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Six Sigma in Health Care
The health care field may be viewed as extremist: extremely conservative in many practices, but very innovative in researching new treatments. How does Six Sigma relate to health care?
This article will introduce the Six Sigma concept of measuring defects, then relate this to several potentially valuable metrics in the field of health care.
Measuring Defects in Six Sigma
Based on its roots in quality control, Six Sigma sees defects as unacceptable variations in output. In the course of treating a patient, both an avoidable death and a foreseeable allergic reaction to a drug are obvious defects. So may be the failure to begin diagnosing a person in an emergency ward; or prescribing unnecessary antibiotics to a hypochondriac.
One patient’s case may present many “opportunities” for defects. Here are five opportunities:
- The patient failed to seek medical assistance when appropriate
- An inappropriate test wasted time and money
- An appropriate test was not made
- An inappropriate prescription was written
- The patient took the wrong dosage of the drug
Six Sigma’s goal is to reduce the process defect rate to below “six sigmas”, or about 3.4 defects per million opportunities.
The use of “metrics” requires gathering the data, performing statistical analysis, and also determining what the results mean.
Six Sigma may have one problem in dealing with health care field. Normally a business has a “customer” whose needs and wants are critical for defining what is acceptable, and what would be a defect. Most patients may want “perfect health without further intervention” as their desired outcome. Since this may be impossible to achieve, each medical condition may need its own definition of “desired outcome”.
Usage Metrics
Costs are a significant concern for all health care organizations, whether private, insurance-based or government-funded. Likewise, costs affect the patients who pay directly, the people or companies paying premiums, and tax-payers.
From a patient’s view, delays in obtaining access to care may be the most important consideration.
Usage metrics deal with these concerns. Many HMOs (Health Maintenance Organizations) and insurers set targets for care. How many in-patient days are required to recover from a specific surgical procedure? How long should a doctor spend to treat an earache or support a pregnancy?
A Six Sigma approach would gather the data to statistically analyze whether these targets are being met. In fact, this approach would ensure that the data is captured and analyzed as part of the standard processes followed by each practitioner and institution.
Deviations from the standard would also be analyzed. Questions here may include:
- Why are 30-39-year-old men not getting annual check-ups? (Cost? Waiting-room delays?)
- Why do so many appendectomy patients require two extra days? (Post-operation infections? If so, where did the infection originate?)
- Why does one city treat more asthma patients than another? (Quality of air? Due to industry?)
- Why does one clinic prescribe more painkillers for back pain than another? (Drug addiction? More office, or factory, workers? Reluctance to recommend physiotherapy or acupuncture?)
Process Metrics
This has received significant public attention in Ontario, for example, in recent years. How long does it take for an ambulance to arrive after the telephone call for emergency help? How long does it take a patient to be seen and admitted in the emergency ward? This also provides a metric for the time “wasted” by the ambulance crew.
Other process metrics may involve whether supplies are over-used or under-used. For example, does a nursing care facility skimp on adult diapers?
Outcome Metrics
For patients whose conditions are expected to result in complete recoveries, how many relapse? Why are some hospitals or physicians statistically likely to see more poor outcomes than others with the same patient demographics? .
Benefits of Six Sigma for Health Care
Often, however, a poor outcome metric is just the starting point for a Six Sigma project to determine the root cause(s) and determine a long-term solution. The Six Sigma approach also incorporates ongoing process measurements to catch problems as they begin, rather than waiting for dissatisfied patients to raise the alarm.
Oskar Olofsson, 2011