six sigma in healthcare value chain

Mar

2002

Volume 3Special Edition 1 The Six Sigma Supply Chain in HealthcareThe Six Sigma Supply Chain in HealthcareThe Six Sigma Supply Chain in HealthcareThe Six Sigma Supply Chain in HealthcareThe Six Sigma Supply Chain in Healthcare

By Don Redinius, Managing Partner, Six Sigma QualtecIn This Issue...

Six Sigma was born nearly twenty years ago and, like all newthings, it has evolved and matured. Through its variousexperiences, Six Sigma has been shaped into one of the mostpowerful problem solving, business and quality improvementmethodologies available today.

The first businesses to experience Six Sigma were in the high-tech manufacturing industry. The industry’s complex productproblems provided a formidable testing ground for the new process.

Later it was applied with great success to administrative, or transactional, processes.Today, Six Sigma can be found in most fields of economic endeavor.

Healthcare systems, in their drive to improve quality, reduce costs and enhance financialperformance, have discovered Six Sigma and its long history of performance in otherU.S. industries. Healthcare is traditionally defined as the delivery of treatment andservices to people in need of medical attention. Yet the industry’s performance is heavilyreliant on a vast and complex supply chain of companies working to design, produce,deliver, and manage a wealth of health and medical related products and services.Although doctors, nurses and hospitals are at the center of this massive and complexindustry, they represent only a small portion of its influence.

A number of companies within the healthcare supply chain have already implementedSix Sigma and are discovering impressive results. Perhaps the most publicized companyis General Electric that adopted its Six Sigma agenda in 1995. Other notables includeGlaxoSmithKline, McKesson and Johnson & Johnson. In addition, hospital systemslike Mount Carmel Health System, Commonwealth Health Corporation, Order of SaintFrancis, Charleston Area Medical Center, Yale-New Haven, North Shore Long IslandJewish Health and Froedtert Memorial Lutheran (to name a few) have implemented, orare in the process of implementing, Six Sigma.

Mount Carmel Health System of Columbus, Ohio has successfully implemented SixSigma after years of trying a variety of “more traditional” health care quality improvementprograms with varying degrees of success. Mount Carmel has produced positive marginsin recent years. But, like all hospitals, it faced declining reimbursements and risingexpenses. Mount Carmel leaders sought an initiative that would significantly improveits operational processes and enhance its financial performance, eventually settling onSix Sigma in July 2000.

Mount Carmel leaders don’t view Six Sigma as just another quality program. Rather,they consider it a business management system that not only improves quality, butalso improves employee morale and reduces expenses. Last year, the system

Supply Chain continued on page 17

The Promise of SixSigma: “GettingBetter Faster”

Page 3

Implementing SixSigma to Achieve“Breakthrough”

ResultsPage 7

Six Sigma WithoutTearsPage 8

Six Sigma: UsingStatistics to ReduceProcess Variability

and Costs inRadiology

1

North Shore - LongIsland Jewish HealthSystem Teams with

GE & HarvardPage 19

CommonwealthHealth Corporation,

the HealthcarePioneer of Six Sigma

Page 22

OperationalExcellence- be the

benchmarkPage 23

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PrPrPrPrPresident’esident’esident’esident’esident’s Corners Corners Corners Corners CornerBy Roxanne O’Brasky, President, ISSSP

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Dear Members:

Welcome to a special edition of EXTRAOrdinary Sense. In ISSSP’scontinued pursuit of its mission to educate and advance the Six Sigmamethodology, we’ve dedicated this issue to a focused initiative that represents a significantmilestone in the history of quality management in business.

The health care industry has long been plagued by a wealth of obstacles. Few industries havefaced the sheer volume of challenges – both internal and external – that limit the ability toevolve and improve. This dynamic has offered a formidable opportunity for healthcare industrymanagement and traditionally accepted quality initiatives alike. With it’s lengthy high technologyand broad industry track record, Six Sigma has come to healthcare in recent years, bringingwith it limitless potential for improved efficiency, productivity and service delivery, not to mentionthe great potential for cost savings passed to customers like you and I.

The challenges that healthcare represents for Six Sigma sets the stage for ISSSP’s newesteducational and development campaign. This effort represents the first time our organizationhas brought together players from all facets of the healthcare industry. Pharmaceuticalcompanies, equipment manufacturers, suppliers, providers and practitioners alike will sharetheir experience, their concerns, and their ambitions in an exciting forum for the benefit of ourcollective membership.

While such opportunities will be exhibited through insight-filled programming — includingroundtables and workshops like the upcoming Healthcare Symposium on April 29 — the overallvision for this campaign is unveiled in the pages that follow. Special thanks to our corporatesponsors for the support they have shown for this new program. If your company representshealthcare interests and you would like to get involved with this exciting new campaign, pleasedon’t hesitate to contact ISSSP. We’d love to have you on board.

This program is only a small taste of what is to come from ISSSP in the coming months. Inorder for us to continue to provide this sort of best-in-class association content, ISSSP launcheda formal membership campaign last month. We are confident that you will find the smallinvestment well worth the benefit of being able to contribute to the continued growth andenhancement of your own industry. For more information about your ISSSP membership,please contact us at 480-368-7083.

Don’t forget to mark your calendar for the 3rd Annual Leadership Conference June 23—26 inChantilly, VA – we’ve just confirmed renowned Six Sigma advocate and business leader iconJack Welch.

Since our inception in Jan 2000, we have been learning from more than 10,000 members aboutthe kind of programming and resources you would like to see made available through ISSSP. Itis this feedback that you have provided that allows us to continue to offer the cutting edgecontent that Six Sigma professionals across the globe seek for their various endeavors.

Your voice inspires our success. So let ISSSP hear from you.

ΣΣΣΣΣXTRAOrdinary Sense March 2002

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How can you tell when an investment in qualityimprovement has truly paid off? Qualityimprovement consultants have suggested that“quality is like pornography…you know it whenyou see it.” But chief executives and seniormanagers clearly need more tangiblemeasures for their investments in qualityimprovement and management effectiveness.Six Sigma, on the other hand, has done morethan demonstrate improvements in quality; thetechniques and philosophy of Six Sigma havefundamentally changed the way healthcareexecutives view their business. According toJohn Desmarais, CEO of CommonwealthHealth Corporation (Bowling Green, KY), “it’sthe single most important thing we have done

in the history of our organization.” Indeed, when a qualityimprovement initiative has truly impacted the entire organizationas it did at Commonwealth, the payoff is everywhere you look.

Six Sigma provides both the framework and tools to “get betterfaster,” a combination of statistical tools and project managementtechniques that enable managers to clearly define problems,measure and analyze them, and reach sustainable improvementsin practice. Six Sigma recognizes that “variation is the enemy ofbest practices,” and it targets excessive variation and waste withinthe system to achieve its intended goal of reducing defects,improving profits, and delighting customers. It has been creditedwith saving literally billions of dollars among the manufacturingsector, including such heavyweights as General Electric, Motorola,Honeywell and Allied Signal.

That Six Sigma has a home in healthcare has already been amplydemonstrated by pioneering CEOs like John Desmarais fromCommonwealth and Joe Calvaruso at Mount Carmel Medical Centerin Columbus OH. The commitment of CEOs to the process alsosends an important message to future proponents: Six Sigma willnot work without a commitment from the top, and without it, thereis no point in ever getting started. Senior management commitmentto Six Sigma is critical because the process will invariably cutacross department lines and change job functions. It will alsorequire that the organization take its best people out of comfortableroles and into the front lines of new initiatives.

