Power Of Six Sigma In Hospital & Healthcare Management

Six Sigma methodologies can change the face of modern hospitals and healthcare delivery systems, observes Pradeep Bhardwaj

Corporatisation and competition in healthcare sector are forcing healthcare organisations to look for new ways and means for improving their processes. This is for improving quality of the hospital's products and services and reducing patient dissatisfaction. As healthcare sector is becoming more complex, the opportunities for errors abound.

To reduce the errors and to move towards perfection, most of the corporate hospitals are now functioning at Three Sigma or Four Sigma quality levels. There is a need to breakdown the traditional boundaries that separate physicians, hospital administrators, pharmacists, technicians and nurses by shifting away from a culture of blame and by working together to systematically design safer, more effective and efficient systems. Six Sigma methodologies can help in this and can change the face of modern hospital and healthcare delivery system. Six Sigma can reduce variability and waste, translating to fewer errors, improve customer satisfaction, provide better processes, greater patient satisfaction rates, and happier and more productive staff. The popularity of Six Sigma is growing in healthcare industry. Many companies worldwide have already successfully implemented Six Sigma.

What Is Six Sigma

Six Sigma simply means a measure of quality that strives for perfection. It is disciplined, has a data-driven approach and methodology for eliminating defect in any process. Six Sigma provides a methodology to continue our improvement in everything we do. It is an organisational philosophy in establishing the belief of 'doing things right, first time and every time'.

Features

• The term Six Sigma means standard deviation.
• Standard deviation measures how much variation exists in a distribution of data.
• Standard deviation is the key factor in determining the acceptable number of defective units found in a population.
• The target for perfection is the achievement of no more than 3.4 defects per million opportunities.
• The principles can apply to a wide variety of processes and services.
• Six Sigma projects normally follow a five-phase improvement process called DMAIC (Define, Measure, Analyse, Improve and Control).
• Six Sigma requires commitment from the whole organisation.
• Six Sigma healthcare organisations have the ability and willingness to adopt contrary objectives, like reducing medical errors and getting things done faster.
• It is customer focussed and raises performance at breakthrough level.

How And When To Use It ?

First you need to determine your cost of poor quality. Six Sigma is complimentary to other initiatives such as ISO, JACHO, TQM, NABH etc.

In a hospital, everything is built on integrity, trust and care. There is requirement for a fairly high level of understanding between hospital administrators, doctors, nurses, supportive staff and providers of services. Also, suppliers need to understand the sensitivities of the business. Clinches are not been discussed here, but these are life, death and every personal issue. First of all, hospital must develop new ways of doing business in order to achieve excellent clinical outcomes, patient safety and optimal financial results. The above can be achieved in the following way:

• Understand who your consumers are and what your service is.
• Review consumer surveys, concession reports and other data.
• Screen and prioritise issues by severity, frequently/likelihood of occurrence etc.
• Determine the internal processes causing the most dissatisfaction and pain.
• Find out why and where the defects are occurring.
• Devise ways to address these defects effectively.
• Set up good metrics (Six Sigma places a lot of emphasis on measurement).

Phases Of Six Sigma

There are six phases of Six Sigma:

• Establish management commitment.
• Business diagnostics.
• Develop the management infrastructure.
• Business process identification and metrics.
• Project selection.
• Deployment- training, project execution, and review.

Steps In Six Sigma Methodology (DMAIC)

Define: Define the problem and improvement activity.

Measure: Measure the target metric and confirm that the measurement system is accurate. Measure the existing system. Establish valid and reliable metrics to help monitor progress towards the goals defined at the previous step. Begin by determining the current baseline. Use exploratory and descriptive data analysis to help you understand the data.

Analyse: Analyse the system to identify ways to eliminate the gaps between the current performance of the system or process and desired goal. Use statistics to find the root cause of the problem and generate a prioritised listing of them.

Improve: Enhance the healthcare delivery system. Be creative in finding new ways to do things better, cheaper, or faster. Use project management and other operations, planning and management tools to implement new approach. Use facts and statistical methods to validate improvement.

Control: Monitor the new system. Institutionalise the improved system by modifying compensation and incentive systems, policies, procedures, services and other management systems.

Main Players

The key players in Six Sigma initiative are: Champions & Sponsors, Master Black Belt (MBB), Black Belt (BB) and Green Belt (GB).

Champion & Sponsors: Six Sigma champions are high-level individuals who understand Six Sigma and are committed to its success. Sponsors are the owners of processes and systems who help initiate and co-ordinate Six Sigma improvement activities in their areas of responsibilities.

Master Black Belts (MBB): He/she plays a vital role as a leader, project selector, coach, mentor, manager and strategic business planner. An MBB in healthcare needs a variety of skills and information in order to function effectively. An MBB teaches other sigma students and helps them achieve Green Belt and Black Belt Status.

Black Belt: He/she is a person that is part of the leadership structure for process improvement team called 'Black Belts'. They are highly-regarded personnel who have an ability to lead teams as well as to advise the management.

Green Belt: He/she is person trained in Six Sigma methodology and is a team member of a Six Sigma process improvement action team.

Most Popular Outcomes From Six Sigma

Increased Customer/Patient Satisfaction And Care

• Higher satisfaction.
• Fewer complaints.
• Improved billing.
• Increased prescription accuracy.
• Reduced waiting time and variation.
• Safer and more efficient emergency services.
• Fewer medical errors and defects.
• Increased service orientation.
• Eliminate the 'I don't know' factor.

Increased Physician Satisfaction

• Reduced scheduling delays.
• Fewer physician complaints.
• Improved working condition of clinician and staff.

Reduced Cost & Savings

• Better financial and higher annual savings.
• Optimised materials management chain.
• Less rework and waste.
• Better recruiting and retention power.
• Stronger growth.

If you make Six Sigma a strategy in your hospital, the end result will get reflected in sustainable bottom line improvement. The average time taken to develop a plan and improve a process takes 3-12 months, depending on the scope and goals of the organisation. Successful Six Sigma project requires cross-functional teams.

Formula Of Six Sigma

Quality (Q) X Acceptance (A) = Effectiveness (E)

Hence, the effectiveness of the result is equal to the quality of the solution time and acceptance of the idea.

The writer is Six Sigma Hospital & Healthcare Management Consultant, Delhi.
E-mail: pradeepkb28@rediffmail.com