Whenever I attend a Six Sigma symposium or healthcare conference, the same question comes up: “What’s the difference between Six Sigma and what we’re already doing?” Of course my response is, “Tell me more about what you’re doing so I can better answer that question.” After fielding this question for over a year, I’ve come to several conclusions:
- There is a certain level of variability in the way healthcare systems attack internal quality or process improvement issues.
- Depending on the particular methodology a hospital is using, the differences can be anywhere from glaringly obvious to fairly difficult to ascertain.
- There are a few extremely critical areas within the Six Sigma methodology that set it apart from other processes.
The following is offered as a brief comparison between the Six Sigma DMAIC process and FOCUS-PDCA. The DMAIC process includes phases for Define, Measure, Analyze, Improve and Control. FOCUS-PDCA is an extension of the plan-do-check-act (PDCA) cycle, sometimes called the Deming or Shewhart cycle, and is considered the most in-depth of the PDCA or PDSA methodologies. FOCUS is an acronym representing the five phases of the process known as Find, Organize, Clarify, Uncover, and Start. As with other quality initiatives such as TQM or CQI, there are some similarities with Six Sigma, however there are also significant contrasts and gaps that should be examined.
From my perspective, whether Six Sigma Steps are included or omitted the significant difference between Six Sigma and FOCUS-PDCA is that in FOCUS, there is no roadmap. In addition, there are very few tools and templates to help navigate through the methodology to ensure successful identification of problems and appropriate resolutions. If you are successful, the success could be just as easily attributed to your expertise or knowledge of the area, versus the methodology you used. With Six Sigma, a person knowing little to nothing about an area can still come to the same conclusions in the same amount of time, if not quicker. Furthermore, a novice using the Six Sigma methodology will be able to convey how confident they are in their analysis and subsequent recommendation using statistics instead of intuition.
Finally, the people side of any process improvement requires as much work as the technical side, and sometimes more. This is not addressed anywhere within the FOCUS-PDCA cycle. Built into the Six Sigma methodology is an arsenal of over 30 tools, some mandatory and others optional, to ensure that the impacted business area agrees on the recommended solutions. These tools also help address issues related to the systems and structures after the project is complete, ensuring sustainability.
There are opportunities to integrate the Six Sigma methodology where businesses have already adopted FOCUS-PDCA. Such integration would offer a robust process improvement methodology without reinventing the wheel. The modifications would focus on gaining acceptance from the key stakeholders, everyone from front line technicians to clinicians, management and board members. It would also require putting control mechanisms and systems and structures in place to ensure that successful project improvement outcomes are sustained over time.