The popularity of Six Sigma in healthcare was clearly evident atthe second annual Six Sigma Leadership Conference, held lastOctober in Scottsdale AZ. Sponsored by the International Societyof Six Sigma Professionals, the conference featured six

The PrThe PrThe PrThe PrThe Promise of Six Sigma: “Getting Better Fomise of Six Sigma: “Getting Better Fomise of Six Sigma: “Getting Better Fomise of Six Sigma: “Getting Better Fomise of Six Sigma: “Getting Better Faster”aster”aster”aster”aster”By Ian R. Lazarus, FACHE and Beatriz Stamps, MD MBA

presentations by health system executives, even though the eventrepresented both manufacturing and service industries. “Thehealthcare industry, which has focused so much effort on thedevelopment of best practices, has a tremendous opportunity togain from the application of Six Sigma principles,” notes RoxanneO’Brasky, President of ISSSP.

A new compass. Most Six Sigma projects begin with a definitionof healthcare deliverables that are critical to quality, delivery andprice (see illustration). These tie inevitably to existing functionswithin the enterprise, and can be measured through the rate ofdefective procedures, length of stay, and cost. All too often,healthcare organizations find that their processes were designedaround the convenience of their staff and physicians, and not thecustomer or patient. Ironically, physicians become strongproponents of Six Sigma programs once they understand thescientific basis and practical benefits of the methodologies.

It’s hard to ignore the potential and broad appeal of Six Sigmawhen talking to its proponents. Dr. Glenn Crotty, MD and COO ofthe Charleston Area Medical Center insists that “Six Sigma qualityis more than a goal. It is a commitment woven deeply into thefabric of everything we do.” The changes caused through Six Sigmaare “awesome and exciting” according to Lisa Thomerson, SixSigma Corporate Champion at Commonwealth Health Corporationin South Central Kentucky. “Our CEO as well as our senior leaders

Promise continued on page 4

Six Sigma Aligns Patient Goalswith Strategic Goals

Six Sigma applies customer-driven measures to process improvement;Customers can be patients, physicians, and employees.

PatientSatisfaction

Delivery

Lengthof Stay

Cost

HospitalGoals

CHCCreative Healthcare USA

Price/Value

Cost

Quality

Outcome


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are fully behind it. John Desmarais is full of passion. Hiscommitment is tremendous.” To date, Commonwealth has investedabout $900,000 and has realized improvements well in excess of$2.5 million.

Spare parts. There are multiple day-to-day applications of SixSigma in the healthcare and managed care setting. Typical projectsinclude billing office, supply chain management, emergencydepartment, operating room, high volume DRGs and analysis ofhigh cost admitters. Charleston Area Medical Center (CAMC), a919-bed three campus medical center in Charleston, West Virginia,focused on supply chain management to test the potential of SixSigma methodologies. Upon reviewing and identifying this projectthey found a $1.7 million opportunity within the inventory of surgicalequipment that remained in storage for over a year. Over 50% ofthis inventory were in orthopedic trays. Further analysis revealedthat old items were not being removed from shelves when newproducts replaced them. Once Six Sigma techniques were utilizedto assess improvements from more rapid turnover of inventory,specific team members were assigned to negotiate with eachprincipal vendor.

Requests for immediate refunds or “forward sales arrangements”were made that included no future requirement for bulk purchases.The medical center also initiated more rigorous inventory reviewprocedures as part of Six Sigma’s “control process.” Today, thereare plans for a just-in-time inventory system with a centralizedprocurement database for all 3 hospitals. Although the initialsavings in this project was merely $163,410 (from returnedmerchandise), future cost avoidance is estimated to be $841,540,according to Beverly Begovich, a fulltime Six Sigma Black Belt at

CAMC. CAMC has moved forward on many additional Six Sigmaprojects, with stunning results (see illustration).

Out of control. In Six Sigma jargon, a process is said to be “incontrol” when it operates within acceptable specification limits.At Scottsdale Healthcare (AZ), the process of “Bed Control” wasdecidedly “out of control.” The process of locating a bed andtransferring a patient from the Emergency Department to theinpatient unit consumed fully 38% of the total time within thedepartment. Six Sigma consultants defined this problem as a“defect” and through additional analysis, found that the problemwas not locating a bed, but reducing the number of steps requiredto make the transfer possible. The hospital employed the use ofan Administrative Nurse to perform “inspections” by locating bedson different floors, and this process actually complicated theprocess rather than expediting it.

The process at Scottsdale Healthcare violated two arguments ofSix Sigma: that inspection is fundamentally unproductive, andthe more interim steps you add to a process, the more you reducethe potential yield on that process. As a result of eliminating theAdministrative Nurse position and through related streamliningtechniques, the hospital reduced the cycle time for bed control by10%, increased ED throughput by an estimated 0.1 patients perhour, and produced nearly $600,000 in incremental profit. Thehospital system is now considering the application of Six Sigmain improving the performance of specific DRGs.

Culture Shock. Beyond obvious financial measures, the mostsignificant change across these profiled institutions has been thedevelopment of performance improvement cultures. But what makesSix Sigma different from previous quality management programs?

Ms. Thomerson from Commonwealth suggests“staff and involved physicians are buying itbecause it is data-driven, and is based onstatistical analysis. It points to specificproblems. Physicians understand and supportthis analytical approach to problem solving andimprovements. They practice it everyday.” “SixSigma gives practical applications to getprojects started and to get them done quickly.People are tired of forever committees,” addsMs. Begovich from CAMC.

Commonwealth Health Corporation’s, SixSigma vision (posted plainly on their website)is that “by the year 2004, we will be proudlyrecognized by our employees, patients, clients,community, physicians and payors as theunquestioned leader in care and service,

Promise continued from page 3

Promise continued on page 5

Six SiSix SiSix SiSix SiSix Sigmgmgmgmgma Pra Pra Pra Pra Prooooojecjecjecjecject Pot Pot Pot Pot Potentialtentialtentialtentialtential

One Hospital’One Hospital’One Hospital’One Hospital’One Hospital’s Experiences Experiences Experiences Experiences Experience

Project Validated Savings LT Cost Avoidance

Supply Chain Management $163,410 $841,540

“Captain of the Ship” 519,000 790,000

Denials 232,637 425,000

Results Reporting 367,621 341,000

Medication Safety 31,774 242,777

ED Wait Time 100,000 202,428

HR Recruitment 32,000 124,430

Physician Satisfaction 39,780 66,000



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providing flawless quality never before achieved in the healthcareindustry.” Their dependence on these techniques to deliver suchimpressive results is a testament to The Promise of Six Sigma.

“Shaken, not stirred.” If the culture of an organization can bedescribed as a product of its “corporate DNA,” then Six Sigmaaims to reshape the DNA of the organization, and to create ahighly effective organism in the process. Its promise of “disruptiveinnovation” is cause for optimism and hope in an environment ofregulatory and market constraints that are stifling in its effects.But CEOs considering Six Sigma must be careful not to push toohard or too fast. As with any cultural change, the process ofintroducing Six Sigma must be approached with patience andleadership.

Although the development of knowledge workers has beenrecognized as one of the most impactful competitive strategiesavailable to service industries, implementing such a strategy in ahealthcare enterprise can feel like trying to boil the ocean.Because change is uncomfortable, CEOs can expect initialresistance and anxiety in connection with these efforts. If notaddressed early on, any of the following conditions can ultimatelylead to a failed attempt at implementing Six Sigma methodologies:

Lack of understanding of Six Sigma principlesAmbivalent involvement of senior management

Lack of broad participation and involvementDependence on consensus-based decisionsInitiatives too broad or too narrow in scope

Failure to attack cultural impediments

Ultimately, the CEOs job in implementing Six Sigma is to engineera cultural change first that recognizes the moral imperative of theorganization to forge new ground in performance improvement.Attitudes that suggest “we are the best we can be” must bereplaced with “we must get even better.” Constant monitoring toensure quality must be replaced by systems and controls thatmake defects nearly impossible. On one hand, it may seem thatSix Sigma demands as much from the organization as it deliversin return. This may be a valid observation, but you do not hearany of its proponents expressing anything but enthusiasm andanticipation from the promise that Six Sigma can offer them.

