The “Lean Six Sigma” Brigade at work!
Data on the Gemba floor,gaily dancing away…
Up came a fervent sigma score,Requesting; “lead my way…”
“Oh sure!” said, Chance data,“I don’t mind…”
“Aw!” minced, Assignable data,“Time to grind…”
Loud was an invoke, for the process in line
“Do a Pokayoke!”was voiced, to perform in fine
Spruced is now, the sigma score,daily, in the process bay…
“Cheers!” said the MBB galore,“Celebrate all, we must today!”
I believe that one can deploy these methodologies with little knowledge and clear understanding of quality management concepts, a bit deeper than a novice and a conscious recognition of our important customers as to what would delight these customers. Using the lean Six Sigma learnings and tools appropriately and adaptively with whatever limited knowledge gained about the concept can also result in a positive impact on process performance in consideration. But of course one must remember that half knowledge is dangerous, so whatever bit of tools and methodologies one learns in a Six Sigma training sessions, be it at white belt level/yellow belt/green belt or black belt level, one must know the utility and applications of whatever limited concepts and tools learnt, completely to ensure an effective professional practice in the role play that one is empowered with.
The more intense part like project selection, type of data and statistical definitions and statistical solutions can be trusted on to the Six Sigma black belts and Master black belts designated with the team, others need to only be conscious of customer requirements, be alert of possible flaws, in the process and responsible and accountable to report such possible mistakes occurring in the process.
Not long ago, in 2006 when I was talking of Six Sigma initiatives in Indian hospitals, I had observed a raw and laid back attitude towards “Six Sigma”.
Remarks like “Six Sigma is for manufacturing, not applicable in healthcare”; “Six Sigma is a fad!”; “Let’s talk of TQM, Accreditation, ISO 9000:2000, instead”; “Sounds expensive!” were frequent answers to a proposition of Six Sigma deployment.
| Meeta Ruparel |
Let’s not blame any industry personnel, let us understand that importance of quality and the necessity of quality management/ accreditation systems in the Indian healthcare setups have gained pace in these past few years and this accelerated recognition is such that it would not loose its momentum.
It is now obvious that Six Sigma is not intended to replace any traditional quality initiatives; however, the key differences in the methodologies have enabled Six Sigma methodologies to overcome the challenges that may have not been sufficiently addressed with the existing techniques.
Organisations that implement Six Sigma methodologies do not necessarily dispense with their existing quality assurance functions. On the contrary, the QA department if existing is trained in the Six Sigma techniques to ensure smooth functioning and an integrated synchrony with the organisation and the Six Sigma consultants/ trainers.
Healthcare today is highly dynamic and offers creative advances in technology and treatment. It is a complex web, overburdened by resource limitations, other constraints, inefficiencies, negligence, errors and other issues that threaten the safety of patient care and service delivery. Quality care and quality service delivery becomes the prime focus in this race.
If we consider the efficacy of a six sigma initiative in hospitals, it is observed that:
- Even if some processes cannot achieve some ambitious goals as implied, it does not diminish the importance of the Six Sigma methodologies. These techniques improve the performance of most processes substantially.
- Highlighted fact is that when a Six Sigma project moves from ‘2 sigma’ level to a ‘3 sigma’ level the project will have an improved accuracy from 69.15 per cent to 93.32 per cent.
- Six Sigma methodologies assist in minimising errors, achieving set quality benchmarks, optimal utilisation of resources, elimination of wastes and guides as to how a set goal is achieved in terms of tangible results (facts and data).
- Cost implications to implement Six Sigma methodologies are very minimal compared to the losses/ wastes occurring in any process variations, without any quality initiative.
- When compared in terms of cost for quality and in financial language, on a cost benefit analysis, it is observed that the results are cost savings and resource savings, directly/indirectly; tangible profits annually.
Having said this much on significance and benefits of Six Sigma deployment in healthcare delivery systems, I would like to elaborate on the approach that we need to follow for an effective interpretation of success and benefits of six sigma initiatives in hospitals.
I would like to stress on this point that healthcare service delivery is a complex process in itself, the variance in customer satisfaction due to individual specific uniqueness in every delivery process, makes it all the more complex. The demands and requirements of internal customer also varies with different work levels and is again at times unique and process/case specific, not to forget the tantrums of some customers (unions/ consultant demands based on authorities/non co-operative customers/political influences/regulations/media, etc) and stress thereof. One needs to be aware of the thin invisible line between care delivery, safety, quality and optimal resource management to impact costs. A slight ignorance or leniency on any of these factors can result in a possible damage or harm to a life, care process outcome or brand image. It is therefore very important for the master black belt to hold some knowledge and experience in the healthcare service delivery field.
Allow me to suggest here; just because Six Sigma was pioneered by manufacturing industry and accepted first by these industries, hiring/ appointing a Six Sigma BB/ MBB from such non-healthcare industry for a senior work profile in a hospital, is a possible mistake in its own self. What an irony! We follow accreditation standards that talk of and insist on credentialing and privileging a personnel before recruiting a position in hospitals and we overlook or ignore this fact that; an important role/ process enabler of quality care delivery practice system is having no knowledge of the healthcare system!
