The doctor-patient relationship has been at the core of medicine for centuries. However, the last decade has seen radical accelerating change in the context in which that relationship is embedded. It is increasingly complex and hurried and, disturbingly, it is fraught with substantial risk to the patient.
The quality and variability of care delivered is highly profiled in the media today. Pick up a newspaper, turn on the television or open a healthcare trade journal and chances are there will be an article detailing the real or possible occurrence of medical errors, allegations of a provider’s failure to comply with federal or provincial regulations, or some other issue questioning the quality of medical care.
With 185,000 adverse events (70,000 out of which are preventable) causing up to 30,000 deaths a year1 (projecting an accuracy of only 92.5% in our hospitals), a major portion of our resources should contribute to fixing the existing healthcare system.
That is precisely where Six Sigma comes into play: rapid development and deployment of breakthrough solutions in areas of critical need Six Sigma seeks to understand how systems permit and even facilitate the occurrence of errors, and provides tools to measure and reduce unwarranted variations in processes to improve outcomes. Six Sigma is the best-known “revolutionary” performance improvement methods practiced at the current time. Many health organizations around the world have either implemented or launched Six Sigma programs to streamline the whole system so that the probability of error is reduced to 2 in a billion opportunities (or 99.999998% accuracy) at the same time waste is eliminated from the system.
Six Sigma offers two similar-but-distinct-models to use, depending upon the nature of the project. Initiatives focused on improving existing processes follow a DMAIC (Define, Measure, Analyze, Improve and Control) model; initiatives focused on the development of a new process, such as those related to a new program or new service, follow the DMADV (Define, Measure, Analyze, Design and Verify) model.
In the development of a new hospital, one can replicate the existing process of other similar facilities, apply the six sigma DMAIC model to make these error proof and then implement in the new hospital while in case a completely new process or service is establish it can use the DMADV model to assure the highest possible performance level from the get go. For this to become really Six Sigma personnel needs to be deeply involved in the planning process of a new hospital.
Most organizations with average quality level of Three Sigma (99.73% accuracy) are losing about 25% or more of their revenues due to costs of poor quality. As the conformance level increases, the revenues that would have gone into waste become available for other uses in the organization for research and development and other uses. A comparison between Three Sigma and Six Sigma Performance is presented in the following table.
Table 1: Comparison of Performance at Three Sigma with Six Sigma
|At Three Sigma (99.73% accuracy)||At Six Sigma (99.999998% accuracy)|
|6700 Deaths from Adverse Events every year.||1 death from Adverse Events in 200 years|
|5400 wrong prescription in Canada every month||1 wrong prescription in 20 years|
|135 wrong surgical procedures performed across Canada per week||1 wrong surgical procedure performed across Canada in 192 years|
|10,800,000 healthcare claims would be mishandled each year.||8 healthcare claims would be mishandled each year.|
|On an average 15 minutes of unsafe drinking water every day.||1 minute of unsafe drinking water every year|