Reprinted with permission from the January 2002 issue of ManagedHealthcare Executive. No reproduction permitted without expresswritten consent of authors and publisher. All rights reserved.

Ian R. Lazarus, FACHE and Beatriz Stamps, MD MBA are principalswith Creative Healthcare USA (www.creative-healthcare.com) aconsulting firm providing strategic advisory services, including SixSigma consulting, to healthcare providers and suppliers. You maycontact either Mr. Lazarus or Dr. Stamps at 1.888.376.8652.

Promise continued from page 4

Black Belt TrainingMarch 25 - 29, 2002 (Measure Phase)April 22 - 26, 2002 (Analyze Phase)Minneapolis, MinnesotaProvided By: Breakthrough Management Group Inc.Visit www.bmgi.com for more information!

Lean Six Sigma Executive RoundtableMarch 14, 2002Atlanta, GeorgiaProvided By: George GroupVisit http://www.georgegroup.com/events/events.asp

ToolMasterMarch 18 - 21, 2002Minneapolis, MinnesotaProvided By: Breakthrough Management Group Inc.Visit www.bmgi.com for more information!

Lean Six Sigma Executive RoundtableMarch 19, 2002Houston, TexasProvided By: George GroupVisit http://www.georgegroup.com/events/events.asp

Lean Six Sigma Executive RoundtableMarch 22, 2002Dallas, TexasProvided By: George GroupVisit http://www.georgegroup.com/events/events.asp

Lean Six Sigma Executive RoundtableApril 4, 2002Chicago, IllinoisProvided By: George GroupVisit http://www.georgegroup.com/events/events.asp

Champion TrainingApril 9 -11, 2002Buffalo, New YorkProvided By: Breakthrough Management Group Inc.Visit www.bmgi.com for more information!

Lean Six Sigma Executive RoundtableApril 18, 2002Detroit, MichiganProvided By: George GroupVisit http://www.georgegroup.com/events/events.asp

ISSSP Six Sigma in Healthcare SymposiumApril 29 - May 1, 2002St. Louis, MissouriProvided By: ISSSPVisit www.isssp.com/symposium01.htm for more details!

ISSSP 3rd Annual Six Sigma Leadership ConferenceJune 23 - 26, 2002Chantilly, VirginiaProvided By: ISSSP


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Creative Healthcare USACreative Healthcare USACreative Healthcare USACreative Healthcare USACreative Healthcare [email protected]

1.888.376.8652

13th Annual National Forum on Quality Improvement in Health Care13th Annual National Forum on Quality Improvement in Health Care13th Annual National Forum on Quality Improvement in Health Care13th Annual National Forum on Quality Improvement in Health Care13th Annual National Forum on Quality Improvement in Health CareBy Bob Swagerty, VP Business Services, ISSSP

Our ISSSP team returned in December from the Institute forHealthcare Improvement Conference in Orlando, Florida andquickly assessed the impact that Six Sigma can have on thehealthcare industry in the coming months and years. Wepresented our sponsoring Affiliates and spoke with hundredsof attending physicians, executives and quality leaders fromall across the world. Our learnings were significant.

First, there is a real and verified interest in Six Sigma methodology, within the Healthcare industry, to provide industry wide solutionsand help solve the mounting problems of inefficiency and patient dissatisfaction. This was expressed in the Six Sigma session, “SixSigma: Is it for Us? From Experiment to Strategy”, presented by Randal Linton, MD, President and CEO Elect, Luther Midelfort - MayoHealth System, and later reiterated by the many attendees that visited our booth over the two days.

Secondly, Healthcare groups seem to be in an exploratory phase and need answers to questions concerning the Six Sigma methodsand best practices. How can it help them? Who can they go to for answers? At what level are they able to enter and reap the benefitsof process thinking across their operation.

As a result of our learnings derived from our conference presence, we have developed our Six Sigma in Healthcare Campaign that willhelp organizations throughout the Healthcare supply chain investigate the power of the Six Sigma solution. This campaign will providethe many healthcare providers interested in Six Sigma a platform to acquire answers to their questions. All of this leading up to our SixSigma Healthcare Symposium - “Six Sigma in Healthcare: Exploring the Opportunities”, scheduled for St Louis, April 29 - May 1,2002.


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Breakthrough continued on page 9

Implementing Six Sigma to Achieve “Breakthrough” ResultsImplementing Six Sigma to Achieve “Breakthrough” ResultsImplementing Six Sigma to Achieve “Breakthrough” ResultsImplementing Six Sigma to Achieve “Breakthrough” ResultsImplementing Six Sigma to Achieve “Breakthrough” ResultsBy Jeffrey Burnich, M.D., and Tammy Weidner, R.N., MBA, Mount Carmel Health System


In the spring of 2000, Mount Carmel HealthSystem -- a three-hospital system in Colum-bus, Ohio with 7,300 employees and a medi-cal staff of 1,200 physicians -- was experi-encing severe financial challenges like manyhealthcare systems nationally.

The senior management team realized thatwe needed to drastically improve our finan-cial performance, and that incremental im-provement wasn't going to be sufficient -- weneeded a breakthrough level of improvement.

At about that time, Mount Carmel's CEO andits Chief Quality Officer each began readingabout Six Sigma without the other's knowl-edge. They both came to the conclusion thatSix Sigma had the potential to help the orga-

nization achieve breakthrough results.

Mount Carmel selected Breakthrough Management Group (BMG),Scottsdale, Ariz., to help facilitate our deployment of Six Sigmathroughout the organization, a process that began in the summerof 2000.

Leadership Buy-In And Infrastructure Development

Our deployment began with a two-day broad overview of Six Sigmasystem for the senior management team, ensuring buy-in and sup-port for the implementation. The Chief Quality Officer was se-lected to provide executive oversight of the deployment, and a vicepresident's position was converted into the dedicated role of VicePresident of Six Sigma to direct the day-to-day implementationactivities.

Next, an in-depth, week-long training session was held for thosewithin the organization who would likely become Six Sigma Cham-pions responsible for identifying and overseeing Six Sigma projects.This group mostly included the senior management team as wellas vice presidents (we currently have 16 active Six Sigma Champi-ons).

Then, a Six Sigma core team was formed with the responsibility ofdeveloping the infrastructure necessary for the successful deploy-ment of Six Sigma at Mount Carmel. The core team was cross-departmental, including representatives from finance, human re-sources, information technology, communications, as well as learn-ing and education. The core team received a full week of trainingand met for two-day working sessions every month during the early

stages of deployment, with additional committee work as needed.

The responsibilities of the core team included developing job de-scriptions and a compensation program for Six Sigma black belts(which the organization prefers to call Six Sigma Guides); prepar-ing the strategy for training black belts; ensuring the informationtechnology resources necessary to track Six Sigma projects; de-veloping the tools and metrics for measuring and validating thefinancial returns of Six Sigma projects; and preparing a strategy forcommunicating Six Sigma to Mount Carmel's internal stakehold-ers -- especially managers, employees, and physicians -- as animportant new strategic initiative the organization was undertakingas an investment in its future.

