Reactions from healthcare professionals to Six Sigma can vary greatly, from “It’s the most reliable approach to process improvement we’ve found,” to “It’s just one of several tools we use to solve problems,” and even “Hate it…not interested…too hard…just another management fad.”

Six Sigma is probably not for everyone and it is certainly not a solution to every problem (though there may be some Master Black Belts out there who disagree). While it has produced impressive results in many cases, it was not able to bulletproof certain companies against competitive threats in the marketplace.

In reality, adopting the best management tools, and then training the best people to use them represents only one slice of a winning strategy. Prevailing over the cost and quality issues that challenge healthcare requires a combination of committed leadership, unbridled innovation and a comprehensive systems approach.

Small Steps or Large Leap?

Reaching this pinnacle, however, is not a quick trip. When it comes to culture change, some healthcare organizations just are not ready to dive into the deep end of the pool. They may need more immediate assistance to address a difficult issue, or they may prefer to test the waters with smaller “proof” projects that provide early wins and build momentum.

For some organizations, the right starting point may be a tightly defined project or working session aimed at improving a particular service line or department, such as radiology, cardiovascular services or the emergency department. Taking time during the planning phase to develop a strategic assessment or business case and gather input from key stakeholders can help to ensure a better outcome.

If the proper planning has been done up front, each project should yield measurable results that support the overall strategic goals of the organization. For instance, if an organization has established patient safety as one of its primary goals, then a project to reduce medication errors or patient falls would have a clear connection. An initiative to improve revenue cycle management would align with financial targets, and a project involving first-case start times in surgery may align with both clinical and operational goals.

Multiple Tools and Tactics

Most organizations that have implemented Six Sigma programs have come to realize that additional ingredients are necessary to maintain long-term results, and that not everything rises to the level of a Six Sigma project.

The use of Lean techniques such as value stream mapping or conducting Kaizen events can be extremely useful in streamlining workflow and improving the patient care environment. Lean can either be used on its own, or as part of a Six Sigma project.

Hospital system fragmentation and poor cross-functional communication often are invisible culprits undermining care delivery, eroding the operating margin and contributing to medical error rates. To remove such barriers, healthcare leaders need to identify and adapt proven strategies that help to break down silos, foster interdisciplinary teamwork and build acceptance for change. Culture-change tools like change acceleration process (CAP) and Work-Out have been helpful, and as with Lean, these tools can be useful on their own or within broader initiatives.

Long-term success also depends on adapting management and leadership systems that incorporate all elements of the performance improvement toolkit. The organization’s strategic objectives must be clearly aligned with the individuals and initiatives that support them.

If management displays little or no interest in an initiative – whether Six Sigma, Lean, PDCA (plan, do, check, act) or another approach – it will not take root within the organization. Leaders must champion the cause, celebrate the successes and ensure accountability for results.

Six Degrees of Separation (Between Average and Excellence)

When adopted appropriately as part of an overall approach to performance improvement, Six Sigma has proven its value as a solid, evidence-based methodology. But it is not a magic wand. Why have there been various degrees of success and sustainability in the industry?

Looking at the longer-term success stories, there seem to be six common ingredients that may account for the disproportionate longevity and results:

  1. Ongoing leadership commitment and sufficient resources.
  2. Attention to up-front planning and assessment.
  3. Credible project-based education, mentoring and guidance.
  4. Clear communication plans, culture-change techniques and a toolkit that can expand and evolve as needed.
  5. Detailed operating calendar that includes planning, reviews and report-outs.
  6. Linkage between strategic goals, and accountability for results.

Holding people accountable for results actually raises the level of satisfaction among employees. People want to understand the major goals for the organization, and how they can contribute to achieving those goals. There should be no ambiguity about what constitutes excellent, mediocre or poor performance.

Taking a systems approach to performance improvement ensures that all aspects have been considered and changes in one area do not adversely impact another area. It helps to create an environment where positive outcomes are the norm on every level – whether the outcome is related to infection rates, patient wait time or an incorrect billing statement.

Organizations that have adopted this approach have found greater predictability and a better sense of timing. They have fewer issues with recruitment and retention – partly because they have been able to measure and share their achievements. As Dr. Mark Van Kooy of Virtua Health put it, “We’re more forward looking now than backward looking. Everyone understands the concept of accountability – there is no excuse-making or finger pointing anymore.”

Connecting the Dots

To encourage a high-performing culture, healthcare leaders need to create a metric-driven nexus between expectations and execution. The stakes are high, and while efforts can start on a small scale, there should be a plan for expansion that fits with the particular needs and style of the organization.

Doing more with less is a familiar mantra in hospitals. Opportunities for improvement abound, and must be prioritized within a well-conceived and coordinated plan. Whatever methodologies or tools are adopted, keep in mind that not all implementations are created equal. Early enthusiasm can quickly evaporate if the right systems and structures have not been put in place to sustain the program.

Adopting a systems approach is important for many reasons. As industry trends push toward greater transparency and public reporting, consumers are increasingly able to access comparative information. Pay-for-performance initiatives are under way, or at least under consideration, in many hospitals. The report card phenomenon is not going away, and hospitals will need measurable evidence to retain a competitive edge.

More than 3,000 hospitals are now involved in the Institute for Healthcare Improvement’s 100,000 Lives Campaign aimed at reducing preventable patient deaths through error reduction and specific interventions. A growing number of U.S. organizations are pursuing the Malcolm Baldrige National Quality Award, or at least exploring the criteria and assessments to understand where they may fall short.

Making these programs work depends in large part on being able to identify the gaps and connect the dots. Healthcare leaders will have a discernible edge if they are able to manage their organizations from a holistic perspective, linking strategies, tools, operating plans, performance management and accountability.

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