With half a dozen years of experience, this may be a good time for the healthcare industry to revisit the question which titled a frequently cited article published in 1998, “Is Health Care Ready for Six Sigma?” The question may best be answered by examining how Six Sigma and related improvement methods have been deployed within the healthcare environment, what kind of results have materialized, which factors might have contributed to the level of success they have seen, and what lies ahead for the industry.

Dr. Mark Chassin’s article (The Milbank Quarterly, Vol. 76, No. 4, 1998) concluded, “We can learn a good deal from industries that are working toward the Six Sigma goal. Let’s try it in health care and see how close we can get.” Just six years later, the methodologies have taken hold in a number of early adopter hospitals and health systems. With cost, quality and regulatory pressures mounting within the healthcare industry, Six Sigma is drawing increased attention from other hospitals and health systems seeking a better approach to achieving long-term results.

Six Sigma has been used to address many of the most common challenges facing healthcare, including patient safety, technology optimization, market growth, resource utilization, length of stay and throughput. In some cases, it has been used to focus on a specific department or process, and in other cases it has been implemented on an enterprise-wide basis to achieve a cultural transformation.

The figures in the table below illustrate several healthcare processes by sigma level. They also illustrate that sometimes being 99 percent effective is just not good enough in healthcare delivery. And the figures show the value in striving for a Six Sigma level of excellence.

Source: GE Healthcare

A Sampling of Six Sigma Success in Healthcare

The following represent some of the successful projects and initiatives taking place at hospitals and health systems throughout the United States, applying a combination of Six Sigma, Lean and change management methods:

• Projects at Thibodaux Regional Medical Center in Louisiana have yielded more than $4 million in revenue growth, cash flow improvement and cost savings.
• A wide range of projects at Commonwealth Health Corporation in Kentucky has produced more than $7 million in savings and provided better quality, and staff and patient satisfaction.
• Good Samaritan Hospital in Los Angeles reduced registry expenses by mapping multiple process drivers and achieved cost savings between $5.5 and $6 million.
• At Rapides Regional Medical Center in Alexandria, Louisiana, projects in the emergency department have led to reduced wait time, fewer patients leaving without being seen, higher satisfaction and an annualized savings potential of $957,000.
• Virtua Health in New Jersey has had a vigorous Six Sigma program in place for several years as part of their Star Initiative to achieve operational excellence. In one project focused on congestive heart failure, length of stay was reduced from 6 to 4 days; patient education improved from 27 to 80 percent; and chart consistency improved from 67 to 93 percent.
• Valley Baptist Health System in Harlingen, Texas, reduced surgical cycle time, adding capacity for an additional 1,100 cases per year and increasing potential revenue more than $1.3 million annually.
• Yale-New Haven Medical Center in Connecticut achieved a 75 percent reduction in bloodstream infection rates in the Surgical Intensive Care Unit, with $1.2 million annually in estimated savings.
• Boston Medical Center improved throughput in diagnostic imaging, with a potential impact of more than $2.2 million in cost savings and revenue growth.
• One project at the University of Pittsburgh Medical Center’s cath lab increased available capacity by 2.08 patients per lab per weekday, with a potential revenue impact of $5.2 million annually.
• Providence Health System, with headquarters in Seattle, has been implementing Six Sigma and change management on an enterprise-wide basis across four regions and has a number of completed projects covering various operational and clinical issues. Total savings achieved so far exceeds $40 million.
• The Women and Infants Hospital of Rhode Island successfully used Six Sigma and change management to standardize operating procedures for embryo transfer, yielding a 35 percent increase in implantation rates.

These successes are impressive, but there also have been challenges along the way. A number of variables may determine whether Six Sigma will yield long-term advantages foran organization. Since numerous studies have shown that roughly 62 percent of change initiatives fail, it is important to understand key factors for success prior to launching any new Six Sigma effort.

Common Factors in Six Sigma Healthcare Success

The following are some of the common Six Sigma success factors shared by healthcare organizations that have been able to sustain momentum and results:

• Providing strong leadership involvement and support.
• Using techniques to promote culture change and break down silos.
• Selecting the ‘best and brightest’ for Six Sigma leadership.
• Delivering project-based training and mentoring for an adequate number of Green Belts, Black Belts and Master Black Belts.
• Selecting and scoping projects to achieve financial and quality results.
• Setting measurable objectives aligned with organizational goals.
• Establishing clear roles and responsibilities.
• Over-communicating by a factor of 1,000.
• Paying attention to the Control phase to maintain results.
• Including project tracking and reporting capabilities.
• Stressing accountability and recognizing achievements.

Conversely, some of the factors that have characterized less-successful Six Sigma deployments are lack of leadership support, poor communication, inadequate training and mentoring, projects that have not been clearly defined, and neglect of the cultural or human side of change.

It also is important for any healthcare organization considering or deploying Six Sigma to recognize that it is not a magic bullet and will not transform the organization overnight. It requires strategic vision, diligence, patience and hard work. Probably first and foremost, Six Sigma takes leadership. If the organization does not make a clear and unequivocal commitment to leading the initiative, providing adequate time and resources and communicating results, the chances for long-term success will be diminished.

Driving significant, sustainable results in healthcare is not about training, and it is not even just about the tools. It is about changing the culture and developing enough experience to know which tool to apply to each issue. Some problems may need the rigor of Six Sigma or Lean, while others may simply be a matter of making a decision – with many variations in between.

Conclusion: The Answer to the Question Is Yes

During the past six years, the Dr. Chassin’s question has been answered. It is yes. The healthcare industry’s Six Sigma experience is just beginning. Momentum is building and the industry is on the threshold of achieving critical mass. The next step will be spreading the key learnings and using Design for Six Sigma (DFSS) to create new systems of care that can meet future challenges with nearly error-free performance.