Lean Six Sigma and Health Care

March 30, 2011

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.

Although the Six Sigma Methodology may have been developed for a manufacturing organization, it can be used in a healthcare organization in order to give the same added benefits. The healthcare industry is a service organization facing challenges everyday. Quality improvement methods are more difficult to implement in a healthcare industry. The comprehensive approach offered by Six Sigma allows for the methodologies to be successfully implemented with positive results.

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.

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.


American Society for Quality. Lean Six Sigma in healthcare. Available at: http://www.asq.org/healthcaresixsigma/. Accessed May 10, 2010.

Implementing Six Sigma Certification in Healthcare. Available at: http://www.sixsigmaonline.org/six-sigma-training-certification-information/articles/implementing-six-sigma-certification-in-healthcare-environments.html. 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.


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