Black Belt/Brown Belt Strategy And Training

We selected a total of 44 employees from among the organization'sbest staff in two training waves to serve as black belts, and anadditional four employees to serve as brown belts (which MountCarmel prefers to call Six Sigma Scouts). While black belts as-sume their positions on a full-time basis in working on Six Sigmaprojects, brown belts retain their functional responsibilities and ful-fill their brown belt responsibilities part-time in helping scope projects.We are now in the process of implementing a green belt strategy totrain select employees in the Six Sigma methodology so that theycan pursue less complex Six Sigma projects in their functionalareas of responsibility and/or assist black belts on their projectson a part-time basis.

To avoid adding unnecessary labor expense, only a few of the blackbelts' previous positions were back-filled. We knew that this ap-proach would cause some consternation in affected departmentssince we were taking one of their best employees our of their role -- and asking the remaining employees to absorb the workload amongthemselves. We acknowledged the sacrifice we were asking themto make, and promised them that they eventually would begin tosee positive benefits as these black belts helped fix problems inwork processes that were a source of frustration and dissatisfac-tion for them.

The black belts and brown belts received four weeks of intensivetraining, one week each month for four months, while spending theother three weeks applying what they were learning by working onan actual Six Sigma project during the training period. The firstwave of black belts graduated in March 2001, and the second wavein July 2001

Organization-Wide Deployment

Rather than limiting the implementation of Six Sigma to one de-

88888

Six Sigma Without TSix Sigma Without TSix Sigma Without TSix Sigma Without TSix Sigma Without Tears:ears:ears:ears:ears:How Healthcare Providers can Effectively Integrate Six Sigma into CQIHow Healthcare Providers can Effectively Integrate Six Sigma into CQIHow Healthcare Providers can Effectively Integrate Six Sigma into CQIHow Healthcare Providers can Effectively Integrate Six Sigma into CQIHow Healthcare Providers can Effectively Integrate Six Sigma into CQIBy Rick Tucci, President, Leap Technologies, Inc.

Picture this: A meeting of the senior staff at aregional integrated healthcare provider afterattending the recent IHI Quality Improvementin Healthcare Conference in Orlando, Florida.

COO, Administrative Services…“Thereseemed to be a lot of attention around Six Sigmaat the conference. The results being reported

by a number of our peers are impressive. Maybe we shouldconsider launching a Six Sigma initiative. What do you think?”

Director of Patient Care…“I’m all for getting a bigger return onour CQI (Continuous Quality Improvement) initiative, but I’m worriedabout the time commitment required. Where will these full timeBlack Belts that Six Sigma relies on come from? We’re shortstaffed as it is!!”

Director of Engineering Services…“I’ve had a number of QATs(Quality Action Teams) launched in my department since we startedCQI. For the time and resources committed, I haven’t seen thereturn. If Six Sigma will get us some concrete cost savings, I’llsupport it. But I wonder if it’s overkill. A lot of the safety and costproblems we have require basic blocking and tackling.”

Manager, CQI…“I’d be crazy to say no to anything that will improveour CQI effort. But, I’m very skeptical about our ability to take onany new quality tools or programs. The fact is we have troubletoday getting consistent participation on our CQI councils andQATs. We’ve invested in quality tools training, including SPC. Itfeels like Six Sigma is a solution to the symptom, not a responseto the root causes of our CQI problems.”

COO, Administrative Services…“I appreciate everyone’sconcerns and will admit that we’re in no position to spend a milliondollars on anything right now. Nonetheless, I’d sure like to be ableto tell our Board that we aren’t sitting here with our heads in thesand when it comes to CQI.”

The Six Sigma “Cross Roads” for Healthcare Providers

The fictional conversation described above is in fact taking placein the executive offices of many healthcare provider organizations.The debate about Six Sigma is a critical one, because the stakesare high – both in risk and return.

What’s clear is that making real breakthroughs in qualityperformance is more likely with Six Sigma versus conventionalTQM methods. The discipline of the DMAIC model, the dedicationof highly trained full-time project leaders (Black Belts) and theemphasis on improving performance measurement systems hasproduced faster and bigger gains over other quality improvementmethods.

What’s much less clear, however, is how to go about implementingSix Sigma in healthcare provider organizations without addinggreater burdens to an already overtaxed workforce; withoutdisenfranchising the internal CQI staff; and without busting thebudget.

Taking a Balanced Approach

A real-world recent experience with a regional healthcare provideroffers a useful case example of what to do and what not to do in“crossing the road” to Six Sigma.

Lesson One: Don’t Buy the Whole Six Sigma Farm

Once on the radar screen, Six Sigma can take on an “all ornothing” or “nothing else works” aura. The message from someSix Sigma consultants seems to say, “You’re not serious unlessyou train everyone on Six Sigma philosophy, build a critical massof Black Belt project leaders, invest in a special Six Sigma supportinfrastructure and do it all fast with a big budget commitment.”

This approach can pay dividends in giant multi-national companieswhere the potential for cost savings justifies the large, upfrontinvestment.

However, for the majority of companies, this approach is simplynot affordable or smart business.

At the aforementioned healthcare provider, for instance, theexecutive team rejected proposals for an organization-wide SixSigma launch with price tags starting at $500,000. Instead, theteam chose a focused project approach that offered a just-in-time, pay as you go plan for deploying Black Belts as each SixSigma project opportunity emerged.

Tears continued on page 15


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issspINTERNATIONAL SOCIETY OF SIX SIGMA PROFESSIONALS

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Six Sigma In Healthcare

Visit www.isssp.com or call 480-368-7083 for more information!

Purchase the ISSSP Six Sigma In Healthcare Video!This video represents featured speakers from the

2nd Annual Six Sigma Leadership Conference

Key Topics Include:

• Creating a Six Sigma Culture in Healthcare

• Clinical & Operational Six Sigma Projects

• Reducing Cycle Time & Improving Productivity in Hospital ER’s

• Open Discussion on Six Sigma Related Healthcare Issues

• Six Sigma in Pharmaceutical Manufacturing

Attend the Symposium!The Symposium is a 2 1/2 day program designed for Healthcare executives and

practitioners. One full day is focused on lessons learned and deployment case

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Six Sigma Experts, Practitioners and Deployment Leaders.

April 29 - May 1, 2002 - St. Louis, Missouri

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Breakthrough continued from page 7


partment, Mount Carmel adopted an organization-wide deployment.All business units across the organization have been expected touse the Six Sigma methodology and the black belt resources totackle business problems that drag down financial performanceand act as a source of patient, employee, and physician dissatis-faction.

Additionally, Six Sigma is now the established methodology in theorganization's Performance Improvement Plan which is reviewedby the Joint Commission on Accreditation of Healthcare Organiza-tions.

"Soulful" Six Sigma

We read in the Six Sigma literature that asa result of efficiencies achieved through SixSigma, an organization could save moneyby eliminating positions. Early on in ourimplementation, the senior managementteam committed to a more “soulful” approach to deploying SixSigma at Mount Carmel by taking into account the potential impactof Six Sigma projects on employees.

We didn’t think that our corporate culture would accept or embraceany other approach to implementing Six Sigma, and we needed

the enthusiastic support and cooperation of our managers andemployees to make the deployment successful and realize theexpected benefits.

If positions are eliminated because we have removed inefficienciesthrough Six Sigma projects, we have pledged that affectedemployees will receive training and have an opportunity to move toother open positions within the organization. That is why we referto our deployment as “Soulful Six Sigma.”

Project Selection

During the first year of our deployment, Six Sigma championsselected business problems that were their biggest operationalheadaches. Now in our second year of implementation, we aretaking a more strategic approach by selecting Six Sigma projectsbased on key business themes. We expect our projects to achievean average financial return of $100,000.

