With the formation of a joint venture between the original healthcare organization laboratory, Sonora Lab, and the larger Quest Diagnostics, a partnership existed in name only. Both labs went about operating in separate locations while continuing with their individual instrumentation and systems. Over time, this led to issues across both teams, and it became clear that a quality management system would need to be implemented. This system would be used to improve processes and work towards having both teams working in the same direction.

Six Sigma would be used to make this a true joint venture

SQL had two labs that often had overlaps. Nevertheless, these two labs were rivals that continued to do things their own way, despite being part of a joint venture. In order to improve the experiences of its patients and clients, as well as make the organization as a whole more efficient, it would take embracing the Six Sigma method, including its Voice of the Customer and DMAIC tools.

SQL Had a Problem Unifying Its Two Labs Which Affected the Customer Experience and Efficiency

Even prior to its adoption of Six Sigma methodology, SQL was not seen as a typical laboratory operation in health care. It brought together Arizona’s largest healthcare system with the largest clinical testing provider in the United States. This venture joined Quest Diagnostics, which covered commercial reference, for-profit commercial operations that were covered by Sonora Quest Laboratories, and the staffing and management of the laboratories at all Banner Hospital locations.

SQL is part of a larger network called the Laboratory Sciences of America. This network manages all of the employees across the six Banner Health hospital laboratories. This means that approximately 1,900 employees are all employed by this larger network. Some of these employees work at commercial reference labs, others at hospital labs, and some extend their duties across both. The Health Diagnostics Laboratory in Phoenix is also managed by this organization. All combined, an average of 17,000 requisitions a day are processed by these laboratories.

In short, this all makes for a complicated working model, and not having synchronicity between the various labs could cause a whole slew of issues.

This became clear shortly after the formation of the joint venture between Quest Diagnostics and the original Sonora Lab. At the time, the two labs were in fierce competition with each other. The original lab was local while Quest was national, so there was a feeling of David and Goliath. When the joint venture happened, both labs decided to continue doing things their own way with little regard for how the other one operated.

Even after the creation of a facility that brought together the two labs, both opted to stay separate in the same building. For any customers that had the need to work with both labs, they were confronted with different and often conflicting standard operating procedures, instrumentation, and methodologies.

In 1999, the two boards of directors got together and agreed on the necessity of getting the business under control. This could only be done by having everyone across the labs work in the same direction. This would require a quality management system, and despite the different approaches of the two labs, all agreed that Six Sigma was the way to go.

SQL Decided to Adopt the Six Sigma Method

There were many examples to draw from as far as attempts to integrate laboratory systems over several years. There were a few to look toward that achieved some degree of success, but far more that did not. Regardless, none had managed to reach the level that this venture was looking to achieve. In other industries, such as manufacturing, defects mean a product is not working correctly and could lead to an unsatisfied customer. In health care, however, defects mean medical errors. These kinds of errors could cost lives. The vast majority of medical decisions are made based on the results of lab work, so it is necessary to be as close to perfection as possible. Achieving the Six Sigma level meant 3.4 errors per every one million opportunities. That is a 99.9997% accuracy rate. This kind of quality is what SQL wanted to make sure it could provide to its physician clients and patients.

For SQL’s first Six Sigma project, it was decided to focus on a reduction of wait time within service centers for patients. Many patients complained that there was way too high of a wait time. Initially, it was believed by the administration that the solution was simply to add more staff. The Six Sigma method pointed to better solutions.

The first stage of SQL’s journey with Six Sigma involved the identification of employees who wanted to undergo the training to achieve either Black Belt or Green Belt status. Becoming a Six Sigma Green Belt involves around 15% of your working time, while achieving a Black Belt involves essentially 100% of your working time. The time this would require met with a significant amount of resistance and even resentment, initially. Everyone was busy in the labs, and there was not an overabundance of available staff to handle any one job. Working a Six Sigma process did not involve deciding to implement it on a Friday and seeing the benefits of the changes on the following Monday, so the commitment required was difficult for some of the staff to accept. This would eventually change, however, once the results of the system became clear.

After the training of the staff occurred, it was time to truly begin working with the Six Sigma methodology on this first project. This involved making those who had received Six Sigma training into project managers. These managers then surveyed the patients and physician clients to gather data and obtain the Voice of the Customer.

