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Six Sigma is a method that provides tools to improve the capabilities of business processes. This helps increase productivity and reduce variation in process leading to eliminating defects, improving the quality of service and products, employee productivity & morale, and finances & profits of the organization.

The main objective of six sigma methodology is to standardize processes so that the probability of errors is reduced. This is done using statistical quality process methods. A six sigma process is one in which 99.99966% of opportunities of a part of process is to be statistically free of defects.

The Six Sigma Methodology -DMAIC & DMADV

Six Sigma methodology mainly consists of two main concepts

DMAIC– Define, Measure, Analyze, Improve, and Control
DMADV– Define, Measure, Analyze, Design, and Verify

DMAIC is a data driven quality strategy that is useful when trying to improve an existing process, service or product. The DMAIC concept is a series of five steps that is used to

understand or define what the problem is,
then it is measured to receive existing data at unaltered state,
once it has been measured the problem and data is analyzed to understand the root cause,
after analyzing improvement strategies are developed to address the root cause,
and lastly is to control the improvements and look for future improvements.

DMADV also known as Design For Six Sigma (DFSS) is a process methodology that is employed to design or re-design a process that does not exist. The DMADV also consists of five steps,

first define what are the requirements of the project from the perspective of the patient/customer,
then understand what are the relevant metrics to track and measure the requirements,
analyze how can the goals be best achieved,
after analyzing the data is used to design the new service or product,
and finally in the verify phase it is checked if the end results meets or exceeds the customer requirements

Application of Six Sigma Methodology in Healthcare

Healthcare is mainly a service oriented industry which can be a hands-on process. This leads to high possibility of variations as compared to other industries. Six Sigma principles can be used to eliminate defects, variation in process leading to a more streamlined process, improving quality and less costly.

Defect– defects in healthcare is defined as a factor that leads to patient dissatisfaction
Define– what do the patient’s want? what are the customer expectations whether- patients, staff or payers? what is the objective of the identified problems or issues?
Measure– converting the critical quality factors (CTQs), voice of the customer into measurable variables. These metrics can be divided into four groups: service level, service cost, customer satisfaction and clinical excellence.
Analyze– the team identifies what are the causal factors (X’s) which are most likely to have an impact on the response variable (Y’s). If the causal factors are controllable and significantly influences the response variable then the results can be improved by controlling the causal factors (X’s). If the causal factors are uncontrollable then a new process should be created to reduce the variability. An example of a uncontrollable factor in healthcare is arrival rate of patients to the Emergency Department (ED).
Improve– implement modifications to improve the process
Control– monitor performance to maintain improvement by introducing new control measures and process metrics to drive behaviour and cultural changes in the organization

Some ways how Six Sigma has helped healthcare. Six Sigma has known to improve patient care by

Reducing the number of variations by physicians, nurses, technicians by standardizing processes
Improving lab turnaround times
Improve patient appointment waiting times
Improving patient outcomes
Decreasing the number of steps in the supply chain
Accelerating reimbursement for insurance claims

Six Sigma Tools & Techniques

Various tools and techniques are used in six sigma projects

SIX SIGMA TECHNIQUES	DESCRIPTION
Brainstorming	Is done by assessing the given situation and gathered information, discussing about creative ideas and solutions. The main aim is to come up with multiple creative ideas and then narrow it down to feasible solutions.
Root Cause Analysis/5 Why	This technique is done to reach to the root of the problem by questioning why the problem occurred 5 times. Solutions are constructed to address the root cause of the problem.
Voice of Customer	Is the customer/ patient’s perspective, comments, requirements, expectations of the product or service under discussion. This is used to define our problem and identify the metrics to measure.
The 5S system	Is used to create an organized environment improving efficiency of work. It consists of 5 steps- sort, set, shine, standardize and sustain.
Benchmarking	It is a process that is used to compare the performance of the output (process, service, product) to a standard. This is done by interviewing, conducting site visits and documenting the performance and comparing the results to the set standard to understand the gaps.
Kaizen	Is continuous improvement of processes, service or products by creating a standardized method, increasing efficiency and reducing waste.
Poke-yoke/ Mistake Proofing	It is a method of taking steps to mistake proof a process. It starts with understanding the cause effect relationship of the defect followed by a remedy that prevents the defect from occurring.
Value Stream Mapping	Is used to understand the information and material flow in a process. It is useful to identify potential areas of improvement leading to increased efficiency.

