Six Sigma In
Healthcare
By Trevor Coons
Brigham Young University
Marriott Business School
What Will Be Covered
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Six Sigma defined in context of healthcare
Brainstorming Exercises
Nuts and Bolts
How It Works
Real World Examples
Exercises
Summary
Reading List
Six Sigma Defined In Context of
Healthcare
Statistically
• Sigma or σ is a character used in statistics to represent standard
deviation.
• Six Sigma denote a process that is so in control that only 3.4 parts are
defective for every million produced.
Six Sigma Defined In Context of
Healthcare
As A Tool
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With Six Sigma Motorola company was able to
Eliminate waste
Improve quality
Reduce cost
Reduce lead time
Six Sigma Defined In Context of
Healthcare
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Coming To Healthcare
Quality improvement plan
Controlling variance is essential
Increases accountability
Builds off of current processes
Brainstorming Exercises
How could Six Sigma help?
• First, come up with ideas how Six Sigma could improve
healthcare as a whole
• Next ,think about how Six Sigma principals could help
your company
• Lastly, think of ways that being able to create strong
measures could help you in your job
Brainstorming Exercises
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How could Six Sigma help?
Scenario 1
You are the manager over Lab and Imaging
You seem to be plagued by complaints about taking too
long
Scenario 2
You are an Emergency Department Manger
A slue of seemingly indeterminable delays are frequently
putting you on diversion
Nuts and Bolts
All or Nothing vs. Contingency
• All or Nothing means that the company either fully
commits to Six Sigma or else it shouldn’t bother
- It offers greater rewards
- But it comes at the cost of greater risk
• Contingency
- Allows a company to tailor its’ own solutions
- If done half-hazard, it can cause more harm than good
Nuts and Bolts
All or Nothing
• Six Sigma Organization
Champion
• Works with Black belts
• Appropriates resources
Black belt
• Heavily trained
• Full time job cost savings
Green belt
• Basic training
• Part time and work in groups
Nuts and Bolts
All or Nothing
Organization- Champion
• Works with the black belts
– Meets frequently with Black belts
– Identifies potential Black belts to train
• Appropriates scarce resources
– They have to balance internal and external concerns
– Has final say on major projects and process changes
Nuts and Bolts
All or Nothing
Organization- Black belts
• Heavily trained
– Costs thousands of dollars and several month to train
– Is a specialist in quality management tools
• Full time job cost savings
– Key to Six Sigma
– Projects vary in duration and scope
Nuts and Bolts
All or Nothing
Organization- Green belts
• Basic training
– Trained in basic quality tools
• Part time and often work in groups
– Depending on the company
• They can do Black belt work
• Or green belts can be relegated lower priority projects
Nuts and Bolts
All or Nothing
• Six Sigma Process DMAIC
• Scope of the project
Define • Critical-to-quality factors
• Create performance baseline
Measure • Collect comparable data
• Use data to identify underlying
problem
Analyze
• Implement process that will correct the
problem
Improve
Control
• Monitor process
To best understand
each of these steps,
we’ll follow a case
example of North
Shore University
Hospital as they
apply these steps.
(The bullets in blue.)
Nuts and Bolts
All or Nothing
Process-DMAIC
• Define
– In specific terms explain what's wrong
– Critical-to-quality factors
– ED and PACU are diversion, Total Turnaround Time (TAT) taking too long,
created a high-level process map
• Measure
– Create baseline
– Collect data
– Target TAT set to 120 min. and upper specification limit set to 150 min., defect
defined as a TAT over 150 min., collected information on 195 patients
Nuts and Bolts
All or Nothing
Process-DMAIC
• Analyze
– Use data to identify underlying problem
– Created a Control Impact Matrix, performed hypothesis testing on what they could
control, found the underling problem was employees lacked proficiency with the
hospitals bed tracking system (BTS).