Getting the Voice of the Customer helps with the Define stage of DMAIC, a guiding principle of the Six Sigma system. The Define stage defines the problem, and the Measure stage establishes the baseline. During the Analyze stage, a Black or Green Belt leads the project team through an analysis of the data. During the Improvement stage, innovative improvement efforts are worked into the process. These improvements are tested and implemented until the desired achievement is reached. Finally, in the Control stage, constant monitoring occurs to ensure that the changes made to the process stick and that the goal is maintained.

With the utilization of the Voice of the Customer in its first Six Sigma project, SQL came to the surprise realization that the amount of time patients were willing to wait to be seen was quite different than the administration figured. It also turned out that simply adding more staff was not an ideal solution, just a band-aid. In order to properly address the problem, it would take dealing with the root cause. In looking at the process, it was found that the wait time got out of hand whenever new procedures were introduced, co-pays were implemented for the labs, and any other factors that were brand new came into play. Using the Six Sigma method, SQL fine-tuned its processes and put measures in place to offset the wait time increase that typically would result from changes.

The Outcome Was Impressive

By utilizing the Six Sigma method, SQL was able to unify the labs and reach its goal of having 5% or fewer patients wait more than 20 minutes to be seen. It has also been able to use Six Sigma to successfully reduce by 61% the order to specimen collection cycle time for STAT tests in the emergency department. Further improvements include a reduction of 90% in data entry errors, a 70% reduction in needle sticks, and a 59% reduction in specimen identification errors. All combined, the process improvements brought about by embracing the Six Sigma methodology have been massive.

The organization has also been able to save a significant amount of money by not simply relying on the addition of more staff when problems arise. In SQL’s very first Six Sigma project, it found that eliminating non-value-added activities, improving training, and streamlining processes did more toward reaching goals than adding the expense of more personnel. The biggest percentage of money the organization has been able to save can be credited to making its processes more efficient through the use of Six Sigma.

The organization’s vast improvements have not only been noticed by patients and physician clients but also by experts in the pursuit of quality. In 2003, SQL was the first healthcare organization to receive the prestigious Arizona Pioneer Award for Quality.

5 Best Practices When Implementing Six Sigma in Your Organization

SQL learned some major lessons when implementing Six Sigma into its processes. These lessons should be taken note of by any company that is planning on its first Six Sigma projects.

1. Understand that this will not be a quick fix

In making the decision to improve its patient wait times using Six Sigma, SQL had to be able to commit to not seeing the results of its improvement efforts right away. A typical Six Sigma project requires diligent adherence to the method for an average of 4-6 months.

2. Prepare for some initial resistance

Making big changes to your organization is going to ruffle some feathers. SQL found resistance and resentment among some of the staff about the time commitment needed to successfully implement changes using the Six Sigma methodology. This should be expected in any organization. Those who showed resistance at SQL turned around once the positive results were clear. This acceptance and embrace of Six Sigma will likely occur once the benefits are clear.

It is important, however, to not simply take a wait-and-see approach with the staff in regard to Six Sigma. Full commitment is required from the top down in order for the full benefits to reach fruition. Being able to convince staff by using the success stories of other organizations as examples to follow or by making clear how strong the need for change is may be necessary.

3. Do not act on assumptions about the cause of the issue

SQL initially believed that the remedy for the patient wait times would be to simply add more staff. This did not actually address what the root cause was. It is important to thoroughly work the Voice of the Customer and the DMAIC tools in order to successfully determine what the true root cause of an issue is and to make the needed improvements that will help your organization reach its goals.

4. Invest in staff training

The first thing that SQL did in preparation for launching its first Six Sigma project was to invest in the training of some of its staff so that they could become Green and Black Belts. This required finding staff that was enthusiastic about receiving the training and making these staff members project leaders once the training was complete. Doing this had a great impact on onboarding the staff and achieving the best results.

5. Build upon your Six Sigma success

After the success of the first Six Sigma project at SQL, the organization went further in improving its processes by finding other projects that could benefit from the Six Sigma method. Once you achieve the goals of your project with Six Sigma, do not stop there. There is still plenty of room for continuous improvement in your organization. Take the time to find other areas in your organization that could use improvement as well as work at continuing to expand upon the improvements of your initial project to further increase efficiency.

Unifying an Organization With Six Sigma

Before utilizing Six Sigma, SQL had two labs that were working independently of one another, despite being part of a joint venture. This led to a variety of complications and a system that lacked unity. By embracing Six Sigma, the organization was able to bring its labs together toward a common goal, improve efficiency, save money, and improve the customer experience. If these are the kinds of results you are looking for in your organization, look toward Six Sigma.

About the Author