department certified, though. Leaders of the organization should have significant training in Quality Management.
What should a healthcare site with a small staff do? For instance, what approach should a primary care site take? If the primary care site is part of a physicians organization or physician/hospital association, it should be able to rely on that organization to provide expertise, whether through a staff person with significant quality training and certification or through the use of a consultant. I would also recommend that the office manager at each primary care site have training in quality management and that at least one physician have quality training too. I know of several instances at primary care sites where the drive to improve quality or design a patient-centered medical home was driven by a physician. Training and certification of other staff would be very helpful.
For a healthcare site not part of a larger umbrella organization and with a small staff it is important that the leader of the site have significant training in quality management. Hiring a consultant to work on a few projects while mentoring a few staff in the use of a few basic quality tools would enable the staff at the site to continuously improve the processes at the site and reap the rewards for doing so-improved patient outcomes, improved bottom line, and more time to get things done.
Overall, I believe that every healthcare organization needs to have staff who are trained in the use of quality tools from several different methodologies which are a good fit with its staff’s abilities. Even better would be to have some staff become certified by a quality organization such as American Society of Quality. By doing this the organization will be able to see that quality improvement is a continuous and never-ending process which can help the organization reach its strategic goals.