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Quality improvement in health care has developed gradually as emerging ideas have been explored and implemented in various clinical and non-clinical settings. One of the newest quality improvement methods that has been introduced in healthcare organizations is Six Sigma. Six Sigma is “a rigorous set of processes and techniques to measure, improve and control the quality of care and service based on what is important to the customer (Woodard, 2005, p. 229)”. The objective of this approach is to bring the procedures to defect-free levels trying to eliminate the variation in the processes. Defects are considered any factor that causes customer dissatisfaction. Many processes in healthcare require almost zero tolerance for error, especially in the clinical setting. Bring processes to a level where flawless approaches can have a positive impact on patient care, safety measures, health outcomes, efficiency, and cost reduction.
Six Sigma efforts have touched a wide range of functions in healthcare. Examples of such implementations show that they can be successful in various capacities: medication error, laboratory response time, supply chain management, claim reimbursement, nurse retention, patient condition results, and others (Revere and Black, 2003). Although the benefits of these projects are clear, the high level of specificity, analysis, and design can make them resource intensive. The resource requirements necessary to carry out these projects are very challenging. When examining the literature related to this topic, at least one article suggests a solution. Revere and Black offers Six Sigma in addition to existing Total Quality Management (TQM) programs. Its rationale is that similar quality efforts can be synergized to achieve better results with fewer disruptions to organizations. “Six Sigma is an extension of the failure mode and effects analysis required by JCAHO; it can be easily integrated into existing quality management efforts (Revere and Black, 2003, p. 377).” Such an approach would involve integrating Six Sigma into an existing program through detailed data analysis. It would be necessary to deepen the examination of the current process and improvement measures at a more detailed level.
Some TQM programs may lack sufficient data collection and analysis to fully understand process variation. Six Sigma can overcome these challenges through its emphasis on understanding process variation alongside implementing change. This aspect of Six Sigma can make TQM more effective. “Six Sigma’s work is no different from TQM; however, its goals are more aggressive and its methods are better defined (Revere and Black, p. 379, 2003).” Using these two approaches together can be valuable in creating successful quality improvement programs.
Although Six Sigma provides a higher level of measurement, this is not the only aspect that can make it successful in healthcare organizations. Improved metrics must be combined with skillful management so that programs are designed that are successful in decreasing process variation. Programs must be designed to alter structures and processes to actually produce changes in results. In addition, methods must be implemented to ensure compliance with these process changes. These tasks become the responsibility of company management and program participants, and the steps involved must be managed effectively if they are to be successful. Six Sigma is guided by the DMAIC approach: define, measure, analyze, improve and control (Riebling and Tria, 2005).
The level of detail and reporting required by Six Sigma also poses challenges for organizations: “Each component of each service must be reported, measured, and recorded on a regular basis (Revere and Black, 2003, p. 388).” The specific challenges encountered depend on the type of organization involved, the processes involved, the data sources, and the quality of the data. The processes involved can be especially complex if they involve multiple entities, multiple layers of interaction, and numerous feedback methods.
The use of Six Sigma in healthcare organizations has clear benefits, but it is not without its difficulties. In addition to the potential benefits of existing quality improvement programs, internal benchmarking and prioritization of other projects can be improved when Six Sigma metrics are used (Revere and Black, 2003). This can be a great advantage for company management when deciding how to allocate project resources. Ultimately, the use of Six Sigma in healthcare can only be successful if management is committed to quality improvement and can manage the costs of such efforts.