Six Sigma Method for QI & PI
MHS 665
William C. Brannan, MD
Classic Componentsof Quality
0
2
4
6
8
10
12
Outcomes CustomerSatisfaction
Cost ProcessImprovement
Institute of Medicine’s New Components of QI
0 2 4 6 8 10 12
Equity
Efficiency
Timeliness
Patient Centered
Effective
Safety
Relationship of Classic & New Components of Quality
Not one or the otherNot competitiveThey are to complement each otherThey form the matrix or fabric for
Quality Management (QM) in either Quality Assessment (QA) or Quality Improvement (QI)
The Fabric of QI
Safety
Effective
Pt. Centered
Timeliness
Efficiency
Equity
Outcomes Customer Cost Process
Satisfaction Improve
History of Six Sigma
Developed by Motorola & General Motors in mid-1980’s
Data-driven quality methodologySeeks to eliminate variation (and its
associated costs) from a process
Sigma Levels
Sigma Defects Per Million
Opportunities (DPMO)
1 690,000
2 308,537
3 66,807
4 6,210
5 233
6 3.4
Sigma Comparisonof Industries
0
1
10
100
1,000
10,000
100,000
1,000,000
1 2 3 4 5 6
IRS Advice
Acute Back Pain
Post-MI Meds
Mammography
Abx Overuse
IP Med Errors
Airline Baggage
Px Hosp Deaths
Prescriptions
Surg Instr Left
Anesthesia
Airline Fatality
What is Six Sigma?
A process must not produce more than 3.4 defects per million opportunities.
In Healthcare it means not more than 3.4 medication errors in 1 million doses.
Not more than 3.4 foreign bodies left in patient during 1 million surgeries.
Not more than 3.4 no shows per 1 million appointments.
The Six Sigma Cycle
Define Training Implementationobjectives, Designate Black Belts. Develop
set goals Train SS methodology. Projects
Involve organization-
wide projects. Define
Staff advancement Measure
in SS Analyze
Continue training Improve
new staff Control
Continue identifying
new projects
Key Six Sigma Roles
CEO
Champion
Master Black Belts
Black Belts * Experts * Guides
Green Belts
Central Components - Existing
DefineMeasureAnalyzeImproveControl
Central Components - New
DefineMeasureAnalyzeDesignVerify
Define
What is the business case for this project?
Current state map vs future state map.What is the project’s scope?Due date determined.
Measure
What are the metrics for this process?Are they valid and reliable?How will I measure progress?How will I measure success?
Analyze
Can the process be improved?Who will help make the changes?What resources are required?What could cause this change effort to
fail?
Improve
What is the work breakdown structure?What specific activities are necessary to
meet project goals?How will I reintegrate various
subprojects?
Control
How will I control quality, cost, schedule, scope and changes to the plan?
How will I ensure that the business goals of the project were accomplished?
How will I keep the gains I made?
Implementation Step 1
Begin with senior leaders. Train them in the principles and tools.Direct the management infrastructure.Cultivate the environment for innovation
and creativity.Reduce organizational hierarchy.Remove barriers to experimentation and
change.
Implementation Step 2
Develop external quality measures.Communicate with patients, employees,
stakeholders and suppliers.Develop rigorous methods to obtain inputConduct baseline studies of starting point. Identify cultural, policy and procedural
obstacles to change.
Implementation Step 3
Rigorously assess and conduct top-to-bottom training in systems-improvement tools, techniques and philosophies.
Implementation Step 4
Develop a framework for continuous process improvement.
Monitor progress and success.Metrics should focus on strategic goals,
drivers and key business processes.
Implementation Step 5
Managers & staff with intimate process knowledge at all levels of the organization choose processes for improvement.
Improve business performance linked to measurable financial results.
Implementation Step 6
Individual employees and teams, led by Green Belts, conduct Six Sigma projects.
Medical Error Reductions
Reducing patient fallsReducing ADE’s from medicationsReducing ordering & administration
errorsImproving turnaround time for pharmacy
orders
Business Operations
Improving revenue cycleImproving nurse or pharmacy technician
recruitmentImproving employee retentionIncreasing OR throughput
Patient Case Management
Decreasing stroke patient LOSDecreasing CHF LOSReducing lost MRI filmsImproving MRI exam schedulingReducing emergency department
diversions
Patient Satisfaction
Reducing ED wait timesImproving patient satisfaction in ED
WEB SITE
www.isixsigma.com
Six Sigma @ Mission
CEOChampionMaster Black BeltBlack BeltsGreen Belts
DMAIC
Bob BurginBill BrannanTom KnoebberPI ConsultantsCollaborative
Practice TeamFOCUS-PDCA
QI Process @ Mission
V ice-P res id en t o f Q u a lity C h ie f M ed ica l O ffice r
Q u a lity C om m ittee o f S ervice L in e
S ervice L in e
P I D irec to r
O p era tion s L ead ersh ip Team
M ed ica l A d m in is tra tive C om m ittee
B oard Q u a lity C om m ittee