Six Sigma and Health Care: The Basics
An increasing number of hospitals are adopting a Six Sigma process as a way to increase patient
satisfaction and reduce errors by improving processes. Statistics compiled by the US Bureau of
Labor Statistics show that health care costs have increased five to six times faster than much of
the rest of the economy during the past 5 years.
Six Sigma is a program of quality that is grounded in statistical analysis of gathered data. The
objective of the program is to improve quality by reducing variation in the output from
organizational processes. In other words, the goal is to reduce variation and eliminate errors in
every process. This consistency will lead to greater customer satisfaction. If a desired outcome is
not delivered, known as a “defect,” it is necessary to discover the root cause and eliminate it
from the process.
The DMAIC process is an important part of Six Sigma, standing for:
 Define
 Measure
 Analyze
 Improve
 Control
Each phase of the DMAIC process involves detailed plans that help to guide managers through
the execution of the quality improvement project.
If implemented correctly, the Six Sigma process should:
 Increase revenue
 Improve patient satisfaction
 Reduce the number of new-hired staff
 Decrease operating costs at health care facilities
The speed of processes and procedures also should improve with initiation of a Six Sigma
program.
Measuring the effectiveness of a Six Sigma program
Levels are developed based on the number of defects that occur per million of opportunities for
them to occur. The highest level of Six Sigma requires a process to have defects ≤3.4 per million.
Sigma Level
2
3
4
5
6
Defects per Million
308,537
66,807
6,210
233
3.4
The basic steps of a Six Sigma program
1. Identify what is critical to the quality (CTQ) of products or services to the customers.
2. Apply intensive analysis to the processes, products, and services to determine whether the
customers are provided with these CTQs.
3. Uncover what variations are occurring in the current processes and whether your operations
are stable (ie, is the same care provided no matter what time of day or night). A defect is
created each time a process does not deliver acceptable results. Find out what defects are
occurring, how often, and how much they cost.
4. Choose focus areas based on translation of company strategy into operational goals.
5. Translate the problem into quantifiable terms using CTQ characteristics.
6. Identify possible causal relationships between inputs and the CTQs.
7. Suggest solutions to the problem.
8. Draft a charter, which includes a cost/benefit analysis.
9. Design and implement process changes or adjustments to improve performance of CTQs.
10. Review implementation and results of process improvement regularly.
11. Quantify and then continually build upon improvements throughout the control phase.
Opportunities for the Six Sigma process in health care facilities
The following are some examples of how to use the Six Sigma process in health care facilities:
 Patient admission
 Accuracy of surgical procedures
 Reducing patient length of stay
 Outpatient scheduling
 Efficiency of the emergency department
Roles of Six Sigma team members
Different team members have different responsibilities:
 Champion—facilitates projects and breaks down barriers, carefully monitors projects and
specified completion dates (4 hours of training)
 Master black belt (an expert)—coaches and supports black and green belts
 Black belt—leads strategic and high-impact process improvement projects, helps to coach
green belts (160 hours of training)
 Green belt—leads process improvement projects within own areas (48 hours of training)
 Management team—commits to improving products and services, oversees recruitment of
participants, assists in deciding upon focus areas, assists in implementing process
improvements (1 hour of training)
 Hospital staff (1 hour of training)
An ongoing program
Six Sigma is not a temporary fix or a short-term program. Rather, it is a permanent change to the
systems of the health care facility.
The perceived downsides of Six Sigma in health care
Six Sigma is a very complex system, and the use of it for solving simple problems sometimes is
viewed as overkill. The danger of suboptimizing a process without considering the whole value
is another concern. Sigma Six offers few standard solutions.
References and recommended readings
American Society for Quality. Lean Six Sigma in healthcare. Available at:
http://www.asq.org/healthcaresixsigma/. Accessed May 10, 2010.
National Association for Healthcare Quality. JHQ 174—lean Six Sigma in healthcare. Available
at: http://www.nahq.org/journal/ce/article.html?article_id=250. Accessed May 10, 2010.
Six Sigma Health Care. What is Six Sigma? Available at:
http://www.sixsigmahealthcare.com/Pages/SixSigma.asp. Accessed May 10, 2010.
TLP, Inc. Six Sigma health care. Available at: http://www.sixsigmahealthcare.com/. Accessed
May 10, 2010.
Review Date 6/10
G-1346