During the strategic planning cycle for our next fiscal year beginningJuly 1, 2002, our Six Sigma champions have identified six keybusiness themes on which our Six Sigma projects will concentrate— revenue enhancement, bad debt reduction, patient throughputin all operational units, labor/right staffing, labor retention andrecruitment, and patient safety.


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ISSSP is proud to recognize the followingcompanies as Six Sigma Affiliates:

Air Academy Associates

Breakthrough Management Group

Convergence Corporation

e-ZSigma, Inc.

George Group

Global Learning Systems

Global Productivity Solutions

Hertzler Systems, Inc.

Human Capital Associates

iGrafx, a product of Corel

Institute for International Research

International Institute for Learning

JMP, A Business Unit of SAS

Leap Technologies Inc.

Minitab

Movaris

Oriel Inc.

Pivotal Resources

ProActivity

PROSPERO LLC

PwC Consulting

The Quality Group

Rath & Strong

Sigma Breakthrough Technologies Inc.

Six Sigma Qualtec

Smarter Solutions

StatSoft

Y-change

ISSSP thanks you for your continuedsupport! For more information on theSix Sigma Affiliates Program, pleasevisit www.isssp.org.

Six Sigma AffiliatesSix Sigma AffiliatesSix Sigma AffiliatesSix Sigma AffiliatesSix Sigma AffiliatesSix Sigma AffiliatesSix Sigma AffiliatesSix Sigma AffiliatesSix Sigma AffiliatesSix Sigma AffiliatesThe Six Sigma Affiliates Program - a programdeveloped for the benefit of ISSSP Six Sigma providers.

Our members regularly request information on the products and services available from thevarious providers, ranging from software to full deployments. This program enables Six Sigmaproviders to share, learn, network and market their Six Sigma products and services. We lookforward to serving you.

Convergence Corporation offers clients Six SigmaQuality Business Management Consulting andSeminar services. Focus: provide clients with theinsight, tools & methods to implement Six Sigma

Business Process Management and Process Improvement Methodology: DMAIC. Vision: enableclients to increase corporate profits, invigorate corporate culture, and achieve corporateExcellence!

Rath & Strong/Aon Management Consulting is aleading provider of customized global Six Sigmasolutions and a pioneer of many conceptsproceeding Six Sigma. Provides acomprehensive, flexible range of Six Sigma

consulting services and training for leading companies, specializing in combining leadershipand people issues with Six Sigma methods. Creators of the best-selling Six Sigma PocketGuide.

Six Sigma Qualtec is a premier provider of training andimplementation services that drive measurable financialresults. The Six Sigma Qualtec methodology is anintegrated deployment of training and tools for achievingbreakthrough performance including dramatically reduced

cycle times, defects and costs. This approach has significantly improved productivity, efficiencyand customer satisfaction with clients worldwide.

Six Sigma Qualtec continues to expand its client base, worldwide involvement, portfolio ofservice offerings, and client services delivery capacity while exceeding our client’s expectations.Our company works with leaders in both the public and private sectors throughout North America,Asia, and Europe, and across all industry and government segments, leading them to increasedprofitability. Six Sigma Qualtec world headquarters is located in Tempe, Arizona with offices inTokyo, Japan and Oxfordshire, UK.

Y-change offers an internet-based, enterprise-wide strategy and projectmanagement application that ensures strategic initiatives are efficientlydeployed down to the individual project level. Y-change’s unique Project/Portfolio Management allows managers to track the progress of multipleSix Sigma projects in real-time. With y-change, Six Sigma initiativescan now be centrally coordinated and monitored leading to faster, moreefficient deployments.


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Six Sigma: Using Statistics to Reduce PrSix Sigma: Using Statistics to Reduce PrSix Sigma: Using Statistics to Reduce PrSix Sigma: Using Statistics to Reduce PrSix Sigma: Using Statistics to Reduce Process Vocess Vocess Vocess Vocess Variabilityariabilityariabilityariabilityariabilityand Costs in Radioloand Costs in Radioloand Costs in Radioloand Costs in Radioloand Costs in RadiologygygygygyBy Jean Cherry, M.S., FACHE and Sridhar Seshadri,

In many corners of the corporate world, Six Sigma has developeda reputation as the mother of all quality initiatives. Pioneered atMotorola Corporation in the 1980s, Six Sigma is a quality initiativebased on rigorous statistical process control. It augments traditionalquality tools with exacting statistical analysis and a systematicproblem-solving approach, targeting the root cause of variationsand redefining processes for long-term results.

The methodology has been used in a variety of settings to solve abroad array of issues: from improving manufacturing capabilitiesto customer service to aircraft design…and everything in between.It has been used to transform organizations of all types and is nowbeginning to be applied in healthcare.

“Sigma” is the Greek letter used by statisticians to define standarddeviation from the norm. A higher sigma indicates a lower rate ofdefects and more efficient processes. At Six Sigma, defects areroughly 3.4 per million opportunities, or nearly error-free. Considerthis: Three Sigma translates into about 5,000 incorrect surgicalprocedures each week nationwide, a somewhat less than desirableratio.

With excessive variability and medical error rates currently underthe microscope, some healthcare administrators and departmentmanagers are looking for some additional guidance and reliability.The point of deploying Six Sigma in healthcare is not to diminishthe authority of a radiologist, physician, nurse or other professional,but to enhance the predictability of positive outcomes, whetherclinical or operational. And it’s an approach that is flexible andscaleable. It can be used to improve a single process in a singledepartment within a small, rural medical center, or it can bedeployed throughout an entire multi-hospital system.

Radiology Takes the Lead at CHC

Initially implemented in CHC’s radiology department in early 1998,the program began to spread throughout the organization withinthe next two years. Results have been impressive across severalareas: within 18 months, the culture had been transformed,productivity levels increased and patient experience improved while

Radiology continued on page 13


Executive SummaryExecutive SummaryExecutive SummaryExecutive SummaryExecutive Summary• Pioneered at Motorola Corporation in the 1980s, Six Sigma is aquality initiative based on rigorous statistical process control. Itaugments traditional quality tools with exacting statistical analysisand a systematic problem-solving approach, targeting the rootcause of variations and redefining processes for long-term results.

• “Sigma” is the Greek letter used by statisticians to define standarddeviation from the norm. At Six Sigma, defects are roughly 3.4 permillion opportunities, or nearly error-free.

• The methodology has been used in a variety of settings to solve abroad array of issues. It has been used to transform organizationsof all types and is now beginning to be applied in healthcare.

• Commonwealth Health Corporation in Bowling Green, Kentucky ,launched its Six Sigma program in its radiology department. Within18 months, the culture had been transformed, productivity levelsincreased and patient experience improved while eliminating morethan $800,000 in total costs.

• After Six Sigma was implemented, CHC’s radiology cost per pro-cedure went from $68.13 to $49.55. With over 100,000 proceduresperformed each year, the cumulative savings exceeded $1.65 mil-lion. And most notably, exemplifying the essential quality aspect ofSix Sigma, errors in the MR ordering process were reduced by 90percent.

• Six Sigma training involves several phases, reaches various lev-els of expertise, and can extend anywhere from one to 14 days.Training is always linked to particular projects impacting opera-tions, giving participants a chance to learn the methodology whileat the same time achieving results within their own work environ-ment.

• One of the primary keys to unlocking Six Sigma success is solidcommitment from leadership. Since this initiative will compete forcapital and time resources, participants have to be able to count onunambiguous support from senior management.

• To carry this quality improvement forward at CHC will requireongoing training and the generation of approximately 120 trainedstaff within two years. Every CHC employee will receive a minimumof one full day’s training.