SIX SIGMA TOOLS	DESCRIPTION
Cause and Effect Analysis	Also known as fishbone /Ishikawa is used to show the potential causes of a particular event or issue. It also helps to understand root cause of the problem.
Flow Chart	It lays out the various stages or steps within the process. It is helpful tool in standardizing a process.
Pareto Chart	It is a graphing method that provides information on the frequency of defects and their cumulative impact.
Histogram	Is an approximate representation of distribution of numerical data. It divides the range of values into intervals and group the values according to the intervals .
Check Sheet	It is documentation of quantitative or qualitative data in real time at the location where the data is generated.
Scatter Plot	Is a mathematical diagram that is used to display typically two variables for a set of data. It can be used either when one continuous variable is under the control of the experiment and the other depends on it or when both continuous variables are independent.
Control Chart	It is a graph that is used to study how a process changes over time. These charts usually have a central line that represents the average, upper limit line and lower limit line. Historical data is used to plot these charts and the charts are used to understand the various patterns in existing data.

A mix of these tools and techniques aid in understanding the existing process, identify areas that can be improved, develop solutions and implement improvement strategies driving organizations to achieve six sigma quality.

References

Human Centered Design(HCD) is a concept of developing systems and processes with the focus of the human in the center. The HCD develops frameworks while always keeping the perspective of the human in view while developing solutions.

A Human Centered Design in the healthcare setting would be developed with the “Patient” in the center, and problems are solved by developing systems, frameworks or protocols leading to favourable outcomes for the patient.

How to create a Human Centered Design?

Creating a Human Centered Design involves

Discovering who will the design benefit, what problems entail the consumer;
Define the problem and understand what can be done;
Design a process or product or system such that it benefits the consumer;
Prototype & Test the design;
Plan & Implement

“Re-imagine the experience of receiving preventive and wellness care“

Our Goal-As a group we began to deliberate what do we want different in the experience of receiving primary care. Our idea of a redefined experience from a primary care visit was to focus on the preventive aspect of wellness.

Our Question-How to maximize the opportunity of inculcating the concept of healthy living and make access to education on healthy living available?

Conception of the idea-Address the disease at its roots. This meant improving facilities and access to information on common health conditions, their risks, how to prevent these diseases, general information on how to maintain physical and mental well being and any other health or lifestyle questions that may arise. Improving health education can help patients to live a healthier lifestyle and decrease the onset of disease and visiting the doctor. After thoughtful deliberation we agreed on our redefined design.

” A casual, community space where patients can receive education and resources from a primary care physician or health professional, without an appointment”

This serves as an inviting space where patients are free to learn about health related concerns from professionals while socialising with like minded people. Health education is also offered by putting up posters, pamphlets and advertising at different parts of the hospital as well as the city.

Other approaches to redefined primary care experience?

The idea of redefining the primary care experience sparked different aspects of the challenge among other peers.

Green- Various areas of improvements identified
Yellow- Proposed ideas/ solutions

Power of the Human/Patient Centered Design (HCD)

The same design challenge was presented to all of us, yet the different groups seems to have approached it differently while keeping the essence of preventive wellness of the patient in mind.

Potential of HCD– The HCD is a useful tool that can be used to view the problem/situation from the view of the consumer/ patient where the ultimate design improves the intended audience experience.

Limitations of HCD– The HCD is more effective when a group or team of people are involved compared to when done individually or a smaller group.

Applications of HCD– HCD can be used in a multitude of situations. It is applicable in any industry or organisation that provides a service or product. Some areas in the healthcare industry that can use the Human Centered Design are

Hospital facility– A patient centred approach can be used to improve any particular aspect of their existing process or system
Medical device companies– The HCD concept can be used when designing a device which may be intended to use by the patients or the doctors/ medical staff
Pharmaceutical companies– The Patient Centric Design concept is used when producing new medications, where the intend of any new drug will be to have less adverse and side effect for the patient

Modified Patient Centered Design

In our previous design model we did not include some aspects of preventive wellness. With taking inspiration and ideas from the work presented by other groups, I would modify our original design to include aspects of

Reducing waiting time to see the doctor by using
- Online check-in which can move the pre-appointment paperwork,
- Patient is redirected to health education professional after doctor’s visit to ensure that patient is well informed about their health condition and answer any questions that a patient might have
Improved navigation or access to healthcare system with the help of a patient navigator

The idea of a Patient Centered Design will include a team of professionals that work together to facilitate an outcome that is patient centric. These different teams of professionals will constitute a clinical microsystem.

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