Until recently, patients at Froedtert Memorial Lutheran Hospital in Milwaukee sometimes endured repetitive lab tests. Specimen carriers placed in a pneumatic delivery system mysteriously disappeared en route from the collection sites to the lab, resulting in finger-pointing between Froedtert's lab technicians and nurses.
Now, medical directors at the 413-bed, not-for-profit teaching hospital say they have cracked the case of the missing tube carriers using six sigma analysis. Six sigma team members broke down the delivery process and investigated each step for possible errors. It led them to discover a hole in the pneumatic pipe above the ceiling near the lab where eight lost delivery carriers had fallen.
"We're very happy with six sigma because it represents a methodology that we think has applicability to the healthcare environment," says Andrew Norton, M.D., Froedtert's CMO and a member of the hospital's six sigma steering committee. "In our experience, it adds discipline and metrics, which have historically been lacking in traditional medical-error reduction."
Every hospital and healthcare organization experiences process errors. Some are only costly and time-consuming, like the missing tubes at Froedtert. Others--like those cited in the 1999 Institute of Medicine report "To Err Is Human"--kill an estimated 44,000 to 98,000 hospital patients a year in the U.S.
It was the IOM report that drove executives at Froedtert to invest in a six sigma quality improvement program. To initiate it and share the experience gained at Froedtert with other organizations, the hospital in 1999 formed a consortium with six sigma consulting partner American Society for Quality, based in Milwaukee; healthcare technology provider CartaNova in Mequon, Wis.; the National Patient Safety Foundation in Chicago; and the Medical College of Wisconsin in Milwaukee.
The disciplined productivity-improvement methodology--developed and trademarked as Six Sigma by Motorola and popularized by General Electric Co. and its former chairman, Jack Welch--has a proven track record in other industries. Following the lead of multinational corporations like Dow Chemical and Sony, healthcare organizations recently have begun looking for salvation in the process.
Some healthcare organizations using six sigma already are reducing medical errors and providing better customer service, while others are hoping to cut costs and become more efficient. But despite six sigma's cult status in the corporate world, it is not a quick-fix management fad. Organizations looking to embark upon a six sigma program must prepare for years of research, training and operational overhaul--all wrapped up in one eye-popping price tag.
Consultants and employee coaches spend months dissecting and analyzing a process from start to finish to unearth a solution that will eliminate defects in the process. And that's just the first step. Six sigma is not just about improving quality, but transforming the culture as well.
Incremental changes, significant results
No one would agree more with that statement than Norton, who has helped lead the six sigma program at Froedtert since its beginnings in 1999. He believes the ultimate goal of six sigma is to institute systemwide change in how an organization approaches its daily work. "It's not about changing physician practices in a microscopic fashion," he says.
His philosophy focuses on teamwork, clinical and administrative collaboration and incremental change. It has helped Froedtert achieve success in several areas in just a few years. "Our institutional insight into the complexity of error reduction is clearly higher now than it was before," he observes.
Since getting to the bottom of the specimen-delivery problem, Froedtert has focused its six sigma system on others. Two and a half years into the program, it has completed several major projects, trained a dozen staff members and invested a few hundred thousand dollars in consulting fees and $1 million in upgrading its medication cabinets.
The results so far have pleased both Norton and Cathy Buck, Froedtert's vice president of operations, whom the hospital board directed in 1999 to halve medical errors within five years.
Errors involving IV drip administration have dropped from 27 in the period from May 1998 through December 1999 to zero in 2001, according to registered nurse Beth Lanham, a six sigma coordinator at Froedtert.
Additionally, she says, the average turnaround time for stat lab tests was 52.7 minutes when the baseline was set in April 2000. By December 2001, it improved to 23.1 minutes. Repairs to the pneumatic-tube system helped, but so did construction of a new satellite lab within walking distance of the high-use ICU and cardiac departments.
The hospital also has significantly reduced patient falls and patient-controlled analgesic (PCA) pump errors using six sigma.
"People always argue that standardization doesn't fit in healthcare because every human is unique . . . but that is a fatal flaw," Norton says with conviction.
Even though standardization has been the most trying challenge of implementing six sigma at the hospital, Norton says he's lucky to have a supportive clinical staff. "The tool kits of six sigma provide classic operational metrics, which most clinicians find very intuitive. So for us, the physicians have accepted it quite willingly."
Other pioneer stories
Like Froedtert, Chicago's Northwestern Memorial Hospital, Missouri's Heartland Health and Kentucky's Commonwealth Health are six sigma pioneers.
Commonwealth, an integrated delivery system based in Bowling Green, Ky., has completed 150 six sigma projects since 1998, working in conjunction with General Electric Medical Systems.
Highlights at Commonwealth so far include slashing radiology costs from $68 to under $50 per procedure, improving billing cycle times to produce $276,000 in annual savings since 1999, and reducing errors in the MRI ordering process by 90%.
"We view six sigma as a culture change rather than a dollar return," remarks Jean Cherry, executive vice president of Commonwealth.
Six sigma also is making inroads in nonacute care environments. Working with Scottsdale, Ariz.-based Six Sigma Academy, one of the oldest six sigma consulting firms, North American Medical Management, California has trained some 11 employees to lead projects for improving its core services of claims processing and referral authorizations.
Rene Moret, president and CEO of the Ontario, Calif.-based management service organization for 15 IPAs, says his eventual goal is to realize $5 million to $7 million in annual cost savings from six sigma.
"If you can get it right the first time, it's cheaper," says Moret, a six sigma enthusiast. The MSO operates at 98% accuracy, but Moret remains unsatisfied. Consultants with the academy quantified the value of reaching 99.6 percent accuracy.
"There's a potential 4,000 claims we can process better each month," he says.
Moret says that incremental improvements, like ensuring that referral-authorization turnaround times are always 48 hours or less (most currently are), will eventually make a big difference in the marketplace image of the company.
But it won't happen fast. "We won't see unbelievable results in a short amount of time," Moret says.
And it won't be cheap.
To get started, six sigma experts say organizations should plan on hiring a consultant and spending anywhere from $100,000 to several million dollars in fees--plus buying any needed hardware or software purchases to collect, monitor and analyze performance data.
Consulting firms usually provide a six sigma software suite as part of the contract. Organizations will need to commit a handful to several dozen employees for full- or part-time "black belt" and "green belt" coaching roles, positions they will hold for two years or more.
Beyond such practicalities lie cultural implications, given the independent decisionmaking mindset in healthcare. Since six sigma is geared toward systemwide change, it must be a top-down mandate, constantly preached by CEOs and other senior officers, Moret warns.
Froedtert's Norton advises that six sigma starters begin with just a few projects in areas with strong clinical leaders. Initiators should not issue sweeping demands for change, he says.
Other roadblocks, like converting the six sigma manufacturing lingo ("widgets") to the healthcare environment ("patients") and selecting projects that are too large in scope have slowed the implementation process for Froedtert, Buck says.
Just how big of an impact will six sigma make in the healthcare industry?
Patrick Molloy, deployment manager with Six Sigma Academy, predicts little for now. Too many healthcare executives believe onerous healthcare regulations, high costs of implementation and inapplicability to the healthcare environment make six sigma a wasted effort, Molloy says.
However, physicians like Dirk Wales, M.D., CMO at NAMM California, disagree. Six sigma's critical evaluation process forces organizations to "peel the onion" and examine every layer of operation, he says.
"The problem-solving methodology has changed our perspective," Wales says.
"We are already applying it to other non-six sigma projects."
Polly Schneider Traylor, of Boulder, Colo., writes about healthcare, technology and business.