1.5

2.0

3.0

4.0

5.0

6.0

500,000

308,537

66,807

6,210

233

3.4

Sigma Defects per million opportunities

1212121212 ΣΣΣΣΣXTRAOrdinary Sense March 2002

Meet the ISSSP Corporate SponsorsMeet the ISSSP Corporate SponsorsMeet the ISSSP Corporate SponsorsMeet the ISSSP Corporate SponsorsMeet the ISSSP Corporate SponsorsThe ISSSP Healthcare 2002 Corporate Sponsorship Program gives corporateleaders the opportunity to effectively develop personnel resources, share les-sons learned with healthcare partners and develop a continuous open forum forhealthcare industry solutions utilizing Six Sigma methodologies.

HeAlTIoN

CHCCommoNWeAlTH

THCoRpoRA

In 1984, Commonwealth Health Corporation CHC) was formed as anot-for-profit holding company for The Medical Center and other healthrelated businesses.

By the year 2004, CHC will be proudly recognized by its employees,patients, clients, community, physicians and payors as theunquestioned leader in care and service, providing flawless quality neverbefore achieved in the healthcare industry.

GlaxoSmithKline - one of the world’s leading research-basedpharmaceutical and healthcare companies - is committed to improvingthe quality of human life by enabling people to do more, feel better andlive longer.

Headquartered in the UK and with operations based in the US, thenew company is one of the industry leaders, with an estimated sevenper cent of the world’s pharmaceutical market.

Since the Company’s founding in 1886, Johnson & Johnsoncontinues to provide innovative health care products thatimprove or save lives. Johnson & Johnson has 197 operatingcompanies worldwide.

A shared system of values, known as its Credo, serves asa guide for all who are part of the Johnson & Johnson Familyof Companies.

Mount Carmel has been caring for residents of central Ohio forover 113 years.

Its core values, which underlies everything that it does, are: dignityof persons, service to others and social justice for all. MountCarmel is committed to treat all people with fairness, respectand compassion and to ensure that everyone has access to qualityhealthcare services. Each year, Mount Carmel provides millionsof dollars in free care and benefits to the community.

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eliminating more than $800,000 in total costs. After this programwas implemented, CHC’s radiology cost per procedure went from$68.13 to $49.55. With over 100,000 procedures performed eachyear, the cumulative savings exceeded $1.65 million. And mostnotably, exemplifying the essential quality aspect of Six Sigma,errors in the MR ordering process were reduced by 90 percent.

Interestingly, hard times weren’t the impetus for this Six Sigmaproject, since CHC was already financially sound and a leader intheir market area. Of course, this comfort level can produce itsown set of challenges, since motivating a team is sometimes moredifficult when things are going well. Also, CHC recognized theneed to maintain their competitive edge, cope with reimbursementand regulatory issues, and meet rising patient expectations.Internally, leaders recognized a genuine opportunity to buildteamwork and transform the corporate culture.

Changing the Cultural Landscape

Six Sigma was seen as having the potential to drive quality to newheights and sharpen the competitive edge for both the radiologydepartment and the system as a whole. Like most providers, CHChas had some form of quality initiative in place for years. The differ-ence is that Six Sigma actually becomes ingrained in work and

thought processes, and instead of simply solving short-term qual-ity issues, creates a knowledge base to get it right the first time.

But Six Sigma can also be viewed as a catalyst for corporate-widetransformation of the existing culture. By collecting and analyzingrelevant data, possibilities for improving even the most intransi-gent processes begin to emerge. Six Sigma relies on a foundationof methodically collected and analyzed data, rather than manage-rial experience or expertise. This evidence-based approach makesit somewhat easier to present the case for change and garner staffsupport.

How the Process Unfolded

As is customary when launching any major change initiative, theSix Sigma project began by assembling key players for apreliminary strategy session. During this meeting, the team set agoal to become a Six Sigma organization by the year 2004. Withthat target set, the first round of training began.

Six Sigma training involves several phases, reaches various levelsof expertise, and can extend anywhere from one to 14 days.Training is always linked to particular projects impactingoperations, giving participants a chance to learn the methodologywhile at the same time achieving results within their own workenvironment.

Through these educational sessions, leaders learn to better managestrategic change, cultivate support, mobilize constituencies, andestablish systems for long-term results. Employees also learn touse a problem-solving approach designed to reduce organizationalredundancies. Participants successfully planning and completingtwo Six Sigma projects attain what is commonly known as GreenBelt status. The completion of additional projects and achievinghigher levels of accomplishment lead to the attainment of BlackBelt and Master Black Belt status.

CHC’s radiology department was chosen as the launching padfor Six Sigma. Twelve participants within Radiology used the varioustraining processes to focus on learning team dynamics, identifyingspecific areas of opportunity within the department, and puttingimprovement and control mechanisms in place. Making sure thatprocess changes are built-in and remain as guidance systems forthe long haul differentiates Six Sigma from previous quality initiativesat CHC.

This radiology-focused phase significantly reduced wait times forpatients, generated faster turnaround times for radiology reportsand increased productivity. In fact, CHC’s team managed to boost

Radiology continued from page 11


• A not-for-profit integrated delivery network located in BowlingGreen, KY.

• The Medical Center in Bowling Green: 487 beds

• The Medical Center in Scottsville: 157 beds (includes 105extended care beds at Cal Turner Extended Care Pavilion)

• The Medical Center at Franklin: 50 beds

• Employees: Over 2,000

• Radiology diagnostic technology includes state-of-the-art MRI,Cat Scan, CT-3D treatment planning and Angiography.

Modalities:• MRI • Radiology• Mammography • CT•Nuclear Medicine • Ultrasound

• Number of procedures per year:

FY’99: 91,055FY’00: 104,036FY’01: 108,780*

*estimate based on available ‘01 data

Commonwealth Health CorporationCommonwealth Health CorporationCommonwealth Health CorporationCommonwealth Health CorporationCommonwealth Health Corporation


issspSix sigma in Healthcare educational program

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Educational ProgramAs a leading source of credible information regarding Six Sigma, ISSSP has decided to provide a platform for those who are learning

how Six Sigma can be the best improvement solution for an organization’s need to improve quality, reduce costs, eliminate defects and

enhance financial performance.

To this end, ISSSP, in conjunction with its Affiliates and Corporate Sponsors, is offering a program of educational, one-hour, interactive

webcasts that will take you through the elements of Six Sigma from A to Z. As a registrant of this program, you will have the option to

attend (12) different one-hour sessions. The schedule of sessions currently available represent many different topics within Six Sigma

and will be updated to ensure that participants have the greatest opportunity to learn and the availability to attend a variety of topics

that may meet their individual scheduling needs.

In the event you've already missed a few sessions, rest assured. ISSSP will continually add new modules and repeat modules to ensure

participants receive the full value of this program. As a registrant, you will receive email notices of any enhancements to the schedule.

Sessions are also recorded and archived. If you miss a session or if there is a particular session that provides you great insight, you

have the opportunity to re-visit those topics that benefited you most.

So sign up now and join us for our next session!

Corporate Sponsors To Date• Commonwealth Health Corporation

• GlaxoSmithKline

• Johnson & Johnson

• Mount Carmel Health System

Special Bonus! Networking ProgramOur Healthcare Corporate Sponsors invite you to join their networking sessions

where they will present case studies and demonstrate the problem and the

solution using the Six Sigma methodology. Each one-hour networking session

includes 2-4 project case studies. Registered participants will receive regular

updates and invitations to these networking sessions. Live recordings are

available for viewing for those that were unable to attend.

Date Topic ISSSP Affiliates

February 28, 2002

March 7, 2002

May 16, 2002

May 23, 2002

March 14, 2002

March 21, 2002

March 28, 2002

April 4, 2002

April 11, 2002

April 18, 2002

April 25, 2002

May 9, 2002

Six Sigma Overview Six Sigma Qualtec

The Keys to the Methodology

What is a Six Sigma Project?

