Six Sigma and Total Quality Management in Health Care

Quality improvement in healthcare has evolved gradually as new ideas have been explored and implemented in various clinical and non-clinical settings. One of the newer methods of quality improvement introduced in healthcare organizations is Six Sigma. Six Sigma is “a rigorous set of processes and techniques for measuring, improving, and controlling the quality of care and service based on what is important to the customer (Woodard, 2005, p. 229).” The goal of this approach is to bring procedures to defect-free levels by trying to eliminate process variation. Deficiencies are seen as all factors that lead to customer dissatisfaction. Many health care processes require a near zero tolerance for errors, especially in clinical settings. Bringing processes to a level that is approaching defect-free can have a positive impact on patient care, safety measures, heat results, efficiency and cost reduction.

Six Sigma efforts have affected a wide range of healthcare functions. Examples of such implementations show that they can be successful with multiple capabilities: medication failure, lab time, supply chain processing, reimbursement of claims, nursing retention, patient condition outcomes, and others (Revere and Black, 2003). Although the benefits of these projects are clear, the high level of specificity, analysis and design can make them quite resource intensive. The resource requirements involved in bringing such projects to fruition are a major challenge. Looking at the literature on this topic, at least one article suggests a solution. Revere and Black suggest Six Sigma be repaid to existing Total Quality Management (TQM) programs. Their underlying rationale is that similar quality efforts can be synergized to achieve better results with less disruption to organizations. “Six Sigma is an extension of error condition and analysis analysis required by JCAHO; it can be easily integrated into existing quality management efforts (Revere and Black, 2003, p. 377).” Such an approach would involve integrating Six Sigma into an existing program through detailed data analysis. It would require going deeper with the current process study and improving measures at a more detailed level.

Some TQM programs may lack sufficient data collection and analysis to fully understand process variation. Six Sigma can overcome these challenges through its emphasis on understanding process variation as implementation changes. This aspect of Six Sigma can make TQM more efficient. “The work of Six Sigma is not unlike TQM; however, its goals are more aggressive and its methods are better defined (Revere and Black, p. 379, 2003).” Using these two methods together can be valuable in creating successful quality improvement programs.

Although Six Sigma delivers a higher level of measurement, this is not the only aspect that can make it successful in healthcare organizations. Improved metrics need to be paired with skilled management so that programs can be designed that successfully reduce process variation. Programs must be designed to change structures and processes in order to actually create results. In addition, methods must be put in place to ensure compliance with these process changes. These tasks become the responsibility of company management and program participants, and the steps involved must be effectively managed to succeed. Six Sigma is guided by the DMAIC approach: defining, measuring, analyzing, improving and controlling (Riebling and Tria, 2005).

The level of detail and reporting required by Six Sigma also presents challenges for organizations: “Every component of every service must be reported, measured and recorded regularly (Revere and Black, 2003, p. 388).” The specific challenges encountered depend on the type of organization involved, intermediate processes, data sources and data quality. Intervening processes can be especially complex if they involve multiple entities, multiple layers of interaction, and several methods of feedback.

Using Six Sigma in healthcare organizations has clear benefits, but does not come without difficulties. In addition to the potential benefits of existing quality improvement programs, the internal benchmarking and prioritization of other projects can be improved when using Six Sigma metrics (Revere and Black, 2003). This can be a great benefit to business management when deciding how to allocate project resources. Ultimately, using Six Sigma in healthcare can only be a success if management is committed to quality improvement and can manage the cost of such efforts.