I do not intend to offend my non – healthcare peer group, I am just stressing on the importance and the value addition that results like magic with a Six Sigma professional with some healthcare background when working in a healthcare delivery system. (Even one/two successful project executions in a hospital by a non-healthcare Six Sigma professional can be notable and makes a difference in practice in a hospital). Let’s understand this fact that a Six Sigma black belt is certified only after at least one successful Six Sigma process improvement project submission and evaluation thereof, so the certificate itself indicates an experience of at least one successful project. Some training panels that I know of insist on two project submissions along with passing of a theory exam and some mandate training hours before certification, so the candidate is not a “fresher”! A sincere suggestion to our hospital human resource team recruiting Six Sigma expertise on a payroll is to kindly evaluate the score continuum of credentialing and privileging for this too and then make the decision.
Technically, Six Sigma is a set of problem solving and statistical tools that aims at reducing errors/ defects to 3.4 or less per million opportunities. In other words it is a measure of quality that demands data and lots of data; I mean evidence. Any solution is derived from decisions based on facts and not some assumption. So it is most important, in fact necessary to collect data. Understanding the high stress levels for all in the healthcare service delivery chain, we cannot and shouldn’t burden the roles in the chain with additional duty hours, for data collection, monitoring, etc.
A hospital must inculcate a strategy that evolves as a culture in practice! Let all understand the concept of Six Sigma methodologies and enlighten on the methodology that the hospital intends to follow to achieve quality care delivery system. I am not saying that all should be sensitised on statistics and its tools, but all should at least be aware of the nuances of possible defects and be able to identify opportunities to improve. This will not only help alert a practice in service delivery but also make all in the chain accountable.
I reiterate; leave the statistics for the process owner/ team leader, the Six Sigma black belts and the Master black belts! Further, all those who go through Six Sigma training do not require to rigorously learn and master statistics. No doubt; Six Sigma means six standard deviations and relates to statistics but there is a lot more to this methodology, which not only enables us to define a process in a correct fashion but also equips us with a skill to introspect and improve the process appropriately, in advance, much before a probable defect.
So let us focus on this aspect of Six Sigma and sensitise our work population on simple practices that can be followed to ensure customer (patient) satisfaction, safety and cost effective systems that not only delights our customers but also our hospital stakeholders (management, employees, doctors, regulatory bodies, vendors, etc).
At this point, allow me to share one of my experiences with you on Six Sigma deployment in hospitals. A couple of years ago, one of our known hospitals in India and an esteemed and recognised healthcare management leader encouraged this initiative in the hospital that he led as a CEO. I was welcomed by the staff being identified as a respectable guest introduced by their leader. But when it dawned on them why I was there, I faced all sorts of reluctance; things like “I have my duty”, “Very heavy patient load”, “I don’t understand statistics so leave me out of this”, “I am scared, because any input on some error can lead to acceptance of that negligence and thereby litigation” and so on, the music continued.
After extensive convincing discussions that the data is not going to be shared outside and that the exercise would benefit all in the process, I finally started with one process improvement project. It took about five months for the completion of project and on evaluating the performance of the project; it was observed that the project had successfully achieved a direct indicative financial gain in terms of cost savings. The management was pleased and declared a reward, a bonus for each and every person involved in this project. This not only pleased the staff that was so reluctant in the beginning but also enhanced their understanding on the benefits of a process improvement activity. All those who were trained were more aware of where there was a possible mistake that was occurring and were more efficient in identifying probable defects in the process. This gained knowledge excited them and gave value to their motivation, they all were enthusiastic for the next project and to my delight were even suggesting possible processes that could be explored for improvement!
This experience made me realise that a lot of sensitisation was required. Here, I had a hospital leader who believed in this concept and was supporting the initiative so a good part of journey is traveled but what with a management that is apprehensive and has doubts? There was a long path and I did travel those miles to be where I am now, to see what I see now. I am happy; the industry now, recognises the need and importance of Six Sigma quality in Healthcare. After initiating Lean Six Sigma deployment as a consultancy, my next step was training; I started with a small batch of six participants for my first Six Sigma training in healthcare and now the batches go full and my email box is flooded with queries as to when is the next schedule! This indicates that our Indian healthcare industry realises the significant benefits of Six Sigma implementation in hospitals and is now also spacing vacancies and job profiles with such roles.
Thanks to our healthcare management fraternity that continues to recommend their candidates for training and recognise ‘AUM MEDITEC’ for Lean Six Sigma training black belt.
Today, I herewith have shared with you my experience on Lean Six Sigma deployment in healthcare systems, when lean Six Sigma initiative in hospitals was in its nascent stage.
This is an attempt to nurture a culture of safe and quality healthcare delivery service practices and to guide the lean Six Sigma aspirants and assist them in successful implementation of relevant projects.
(The author can be contacted at meeta@meditecindia.com)