The Six Sigma Approach - 'doing things right, first time and every time'

Six Sigma is a set of practices originally developed by Motorola to systematically improve processes by eliminating defects. A defect is defined as nonconformity of a product or service to its specifications. The Six Sigma quality certification was established by the International Quality Federation in 1986, to judge the quality standards of an organization. While the particulars of the methodology were originally formulated by Bill Smith at Motorola in 1986, Six Sigma was heavily inspired by six preceding decades of quality improvement methodologies such as quality control, TQM, and Zero Defects.

The term "Six Sigma" refers to the ability of highly capable processes to produce output within specification. In particular, processes that operate with six sigma quality produce at defect levels below 3.4 defects per (one) million opportunities. Six Sigma's implicit goal is to improve all processes to that level of quality or better.

The term and process evolved over the past two decades. “Six Sigma” can be defined in three ways- Literally, Conceptually and Practically.
Is has three levels

• As a metric – Scale for levels of quality: 3.4 defects per one million opportunities.
• As a Methodology- DMAIC & DMADV
• As a Management System

Six Sigma simply means a measure of quality that strives for perfection. It is disciplined, has a data-driven approach and methodology for eliminating defect in any process. Six Sigma provides a methodology to continue our improvement in everything we do.

Methodology
2 basic methodologies:

I. DMAIC – approach for existing facility

•  Define - Identification of the process for improvement, the key customers & elements which are critical to quality. Then development of a team, define goal, project scope, identify team roles and a process map.
•  Measure the current process and collect relevant data for future comparison.
•  Analyze – to find the critical factors that are statistically most significant contributors to the variance.
•  Improve - A previously unknown or known factor that was found to be significant is translated into a new process and improved performance.
•  Control by ongoing performance monitoring can focus on those critical areas, thereby improving overall efficiency. This ensures that any variances are corrected before they result in defects. Set up pilot runs to establish process capability, transition to production and thereafter continuously measure the process and institute control mechanisms.

II. DMADV – approach for new facility

•  Define the goals of the design activity that are consistent with customer demands and enterprise strategy.?
•  Measure and identify CTQs (critical to qualities), product capabilities, production process capability, and risk assessments.
•  Analyze to develop and design alternatives, create high-level design and evaluate design capability to select the best design.
•  Design details, optimize the design, and plan for design verification. This phase may require simulations.
• Verify the design, set up pilot runs, implement production process and handover to process owners.

The Six Sigma Philosophy

The Goal: Support/serve customer requirements through transformation of knowledge–enable capabilities and sustain continuous improvement of performance, processes, products, service, people and profit.

The Vision: Drive organizations to design and offer products/services at increasing sigma levels of quality.

The Strategy: Provide a data-driven structured approach that addresses causes for defects; thereby, improving business processes that meet customer needs.

The Tools: Use process/product exploration and data analysis to solve the equation
Y = f(X) and translate this solution to practical applications.

Scope of Sigma in Hospitals

• Increase the quality of patient care
• Reducing the average length of stay
• Reducing Treatment Cost as well as Overhead costs
• Reducing Variance in :
  
  Medication administration
  Site-marking for surgical or other procedures
  Emergency Department triage
  Case management
  Patient falls
  Patient restraints
  Assignment of patient caregivers

Difference between Traditional Systems of Quality Improvement and Six Sigma, in Healthcare:

Six Sigma is complementary to the traditional systems of Quality Improvements such as “Plan-Do-Check-Act (PDCA)”, “Total Quality Management (TQM)”, “Continuous Quality Management (CQM)” etc. But certain things make it different such as:

1. Initiatives in Six Sigma are identified on the basis on Customer CTQs or Critical to Quality Elements unlike traditional systems where these are figured out internally.
2. During implantation of six sigma it becomes an integral part of the whole business strategy rather than just a side bar activity.
3. This involves cross functional / inter departmental activities rather than just an departmental activity.
4. Focus is on eliminating variation

Organizational Issues	Traditional Approach	Six Sigma Approach
Problem Resolution	Fixing (Symptoms)	Preventing (Causes)
Behavior	Reactive	Proactive
Decision-Making	Experience-Based	Data-Based
Process Adjustment	Tweaking	Controlling
Supplier Selection	Cost (Piece Price)	Capability
Planning	Short-Term	Long-Term
Design	Performance	Producibility
Employee Training	If Time Permits	Mandated
Chain-of-Command	Hierarchy	Empowered Teams
Direction	Seat-of-Pants	Benchmarking and Metrics
Manpower	Cost	Asset

A case study:

Six Sigma is good for Health
As an early adopter of Six Sigma, one leading Wisconsin Hospital has reduced
• Turn around time for intensive care unit lab results from 53 to 22 minutes
• Time elapsed between diagnosis of a heart attack and patient arrival at the hospital for treatment by 60%
• Intravenous medication errors
• Error rates for using patient controlled pumps for administering pain medication
• Frequency and severity of hypoglycemia in the surgical intensive care unit
(Source: Motorola University, http://www.motorola.com/content.jsp?globalObjectId=3069-5787#)