• Improve
– Implement process that will correct the problem
– Improved communication within the staff by: documenting communication and
reformatting admission RN’s beepers. Retraining employees on BTS and providing
laminated instructions cards
Nuts and Bolts
All or Nothing
Process-DMAIC
• Control
– Monitoring the process
– TAT continued to be monitored on a monthly basis
• Results
– Went from a slightly over one sigma process to a 3.1 sigma process
– Cut standard deviation from 170 minutes to 48 minutes
– The average TAT went from 226 minutes to 69 minutes
Nuts and Bolts
Contingency
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Advice for Implementing on Contingency
Manage expectations
Manage for the correct outcomes
Pick manageable problems
Engage the customer
Measure the right thing
How It Works
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Project types
Patient Satisfaction
Safety
Efficiency
Outcomes
Many Others
How It Works
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Performance Variables
Patient Satisfaction
Service Level
Service Cost
Clinical Excellence
How It Works
Physician Engagement
• Why it is essential
• Why so hard to get
– Think differently
– Increases burdens
• How to gain
Real World Examples
Organization
Project
Outcome
Achievement
Charleston Area
Medical Center
Supply chain for
surgical supplies
Lower inventory, Improved
supplier relations
Saved:
$163,410 immediately
$841,540 future
Commonwealth
Health Corporation
Radiology
Decreased time between dictation
and signature, Improved wait
times and staff scheduling
$800,000 savings, 25%
better throughput and
eliminated 14 positions
Froedtert Memorial
Lutheran Hospital
ICU lab times
Reduced turnaround times Cut turnaround times
from 52 to 23 minutes
Mount Carmel
Hospital
Medicare+ Choice
Plan reimbursement
Redefined coding workingaged Medicare recipients
Wellmark Inc.
Physician addition
to managed care
network
Reduced time for adding
Savings: $3 million
physicians to medical plan per year
Scottsdale
Healthcare
Over crowded ED Improved transfer time
from ED to inpatient
hospital bed
Profit $857,000
Profits: $600,000
Exercises
You are trying to figure out what Sigma level your at
• You take meticulous notes of what’s going on in
your unit and observe 195 turnovers
Sigma DPMO
691,462
• 130 of those observations were defects 1
2
308,538
• Calculate defects per million
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66,807
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6,210
opportunities (DPMO)
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233
(Hint)
6
(Defects/ (Opportunities* Occurrences) ) X 1,000,000
3.4
Exercises
Activities to use in your meeting
• Managers go on a quality waste walk
• Discuss training you’d like to pursue in your
company
• Work to reduce reliance on competitive data for
improvement initiatives
• Discuss how to improve physician engagement
Summary
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Six Sigma defined in context of healthcare
Brainstorming Exercises
Nuts and Bolts
How It Works
Real World Examples
Exercises
Reading List
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“Crossing the Quality Chasm- A new healthcare system for the 21st century”. Institute of
medicine. National Academy Press. Washington D.C. 2001
“To Err is Human- Building a Safer Health System”. Institute of medicine. National
Academy Press. Washington D.C. 2000
Gawande, Atul. “Better- A Surgeon’s Notes on Performance.” New York: Henry Holt
and Company, 2007
“Addressing Variation in Hospital Quality: Is Six Sigma the Answer?”. Woodard,
Tanisha D. Journal of Healthcare Management. 50:4 July/August 2005.226-236
“Healthcare’s Horizon- Form Incremental Improvement to Designing for the Future”.
Stahl, Richard and Schultz, Bradley and Prexton, Carolyn. Six Sigma Forum Magazine
February 2003.17-26. www.ASQ.org
“Lean-Six Sigma – Tools for rapid cycle cost reduction”. Caldwell, Chip. Healthcare
Financial Management Association. October 2006. 1-2. www.hfma.org
Reading List
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“Factors critical to the success of Six-Sigma quality program in an Australian hospital”.
Hilton, Roger and Balla, Margaret and Sohal, Amrik S. Total Quality Management. Vol.
19, No. 9, September 2008. 887-902.
“Engaging Physicians in Lean Six Sigma”. Caldwell, Chip. and Brexler, Jim and Gillem,
Tom. Quality Progress. November 2005. 42-46
“Faster Turnaround Time”. Martocci, Maude, and Pellicone, Angelo. Quality Progress.
March 2006: 31-36 (www.asq.org)
“Integrating Six Sigma with Total Quality Management: A Case Example for Measuring
Medication Errors”. Revere, Lee and Black, Ken. Journal of Healthcare Management.
48:6 November/December 2003. 377-391
“What’s Wrong with Six Sigma?”. Goodman, John and Theuerkauf, Jon. Quality
Progress. January 2005.37-42 www.ASQ.org
“Application of the Six Sigma concept in clinical laboratories: a review”, Gras, Jeremie
M. and Philippe, Marianne. Clin Chem Lab Med. 46:6 2007. 789-796
“Managing Quality-Integrating the Supply Chain”. Foster, S. Thomas. 4th edition. New
York: Prentice Hall, 2010.