Time cover SIX

storySIGMA

Q: What Scares Doctors?

A: Being the Patient

“To a large extent, health care systems were not designed

with any scientific approaches in mind. Too often there are
long waits, high levels of waste, frustration for patients
and clinicians alike, and unsafe care. A bold effort to
design health care scheduling systems, process flows,
safety procedures, and even physical space will pay off in
better, less expensive, safer experiences for patients and
staff alike.” – Don Berwick, IHI
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How good is good enough?

99.9% is already VERY GOOD

But what could happen at a quality level of 99.9% (i.e., 1000 ppm),
in our everyday lives (about 4.6)?

• 4000 wrong medical prescriptions each year

• More than 3000 newborns accidentally falling

from the hands of nurses or doctors each year
• Two long or short landings at airports each day

• 400 letters per hour which never arrive at their destination

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How can we get these results

• 13 wrong drug prescriptions per year

• 10 newborn babies dropped by
doctors/nurses per year
• Two short or long landings per year in all
the airports in the U.S.
• One lost article of mail per hour
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The answer is:

LEAN Six
Sigma
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Six Sigma in Healthcare

Date
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• Defects
• Over-Production
• Waiting
• Non-Utilized Talent
• Transportation
• Inventory
• Motion
• Extra-Processing
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Benefits :
•Improved safety
•Higher equipment
availability
•Lower defect rates
•Reduced costs
•Increased production agility
and flexibility
•Improved employee morale
•Better asset utilization
•Enhanced enterprise image
to customers, suppliers,
employees, and management
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Simply overlaying 21st century
technologies on top of 20th
century workflow will not yield
the necessary cost, quality and
efficiency benefits.

Hospitals must also redesign

processes and address the
human side of change.
Technology alone isn’t the answer…
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Overcoming the barriers

1. Culture
• Overcome resistance
• Shape common goals
2. Alignment and accountability
• Ensure clear linkage between improvement
initiatives, performance and strategic goals
• Develop consistent management structure
3. Control
• Put mechanisms in place to monitor and
maintain results long-term
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Getting there from here
• Transformation in healthcare
won’t happen without
transparency.
• Transparency can’t happen without
culture change.
• Culture change won’t happen without a
bold vision, a common toolset and
unwavering commitment.
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LEAN SIX SIGMA

•Lean Six Sigma focuses on eliminating

defects. In healthcare, a defect can be the
difference between life and death. Use Lean
Six Sigma to improve patient safety by
eliminating life-threatening errors. Lean Six
Sigma uses Define-Measure-Analyze-
Improve-Control (DMAIC ) – a five-step
approach to process improvement
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Six Sigma Basics

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What is Six Sigma
 A Vision and Philosophical commitment
to our consumers to offer the highest quality,
lowest cost products

 A Metric that demonstrates quality levels at

99.9997% performance for products and
processs

 A Benchmark of our product and process

capability for comparison to ‘best in class’

 A practical application of statistical Tools

and Methods to help us measure, analyze,
improve, and control our process
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• “Six Sigma” coined at in the 1980s

• Adopted by Allied Signal (Honeywell) with great success

• Later adopted by Jack Welch (GE) and further developed into

a true management system
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“ the Father of six sigma”

Sir Bill Smith
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What is Six Sigma?

1. The term “Sigma” is a measurement of how far a given
process deviates from perfection – a measure of number
of “defects”. “Six Sigma” implies near zero defects.

2. “A quality improvement methodology that applies

statistics to measure and reduce variation in processes.”

3. A management system that is “comprehensive and

flexible for achieving, sustaining, and maximizing
business success.”
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Conceptual Framework
• Critical to Quality (CTQ): Attributes most important to the customer

• Defect: Failing to deliver what the customer wants

• Process Capability: What your process can deliver

• Stable Operations: Ensuring consistent, predictable processes to improve

what the customer perceives
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Measurement: Six Sigma as a Quality Goal

σ
Defects Per
Million
The higher the sigma, the Opportunities
3 fewer the defects. 1 697,672.15
2 308,770.21
3 66,810.63
A increase from 3 to 6 Sigma
4 6,209.70
represents a 20,000 fold
5 232.67
improvement in quality.
6 3.40

99% “Good” (3.8 Sigma) 99.99966% “Good” (6 Sigma)

No electricity for 7 hours per month No electricity for 1 hour every 34 years
5,000 incorrect operations per week 1.7 incorrect operations per week
20,000 wrong prescriptions per year 68 wrong prescriptions per year
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Control Tools

Sustain

Return on Investment (ROI)

Performance improvement
Improvement
Devise solution(s) and
implement

Benchmarking …and validate root cause(s)

…the current process capability

(get the data!)

…the problem in a measurable way

Project Timeline

Improvement Methodology: DMAIC “Backbone”

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DMADV is a Six Sigma framework that focuses primarily on

the development of a new service, product or process as
opposed to improving a previously existing one
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Improvement Methodology: Key Players
Champions/Sponsors: Trained business leaders who lead the
deployment of Six Sigma in a significant business area

Master Black Belts: Fully-trained quality leaders responsible for

Six Sigma strategy, training, mentoring, deployment and results
Black Belts: Fully-trained Six Sigma experts who lead
improvement teams, work projects across the business
and mentor Green Belts
Green Belts: Fully-trained individuals who apply
Six Sigma skills to projects in their job areas
Team Members: Individuals who
receive specific Six Sigma training
and who support projects in their
areas
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Focus: The End User
• Customer: Internal or External
• Consumer: The End User

the “Voice of the Consumer” (Consumer Cue)

must be translated into
the “Voice of the Engineer” (Technical Requirement)
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A Traditional View

Market Share

Sales Growth
• Output Variables
Profitability

Manage the outputs.

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A Non-Traditional View

Product Quality
COQ Service

• Input Variables On-Time Delivery

Relationships
Credit Terms
Customer
Training

Customer Satisfaction

Market Share

Sales Growth
• Output Variables
Profitability

Manage the inputs; respond to the outputs.

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Measure

Strategy by Phase -
Improvement
Phase Step Focus

Process Characterization
Measure What is the frequency of Defects? Measure

• Define the defect Y

Control
(What)

Analyze
• Define performance standards Y
• Validate measurement system Y Improve

• Establish capability metric Y

Measure

Analyze Where, when and why do Defects occur?

Control
• Identify sources of variation

Analyze
(Where, When, Why) X
• Determine the critical process parameters Vital X
Improve

Process Optimization
Improve How can we improve the process? Measure

(How) • Screen potential causes X

Control
Analyze
• Discover relationships Vital X
• Establish operating tolerances Vital X Improve

Were the improvements effective?

• Re-establish capability metric Y, Vital X Measure

Control
Analyze
Control How can we maintain the improvements? Y, Vital X
(Sustain, Leverage) • Implement process control mechanisms
• Leverage project learning's Improve

• Document & Proceduralize

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Six Sigma Organization
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A Black Belt has…, and will…

Leadership Driving the Use