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Quality Management: Using Six Sigma Concepts in Healthcare

(Nov. 4, 2009)

The importance of quality management appears to vary widely in its priority ranking for healthcare organizations, according to a new study conducted by two Harvard School of Public Health researchers. The report, published online by Health Affairs, a health policy journal, notes that less than half of the respondents (44%) ranked quality among the two highest priorities on the chief executive's performance evaluation. One-third of hospital governing boards received formal quality training and only one-fifth of respondents considered the board chairperson, the board or its committees one of the most influential forces behind hospital quality.

"Our results show quality of care is often not a top priority for hospital boards," write the researchers who contacted 922 board chairpersons from 1,000 randomly selected not-for-profit hospitals ranked by publicly reported quality measures for acute myocardial infarction, congestive heart failure and pneumonia. The survey had a response rate of 78%. Roughly, three-quarters of hospitals (72%) regularly reviewed quality dashboards and 63% included quality performance on every board agenda.

Yet, quality management is an area that proves to be constantly evolving and continuously revisited by quality teams at hospitals throughout the country. Most recently, the industry has experienced a push toward the use of Six Sigma principles to better manage quality and measure outcomes.

Six Sigma is referred to as the process of designing, improving and monitoring all of an organization's activities to minimize and eliminate waste and reduce errors while increasing customer satisfaction and profitability. In the healthcare environment, Six Sigma is being used to reduce sources of variation found in any process from billing, physician practices, patient treatments, patient triage and the use of technology by employees. The practice as originally developed by Motorola in the 1980's as their internal quality improvement program, but the concept was quickly adopted by several world-class manufacturing firms and today, is being used in a wide range of industries - which most recently includes healthcare.

In healthcare, the factors that determine the quality and efficiency are usually the flow of information and interaction between people. Six Sigma helps to streamline the flow of information and achieve strategic business results by initiating cultural shifts all throughout the organization. The process provides the necessary tools and methodologies that help in analyzing and transforming human performance, necessary for achieving significant long-term improvements.

For example, patient satisfaction is of utmost importance to any healthcare organization but it is not restricted to giving proper treatment, but involves other services such as billing systems and bed management. Employing a Six Sigma project could potentially provide substantial improvements in critical services.

For example, potential Six Sigma projects for healthcare organizations may be related to the workflow of the registration and billing systems, the clinical procedures of medication administration or intensive care unit procedures. All these activities are relevant, but they cannot all be improved simultaneously, according to Tony Jacowski, a quality analyst for The MBA Journal. Prioritizing and selecting areas that need immediate improvement is critical to the success of the Six Sigma project, notes Jacowski, who offers the following tips to guide healthcare organizations in identifying projects best suited to the Six Sigma concepts:

• Understand your patient and customer requirements. When prioritizing the appropriate project, significance must be given to customer requirements first. The Critical To Quality (CTQs) elements for the project must be understood. Remember, the customer may not always be the patient, but rather could also be the nursing staff, physicians and administration or department heads.
• Collect data. The Quality Function Deployment (QFD) tool can be effectively used to gain agreement on the best area for the Six Sigma improvement. By carrying out interviews and surveys, the data can be collected and the CTQs determined.
• Identify problem areas. When the data is collected, the Six Sigma team must then determine the problem area and the solution that would best benefit the organization. If a simple project that can show quick results is undertaken, it can help bring about more support and provide a boost to future initiatives. Equally important is to understand the complex nature of the problem. The higher the complexity, with measurable response variables, the better the prospect for a Six Sigma project. Some problems may be sorted out by using other tools like the Change Acceleration Process (CAP), which can be applied to cases that simply need direction and facilitation.

Typically, for a successful Six Sigma project selection and implementation, there must be identifiable input and output of the processes. Some common characteristics of Six Sigma projects are those that allow for measureable benefits, the feasibility of resources and data, clearly defined goals, alignment of critical hospital issues and visible benefits of the initiatives to patients and customers.