Six Sigma practices may provide significant benefits for hospitals

Oct 22 2007

Although Six Sigma practices are widely used in the manufacturing industry, the performance improvement system also may provide significant benefits for hospitals, medical professionals, and patients.

A new study presented at CHEST 2007, the 73rd annual international scientific assembly of the American College of Chest Physicians (ACCP), shows that Six Sigma performance improvement practices may help hospitals decrease in-patient mortality, length of hospital stay, and health-care costs, and also improve compliance with Joint Commission (JCAHO) Core Measures as they relate to community-acquired pneumonia (CAP).

“Although national guidelines for CAP care existed, they were not being followed consistently throughout our organization and percentages of patients with core measures met were lower than best practice hospitals,” said study author Karen Gamerdinger, RN, MSN, Mercy Medical Center, Des Moines, IA. “By implementing Six Sigma practices, we showed that a quality improvement project can lead to benefits, not only to the patients in decreased mortality, but also to physicians and nurses by making it easier for them to provide the best, evidence-based, guideline-directed care possible, and to the hospital itself with decreased lengths of stay and decreased costs.”

Six Sigma is used the same way in health care as it is in technology and auto industries – to eliminate non value-added steps in processes and reduce defects and variation resulting in more efficient processes.

“The focus is still on identifying defects and improving processes to reduce variation, whether that is improving how a patient navigates through the health-care system or whether it is looking at how parts are assembled in an automobile factory,” said Ms. Gamerdinger. “This leads to improved quality care and cost-savings in health-care organizations.” Although it is not common, researchers note that Six Sigma is becoming more prevalent, especially in larger institutions across the nation as more organizations in the health-care industry share their successes in improving processes, quality care, and financial savings using the Six Sigma approach.

In a retrospective study, Ms. Gamerdinger and colleagues from Mercy Medical Center evaluated the outcomes of a Six Sigma performance improvement project focused on compliance with JCAHO CAP Core Measures to ensure that each measure of care was met. Utilizing Six Sigma methodology, researchers identified critical processes and key stakeholders in patient care and utilized specific tools for process flow, cause/effect matrices, and outcomes analysis. The hospital also dedicated several full-time positions to the new methodology and trained more than 100 individuals in the Six Sigma program. When deviations from the Six Sigma protocol occurred, timely feedback was provided to care providers.

After program implementation, researchers collected and analyzed data related to core measures, length of stay, and mortality in 1,550 patients with CAP admitted to the hospital during the study period. Results indicated that compliance scores for each JCAHO Core Measure improved from 70% to over 90%. CAP order usage improved from 40 %to 73%, yielding an 82.5% increase. Mean length of stay was reduced from 5.9 days to 5.1 days, a 13.56% reduction, which was associated with over $300,000 in cost savings. By the end of the study period, in-hospital mortality rates also decreased from 6.7% to 3.5%, a 47.8% reduction.

“We have made significant changes in the culture of our organization; however, changing behaviors can be challenging, especially in large organizations with multiple health-care providers,” said Neil R. Horning, MD, FCCP, study coauthor and Medical Director of Mercy Hospital's Pulmonary Care Improvement Team. “It is important for hospitals to improve processes of care, and Six Sigma has worked well for us. However, Six Sigma may not be the performance improvement methodology for everyone.” Although researchers specifically measured outcomes related to CAP, the hospital has applied Six Sigma to other in-patient populations, including patients with cardiac conditions, and to system-wide issues, such as delays in medical imaging, home medical equipment projects, and reducing patient registration times for in-patients.

“It is important for hospitals and health-care professionals to evaluate how departmental and system-wide processes affect patient care outcomes in order to identify and address gaps in patient care,” said Alvin V. Thomas, Jr., MD, FCCP, President of the American College of Chest Physicians. “Improvements in these processes may, ultimately, improve how patient care is delivered.”