QUALITY HEALTHCARE: THE SIX SIGMA APPROACH

I delivered this paper at a program organized by healthcare providers and would love to share it. Please note that it has been edited for this purpose.

This paper is intended to introduce executives and professionals involved in health care provision to the Six Sigma concept and help them tap into the numerous advantage this strategy present.

Introduction
The world over, businesses are established to meet particular objectives. Business owners employ various strategies to meet these set objectives.

Healthcare delivery though humanitarian in nature is similar to other service provision businesses that are also set up with an aim in mind. While the main aim may not be to maximize profit, it is essential that the venture runs profitably to pay its bills and offer a sane level of return on investment to major financial stakeholders.

The fundamental objective of Six Sigma methodology is the implementation of a measurement-based strategy that focuses on process improvement and variation reduction through the use of specific tools. In healthcare environment, Six Sigma is applied in the improvement of various processes ranging from administrative, improvement of medical process outcomes such as clinical and patient safety. This strategy aims to align and optimise a process by the removal of errors and defects in the process. Quality healthcare is co-dependent on both the facility’s business process and medical service delivery processes.

What is Six Sigma?
Sigma s, is a Greek letter assigned to represent the amount of variation or inconsistency a measurement outcome exhibits. This concept is now adopted in business as a way of measuring variation. It is fair to say that variations are a burden on any business. In healthcare service delivery, the repercussions of variations might be the death of a number of people, legal actions, termination of licence of practice and so on. Six Sigma establishes a framework for quality service delivery through a statistical and systematically defined approach called DMAIC. This five-phased problem solving methodology does the following:

• Defines the problem
• Measure the opportunities
• Analyse current process using a combination of methods and tools taking into account all stakeholders’ view
• Improve the process by making use of the findings in the above process to redesign the current process to reflect the views of the stakeholders
• Control the process to align with the new objective

While these phases may look rigorous, it is the best for the business after all, bitter pills have been known to work magic.

Six Sigma was developed in the early 1980s by Motorola and made popular by GE’s Jack Welch. Businesses have used this process improvement methodology to achieve a monumental success in process improvement. This has led to great financial savings at the end of the day.

Cost of Poor Healthcare Quality
From a quality perspective, Six Sigma aims to achieve a defect level of not more than 3.4 defects in a million opportunities. Translated thus, any medical process is expected to be so perfect that chances of errors are reduced to 3.4 defects in a million cases. This means that 99.997 percent of surgeries, drug mixes at the pharmacy, medical billing, patient interview, medical diagnosis, laboratory examinations and such other processes performed by a medical facility must be perfect. This places an enormous task on practitioners in that they must devise their specific strategies that will eliminate errors and improve patients and overall clients’ satisfaction. An opportunity is defined in this case as a chance for non-conformance. To achieve Six Sigma, a process must eliminate all undesirable results such as waste and rework. In healthcare service delivery, waste and rework cannot be permitted to strive as the most of the time have grave consequences.

Poor quality healthcare service delivery is not limited to the action of quacks or opportunists alone as seasoned professionals are also liable. Quality in healthcare however is not only attributable to an individual such as the nurse, doctor or hospital administrative staff. It is most often a result of poorly implemented or managed process.

What is Quality
Quality is the totality of features and characteristics of a product or service that bear on its ability to satisfy given needs. This definition reveals that quality is an all-embracing and inherent service feature. Healthcare service delivery is not only restricted to a patient getting well after doctor’s consultation and medication. Quality healthcare service delivery involves the whole process of administering the services; this includes physical and personal contact made with all arms of the hospital facility. The patient and other stakeholders play a major role in defining those features that are critical to quality. Quality is often best defined by the person receiving the service. An attempt by Healthcare providers to define quality healthcare services is only an attempt in futility.

Benefits of Six Sigma
Six Sigma benefits are endless, but most apparent results are the significant financial returns that result from optimising a process and elimination of defects. Six Sigma implementation has also been known to cause major positive changes in corporate culture.

Summarily, Six Sigma benefits in healthcare service delivery include:
. Reduced Cycle times or turn around times
. Higher efficiency and lower costs
. Lower inventory levels
. Reduced error margins

The above benefits and achievements will ultimately increase:
. Customer satisfaction
. Employee satisfaction
. Higher market share
. Greater profits

Six Sigma Tools
Six Sigma process is data driven. To use data in this systematic problem solving approach, specific tools are used to collect data. Tools like:
. Questionnaires
. Customer surveys
. Focus Group discussions
. Root-cause analysis tools (Pareto Analysis, PERT, Check sheets, DOE, etc)
are all aimed at getting the VOC (Voice of customer). Responses and issues gathered from the administration of these tools are used to further determine the root-cause of identified problems and issues. These tools can also be combined in the analysis of the identified problems and may further be used to sample recommended solutions or even request inputs from customers as to what level of quality they expect or what they consider as important.

The intention of Six Sigma is to move an organization from a traditional to customer-driven organization.

Success Stories of Six Sigma implementation in healthcare
The statistical inclination of Six Sigma makes it a rigorous and robust approach to process re-engineering. The peculiar nature of healthcare delivery service makes it an important industry that cannot afford to thrive on trial and error. Many healthcare facilities have implemented the Six Sigma methodology to achieve excellent results and improvement in their business activities. Aside of this, healthcare facilities in developing economies face huge pressures to reduce cost and lower their bills without a corresponding effect in service delivery.

Summary
Businesses are continuously evolving and becoming user-friendlier and customer-centric. Healthcare service delivery is not an exception in providing quality services. While it aims to provide quality healthcare services, the best definition of quality is the judgement of the patient. This feedback is most important than any explanation that may be rendered for defect in service delivery. Six Sigma provides a rigorous methodology that takes advantage of various tools to review and improve processes to maximize opportunities and save costs. Six Sigma prides itself in reducing wastes, rework, cycle time, save costs and most importantly improve customer satisfaction amongst other benefits.

The increased pressure on healthcare providers in developing countries to provide quality healthcare services at a reduced cost means that service providers have to be proactive utilizing measures that keep them in business without compromising on quality. Six Sigma strategy and its tools also help healthcare providers to arrive at best solution that meets the needs of the patients.