Tag Archives: process

Six Sigma

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
Source:https://www.process.st/dfss/

 

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

Clinical Microsystem Theory

A healthcare Clinical Microsystem is a group of professional who work together on a regular basis, or as needed to provide care to discrete populations of people.

Clinical Microsystem

The idea is based on the fact that smaller teams of professionals can work interdependently to provide quality patient care experience. The essential elements of the microsystem include patients, clinicians and support staff, information and information technology and the care processes.


 

What is Microsystems Thinking?

Microsystems thinking was introduced by statistician and consultant Dr. Deming and business school professor James Byron Quinn. This concept makes some organisational assumptions

  1. Bigger systems (macrosystems) are made of smaller systems.
  2. These smaller systems (microsystems) produce quality, safety, and cost outcomes at the front line of care
  3. Ultimately the outcome of the macrosystem can be no better than the microsystems of which is it composed.

A successful microsystem has good leadership that is distributed to the front line staff, staff which is able to empower improvement, have a patient centred approach in the improvement and a way to measure the performance of the system


 

How to assess the effectiveness of clinical microsystems?

The effectiveness of a clinical microsystem can be assessed using the 5 P’s of clinical microsystem


 

How can the microsystems approach be used in healthcare?

It is necessary to understand the clinical microsystem at the process level. At the process level it provides a conceptual and practical framework for approaching organizational learning and delivery of care.

The clinical outcome of care consists of the core processes ( the basic work that involves patient care) and supporting processes ( that makes the core processes functional and operational) that would be required to provide care. The process can be detailed by using process mapping tools. Laying out the process can be used to identify potential areas of improvement on the system that is producing the processes and outcomes.

The microsystem does not focus exclusively on outcomes; rather gives comparable attention to process and structure, to the linkages among them, and to how they interact to respond to meet the needs of the patient population.

Here is an example of a process map to understand a microsystem designed to provide cardiovascular surgery care for children.

The power of such maps is that it can be used to analysed to generate improvement ideas like:

  • What is the goal of the process?
  • Is the process working like it should?
  • Are there any obvious redundancies or complexities?
  • How different is the current process from the ideal process?
  • What are the various factions within the larger group, and how does this division support/ hinder more effective processing of patient care?
  • What are the workarounds to the proscribed process?

Let us look at another example of service and information flow within the microsystem. This diagram shows the core process flow of patients in a microsystem and how planned services and planned care is designed to meet the individual patient needs.


 

References: