Healthcare must adapt the sigma view of analysis

Healthcare is far from accepting six sigma but it may do well to look at the sigma way of analysing processes writes Dr Harish Nadkarni

The modern concept of quality in healthcare is developed from various concepts of quality in manufacturing, which were later applied to services and thereafter to healthcare. Such application therefore borrows heavily from the developments in manufacturing and is still affected by the same.

Changes in healthcare

In ancient times the manufacturing and services (including healthcare) were delivered on case-to-case basis by various artisans who had perfected their art within the scope of available knowledge and perceptions. Therefore there was an element of perfection in built into the delivery of the product. With advent of the modern age it became necessary to deliver the products on the basis of mass production to a large number of people simultaneously. This removed the element of individualized service that was going on, while simultaneously reducing the attachment of the actual technical people from the users. This brought into picture a large number of people whose presence became necessary for management of this process and who started adding their own criteria of quality to this process and to the product. The concept of pride in one’s own individual work has now given way to concept of capability of the organization delivering a consistent output with minimal variation towards customer satisfaction.

Predictability and healthcare

Medical service is unique in its nature. A mistake in the delivery of the service can cost the user his life. As its nature highly technical it is near impossible for the user to assess it correctly. Any mistake in treatment has domino effect if it occurs at the crucial stage of management and can lead to serious consequences later on. This problem is compounded by the fact that there is tremendous variation in the expertise and knowledge of the deliverer, the facilities, the purchasing abilities of the consumers and different regulations, which intend to control this service.

The inherent nature of healthcare demands that there is predictability in the outcome of the service. This necessitates use of techniques that will increase this attribute of the service. One such concept is Six Sigma.

Six sigma concepts

Six sigma is a statistical concept of the outcome where the undesirable outcome or the out of specifications outcome is brought to fewer than 3.4 per million events. If we actually check this number on the Gaussian curve of normal distribution, we find that six sigma corresponds to 0.002 per million. The limit of 3.4 per million is arrived at by accepting the possibility of total shifting of process mean by 1.5 standard deviations in either direction. This converts to 4.5 sigma and gives us the figure of 3.4 per million. To achieve this level of perfection the organization has to critically and factually look at each and every aspect of the processes that make the whole system. The comparison between three-sigma level and six sigma will highlight this problem better. In a ten-step process a three sigma level functioning shall lead to 26674 defects!

Traditional v/s six sigma approach

Traditional quality model of process capability differed from six sigma in two fundamental aspects:

1. Traditional model is applied to only core process.

2. It stipulates that a capable process is one that has process standard deviation of no more than one sixth of total allowable spread. Six sigma requires that the process standard deviation be no more than one-twelfth of total allowable spread.

Customers demand more than just the primary service. They demand price, service, style, availability and support. Six sigma therefore is more useful for the customers than traditional approach. Second point states that six sigma is a process quality goal where sigma is the statistical measure of variability of the process, while it applies to attribute data; such as count of the things that went wrong. This is done by converting the six-sigma requirement to equivalent conformance level. A six-sigma level organization in healthcare will have such negligible mishap rate. It can offer extreme level of predictability and assurance. Application for the concept of sigma has been applied to healthcare to process of general anaesthesia.

To become six sigma level, healthcare organization has to understand data collection, institute rigorous training about thinking in terms of process approach and process capability, understand and master various techniques of data analysis, fundamental concepts of statistical variation and control, knowledge of design of experiments and have a customer oriented view all the time. The organization must also know how to achieve balance between quality costs and benefits that are arising out of the quality initiatives.

ISO 9000:2000 and six sigma:

ISO 9000:2000 approach and six sigma are not contradictory to each other. The clauses in ISO 9000:2000 that are concerning corrective and preventive approach expect that techniques leading too process improvement and reaching to the level of six sigma are used. Six sigma management techniques in term utilize the eight guiding principles of ISO 9000:2000 for achieving the improvement.

Conclusion

Six Sigma or at least sigma related analysis of process are getting more acceptance day by day and healthcare organizations shall do well to adapt to this view of looking at things.