Six Sigma Roles & Responsibilities

The Financial Impacts of Six Sigma

Using Action Workout™ as the "on ramp" to Six Sigma in Healthcare

Statistical Analysis for the Healthcare Industry

Six Sigma, The Medical Staff and You

Engaging Your Partners: Including Your Customers and Suppliers

TBD

TBD

TBD

Global Productivity Solutions

Breakthrough Management Group Inc.

Six Sigma Qualtec

Six Sigma Qualtec

Leap Technologies

Minitab

Creative Healthcare USA

PwC Consulting

Smarter Solutions

Pivotal Resources

Rath & Strong

For a more detailed description of each session, please visit our website at www.isssp.com.

S A M P L E


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Tears continued from page 8

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Lesson Two: Refocus and Recharge Internal CQI Staff

CQI managers and quality professionals are often threatened bySix Sigma. They know that in some Six Sigma companies, theinternal quality staff ends up marginalized and reduced to apaperwork compliance office.

Of course, some CQI managers persist in spinning the brokenrecord of “no management commitment” as the cause of failedCQI efforts in the past and use this as an excuse to block SixSigma introduction.

The truth is that CQI efforts in many healthcare providerorganizations have yielded significant benefits by identifying patientexpectations, educating the workforce on quality values andconcepts, and establishing process documentation systems.

The COO of the healthcare provider in our case example made thewise choice of holding his CQI manager accountable for the successof Six Sigma. In addition, the COO used the introduction of SixSigma to conduct a complete audit of the CQI effort, “sunsetting”unproductive Quality Action Teams and refocusing the CQI staffon improving the CQI infrastructure – from satisfactionmeasurement to best practices.

Lesson Three: Get More Employees and Managers “Into theRight CQI Game”

One of the biggest concerns about Six Sigma is captured in awater cooler exchange making the rounds.

Question: “How many Black Belts do you need to achieve SixSigma performance?”Answer: “A few good ones to do the work and an army of certificateholders to impress Wall Street.”

Sarcasm aside, the point worth noting is that Six Sigma is not abackyard sport. Black Belt training is rigorous and not for themasses because everyone can’t be an expert. Furthermore, theretypically aren’t enough problems worth the dedication of BlackBelts to justify “excess inventory”. Black Belt certification as acareer or stock price booster becomes very expensive.

When Black Belts become a substitute management team forsolving problems that don’t require rigorous statistical analysis,Six Sigma initiatives spiral down into a game for the elite only.

A better approach is to adopt a simpler, but equally reliablemethodology for getting more participation in quality improvement

efforts, just as our example regional healthcare provider chose todo.

The decision was made to introduce a complementary improvementprocess called Action Workout to work in parallel and in support ofthe Six Sigma DMAIC process.

Action Workout is the latest generation of the fast change processfirst used by Jack Welch at General Electric to “break downbureaucracy”. Action Workout has evolved over the last decadeinto a system for converting employee know-how and creativityinto focused results.

Action Workout is a natural complement to Six Sigma. It usesthe same rigor of business case-based project selection, astructured improvement process and expert guidance.

What’s different is the nature of the problems Action Workoutattacks and hence, the level of expertise and time required tosucceed. Action Workout fills the gap between the “no-brainer”fixes made with decisive management action and problems thatcan’t be reliably fixed without detailed analysis.

At our regional healthcare provider, Action Workout was used toattack problems like these:

• Reducing the use of contract nurses through moreeffective scheduling and management

• Improving the accuracy of patient treatment records tosmooth claims processing

• Reducing materials and energy waste• Shortening hiring cycle time and improving employee

retention

These problems were attacked using frontline employees,supervisors and managers organized into small (five to seven people)action teams and equipped with an Action Workout Team Kit – anexpert improvement process literally packaged in a box.

Action Workout was chosen over DMAIC or the in-place QualityAction Team process for two reasons: Speed and simplicity.

Action Workout allowed this particular healthcare provider tomobilize more than 50 employees to make performanceimprovements without classroom training or overtime. Then, theywere turned loose to achieve major financial gains in a 60-day“sprint” timeframe.


issspsix sigma in healthcare symposium

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Companies Featured to Speak

Program Highlights

Leadership Program (1.5 Days)

• Company leaders of Healthcare organizations present their

deployment strategies, lessons learned and the value of Six

Sigma within their organization

• Networking Reception with Project Storyboards

Full Program (2.5 Days)

• Six Sigma Applications and Project Case Study Presentations

• Advanced Educational Sessions

• Networking Riverboat Trip

• Member Challenge Game

Featured speakers will be from the Healthcare industry

(across the supply chain) and Six Sigma professionals

from across the country.

Distinguished companies include:

• GlaxoSmithKline


• Commonwealth Health Corporation

• McKesson


• GE Medical Systems

Who Should Attend?• Healthcare Executives

• Physicians

• Senior Managers

• Deployment Leaders

• Champions

• Six Sigma Practitioners

Corporate SponsorsTo Date

• Commonwealth Health

Corporation


• GlaxoSmithKline

• McKesson


Day 1 Day 3Day 2

Networking

Reception with

Project Storyboards

Riverboat Trip

for Full Program

Participants

Final Round of

Member Challenge

(interactive

Six Sigma game)

Affiliate Sponsors To Date

• Breakthrough Management

Group Inc.

• Creative Healthcare USA

• Global Productivity Solutions

• Leap Technologies

• Minitab

• PwC Consulting

• Rath & Strong

• Six Sigma Qualtec

If you are interested in Speaking Opportunities at this Symposium, please contact Edna Cribb at 480-368-7083 or [email protected].

If you are interested in Sponsorship Opportunities, please contact Roxanne O’Brasky at 480-368-7083 or [email protected].

HHotel ReservationsMillennium Hotel, St. Louis

To reserve your room, please contact the hotel

directly at 866-866-8086.

Refer to the ISSSP Six Sigma in Healthcare

Symposium to receive the discounted rate.

Leadership Program

Full Program (Leadership Program included)

The Symposium is a 2 1/2 day program designed for Healthcare executives and

practitioners. One full day is focused on lessons learned and deployment case

studies targeted to Healthcare leadership. One and a half days are focused on

best practices, advanced educational sessions and project case studies demon-

strated by Six Sigma Experts, Practitioners and Deployment Leaders.

* All cancelations/substitutions must be received in writing. All cancelations will be subjected to a $150 administrative fee. No refunds will be given after April 12, 2002.

April 29- May 1, 2002St. Louis, Missouri


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Making the Transition Without Tears

The introduction of Six Sigma into healthcare provider organizationscan be made smoother with attention to three key questions:

• Where are the opportunities for the Six Sigma DMAICprocess and Black Belts to achieve a return thatjustifies the investment?

• How to reliably and cost-effectively get more managersand frontline employees into the CQI game to quicklysolve problems outside the DMAIC domain?

• How to refocus existing CQI activities and redirectthe CQI staff to hold gains from all improvementprojects?

Healthcare provider leadership teams who fully answer thesequestions will get “on the Six Sigma bandwagon” at a ticket pricethey can afford and experience a smooth ride.

experienced a 23 percent turnover rate. After seven months ofapplying Six Sigma, that rate dropped to only 11 percent. Therealized cost savings are also impressive. Since beginning theimplementation of Six Sigma, the organization has seen a financialreturn of $2.4 million through the end of 2001. And those returnsare expected to grow as they tackle more Six Sigma projects.

