Is Six Sigma the Prescription for Ailing Healthcare Industry?Published: July 11, 2007 in Knowledge@Emory
Without a doubt, the crisis in healthcare, from soaring costs to a need to address rising medical errors, remains a quandary for today’s healthcare industry. In the new book titled Improving Healthcare Quality and Cost with Six Sigma by Dr. Brett E. Trusko, Carolyn Pexton, Dr H. James Harrington, and Praveen Gupta, the authors concentrate on applying Six Sigma principles to determine the solutions. Pointing to some significant developments in the healthcare field, the writers indicate that the fast changes in healthcare technology and offerings, as well as an increase in educated consumers, are accelerating the need for process improvements, such as what Six Sigma could provide. The authors, all industry insiders as well, say that Six Sigma should appeal to healthcare professionals interested in intrinsic improvements in the system.
Interestingly, the authors point out that technological improvements in healthcare delivery and testing aren’t the resolution as once thought. Even efforts by the U.S. government to force healthcare providers to utilize technology to share data on care and outcomes isn’t the answer, they say, adding, “Efforts are being made by the federal government to promote healthcare technology as a shortcut to quality, but as we have seen in the examples, IT is a tool of quality and not quality itself.”
And, with the aging of the population, the growth in demand on the system is also placing tremendous burdens on healthcare providers. Of course, the authors acknowledge the brewing debate on the best way to handle the need for healthcare coverage, especially as labor and medication costs are rising dramatically. The solution: use Six Sigma principles to improve quality and, in turn, lower costs. The costs reductions, they argue, would allow for more options and flexibility.
Establishing a process management environment becomes essential to applying Six Sigma, as it allows for accountability along the healthcare delivery chain, the authors argue. Certainly, process breakdown is a big part of the errors facing many medical institutions today. And, while Six Sigma initially dealt with manufacturing concerns, created by leadership at Motorola in the early 1980s, its application to a variety of industries is now being recognized. The authors also breakdown the six steps that are keys to the process improvement methodology, including:
Define your products or services.
Know your customers and their critical needs.
Identify your critical needs to meet customers’ critical needs well.
Establish a process of doing your work consistently.
Error-proof your process and eliminate waste.
Measure and analyze your performance. If not perfect, improve your process.
Of course, the authors note that the patient is the customer in this case, and they also say that buy-in needs to occur, in order for the Six Sigma principles to work. Doctors, management, nursing staff, as well as lower ranking employees, need to be devoted to this sort of overhaul to internal processes. Additionally, the authors note that “strong and demanding leadership” and measurement of performance are also essential parts of Six Sigma. The authors are wise to point out that failures in the Six Sigma process are often due to “not identifying opportunities for improvement in the bottom line, and blindly committing to the Six Sigma initiative.” This requires an “understanding of intent of the methodology, key tools associated with various phases of DMAIC (define, measure, analyze, improve, and control), and any organizational bottlenecks are critical requirements” to get the process underway successfully.
While the book goes in-depth and spends much of the pages on the various aspects of Six Sigma, including Statistical Process Control, Pre-Control, Variability Reduction Methods, and Design of Experiments, as well as Process Maturity Grids and SIPOC charts (supplier, input, process, output, customer), the authors take the reader step-by-step to understand the terminology involved, while breaking down the measurement tools key to the process improvement. The statistical measurements are laid out as formulas, making it applicable to the healthcare model, with accompanying descriptions and illustrations/charts to make the example clear. Six Sigma, as it turns out, sets up the needed best practices and benchmarks for process improvement. Essentially, prioritizing efforts is the first step in Six Sigma. The authors note the PPI or project prioritization index, “which is calculated as follows: PPI=(Benefits/cost) x (Probability of success/Time to complete the project in years).” The more critical the project is to the business, than management should then be more willing to accept a lower PPI number. The selection process is an obvious, though important one, based on “resources, returns, risks, and rewards.”
Additionally, the various stakeholders in the organization are critical to the process improvement, as the doctors, staff, patients, and nurses, can offer key insights into the effort, note the authors. Even before their input is solicited, the organization must establish “players in the theater of operation” by using a process map. Whether identifying stakeholders or laying bare the processes involved in a key operation, at the base of Six Sigma, is the understanding of just what is going on in an ever-evolving and complex organizational structure. The book succeeds by making clear the need for transparent processes and the prioritization of limited resources. Identifying improvement opportunities across the majority of healthcare organizations, the authors note that the following items appear to be some of the more common items that need addressing, including “reducing inpatient wait time, reducing billing errors, reducing pharmacy errors, reducing response time to bed calls, improving information sharing, reducing record errors,” and more.
Through a variety of case studies of hospitals in the second half of the book, the theoretical then becomes the actual, and also becomes much easier for the reader to digest the information given, such as the breakdown example of Commonwealth Health Corporation in Bowling Green, Kentucky, as they initiated efforts to improve turnaround times in radiology, revision of the billing process, and more. The authors indicate that Six Sigma initiatives do play well with management systems and certification requirements in hospitals and other healthcare centers.
Of course, Six Sigma initiatives are not fail-proof. But, a lack of commitment to the process can generally be blamed for this result. The authors point to a lack of resources, lack of top management participation, the notion that Six Sigma only applies to manufacturing, poor project management and project selection, no culture change, selecting the wrong people, shallow thinking, and a focus on problem solving and not prevention, as some of the reasons for a failure. The authors conclude, “The U.S. is spending a higher percentage of its GNP on healthcare than any other country, and yet it is far from providing the best service and results.” They see Six Sigma as a critical solution to this vexing dilemma. If there is one concern about Improving Healthcare Quality and Cost with Six Sigma, the authors need to spend more time discussing the initial costs associated with implementing large-scale process changes. However, if implemented correctly and on the appropriate measures, healthcare institutions can certainly use Six Sigma to deal with control, loss, and risk issues that they currently face.