How many healthcare processes have you measured that are 2.0 Zst or higher at the start of the project? I’ve never had one of these – most of mine have started at below 1.0 or in the negative Sigma range.

In every one of my projects, I’ve had to use lean tools to get where I needed to go. Usually, I can’t find a standard procedure (or there’s a paper procedure that no one follows). Or, there are such variances between shifts that there are 2 or 3 standard processes.

In my very first project, Inpatient Discharge, we found that none of the x’s were significant. In my second project, Emergency Department Door-to-Doc, we found that all of the x’s were significant. In addition to these clues, in both projects, everyone we interviewed had a different version of what the standard process was.

In my most recent project, Admission through the ED, there were 12 “supplier groups” in our SIPOC process map (ED Nurses, ED Techs, ED Physicians, Admitting Physicians, Case Managers,Bed Control Managers, ED Unit Clerks, Nursing Unit Clerks, Nursing Unit Nurses, Housekeepers, Maintenance, and Registration Clerks.) Each had a different time for shift change, with 8, 10, and 12 hour shifts among the various groups. The process changed each time a group’s shift changed. You won’t be surprised to find out that we started at a negative Sigma level. We moved to lean tools almost immediately. And yes, we did reach a positive Sigma outcome, although we also followed up by chartering two Standard Work Projects, one for housekeeping and one forgetting the patient ready for departure to their inpatient room.

This makes me think that perhaps we should not start a DMAIC project with a very low Zst score – we should do a standard work project first. Is Lean – then Six Sigma – a logical approach? Or should we start with Six Sigma / DMAIC and then incorporate lean in the Improve phase? I’d love to know more about your own experiences. Thanks in advance for sharing.