The International Society of Six Sigma Professionals (ISSSP), inconjunction with its Affiliates and Corporate Sponsors, has beguna campaign to help tell the story of health care entities that haveexperienced great success with Six Sigma. ISSSP’s objective forthis campaign is to provide credible information and expertise inSix Sigma to quality-minded practitioners in healthcare and itsallied fields. The source of this information comes from thehealthcare industry itself, from outside the industry and from thehealthcare supply chain.

Programs have been developed to equip healthcare professionalswith the knowledge to make informed decisions about theapplication of Six Sigma. One specific forum brings togetherorganizational leaders from the healthcare supply chain andhospitals to examine a variety of issues facing healthcare.Programs like this and others have been developed to providehealthcare professionals with a keen understanding of Six Sigmaand the potential it represents.

The health care industry, with its unique challenges andopportunities is clearly ready for Six Sigma…but what about you?

Supply Chain continued from page 1


Tears continued from page 15

Participate in an online networking exchange ofinformation and best practices about

Six Sigma in Healthcare!

Post your comments and questions using this state-of-the-art bulletin board system located on the ISSSP

Members website.

1919191919

I had an opportunity – thanks to an invitation from GE MedicalSystems — to attend a special event announcing the launch of anexciting new venture called “Center for Learning and Innovation.”This new initiative — a collaborative effort between the North ShoreLong Island Jewish Health System (LIJ), GE Medical Systemsand Harvard University’s School of Public Health – is the largest ofits kind in the healthcare industry to date.

The afternoon program featured four key players, among others, inthe Center’s planning and implementation. They included MichaelDowling, President and CEO of North Shore - LIJ; David Shore,Associate Dean Harvard School of Public Health; Paul Mirabella,President and CEO GE Medical Systems Healthcare Services;and Jeffrey Immelt, Chairman and CEO General Electric.

As the guest speakers explained, the new Center represents thefirst learning initiative ever undertaken by a healthcare organizationin cooperation with these two internationally renownedorganizations.

Created to enhance the health system’s ability to deliver servicesin today’s competitive marketplace, this effort signifies a majorstep in the healthcare industry that could spark far-reachingchanges. With GE’s business leadership and Harvard’s unparalleledacademic program, the Center aims to transform North Shore -LIJ’s organizational culture, invest and develop new groups ofleaders at different levels in the health system, and create world-class learning organizations.

Opportunity for ChangeThe healthcare industry has long been ripe for implementing a newmanagement perspective. As one of the most complex andconstantly changing industries, representing more than $10 billionannually, the healthcare system is synonymous with countlesspressures and obstacles that inhibit ongoing implementation ofquality improvements.

The combination of ongoing financial pressures, discovery ofrevolutionary new technologies and medical treatments, moreeducated and demanding work force and consumers, nursingshortages, declining reimbursements, changing patientdemographics, and aging and diversifying populations all contributeto an industry whose evolution has been stifled by internal andexternal limitations. And, what’s more, consider the statistic that

medical errors are the 8th leading cause of death accounting for50,000 per year.

According to David Shore, Associate Dean Harvard School of PublicHealth, “In response to the changing demands of patients andother constituents, organizations and technology are evolving sorapidly that health care professionals must continually seek newinsights, perspectives and skills that enable them not only torespond to change, but also to anticipate it.” Jeffrey Immelt,Chairman and CEO General Electric. Agrees, “In the US, we havethe best technology, best hospitals, best doctors, but healthcarestill isn’t where we want it. I think the missing link is leadership.”

Such common shortfalls have long represented a call to arms forindustry heads to seek out new and better alternatives to managethe system. In healthcare, there is a prevalent understanding ofthe connection between patient satisfaction and employeesatisfaction.

Michael Dowling, President and CEO of North Shore-LIJ adds “Wemust invest in our people…by creating an environment thatfacilitates learning and professional growth.”

Outside of the health care system, organizations that foster anenvironment of professional growth and life long learning amongtheir employees create a culture dedicated to excellence,innovation, teamwork, and continuous change. This notion plantedthe first seeds for the Center for Learning.

The shift toward a learning organization promotes a culture that ismore productive, delivers improved care and more passionate care,more services and customer focus, and continues to strive tostreamline work processes throughout the organization. This isthe basis for The Center.

North Shore – LIJ, like many of its industry peers, acknowledgesthe success of its traditional educational resources such as jointprograms with local colleges, technical training and internalmanagement development programs. However, the urgent needto coordinate, enhance and expand these efforts throughout thesystem is obvious. “We have done many things in the past, butwe need to do more,” says Dowling. “We want to be an organizationthat people want to come TO and work FOR.”

North ShorNorth ShorNorth ShorNorth ShorNorth Shore - Long Island Jewish Health System Te - Long Island Jewish Health System Te - Long Island Jewish Health System Te - Long Island Jewish Health System Te - Long Island Jewish Health System Teams with GE andeams with GE andeams with GE andeams with GE andeams with GE andHarvard to Launch Center for Learning and InnovationHarvard to Launch Center for Learning and InnovationHarvard to Launch Center for Learning and InnovationHarvard to Launch Center for Learning and InnovationHarvard to Launch Center for Learning and InnovationBy Roxanne O’Brasky, President, ISSSP


North Shore continued on page 21

issspSix sigma in Healthcare Video

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ISSSP is proud to present this 2001 Six Sigma in Healthcare Video. This video represents featured speakers from the

2nd Annual Six Sigma Leadership Conference and we are excited to offer this to you. As you learn from these experts,

you are sure to create energy and commitment for your team, helping you develop a strong and successful

Six Sigma program.

Specific Topics:• Creating a Six Sigma Culture in Healthcare• Clinical & Operational Six Sigma Projects• Six Sigma in Pharmaceutical Manufacturing• Open Discussion on Six Sigma Related Healthcare Issues• Reducing Cycle Time and Improving Productivity in Hospital ER’s

Some of What You Will Hear:

“I have not seen anything that can deliver the sustainable results like Six Sigma.”

“You have to get the best people you can.”

“Leadership is the most critical aspect of any successful program.”

“You have to dedicate yourself to a life of learning.”

“There's plenty of data that indicates you will get twice your money back in the

first year (of Six Sigma).”

“Six Sigma takes an organization and shakes it up.”

“Six Sigma has the ability to change an organization...as if by magic.”

“Six Sigma creates a restlessness within an organization.”

“Give Six Sigma constant care, until it becomes part of the culture.”

Featured Speakers:Larry Bossidy, Chairman & CEOHoneywell

John Desmarais, President & CEOCommonwealth HealthCorporation

Tim Tyson, Pres. World Wide Mfg. &Supply OperationsGlaxoSmithKline

Jeff Burnich, CQO & Senior VP.Mount Carmel Health System

Participating Sponsors:

www.creative-healthcare.com 480-473-2525

www.actionworkout.com 800-254-6805


CHCTitle Sponsor:

THE GOAL IS RESULTS™

www.BMGI.com1-800-46-SIGMA


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Leaders of ChangeOver the past three years, Michael Dowling has beenconceptualizing ways of transforming North Shore – LIJ into a“learning organization.” The GE Leadership Institute in Crotonville,NY where Dowling attended several leadership programs servedas a basis for a number of initiatives envisioned for the North Shore– LIJ. In March of 2001, Dowling wrote his initial plans for a broadbased learning center at North Shore – LIJ. By June 2001, strategycommittees were established between the health system, GE andHarvard to begin planning and implementation of the Center.

“To achieve our goals, we turned to GE and Harvard to harness thebest expertise from the private sector, academia and healthcare,”says Dowling. GE’s Leadership Institute, is considered one of thebest corporate universities in the business world. The Institute isa model for promoting organizational change and leadershipdevelopment at GE while affording the Center to draw on experiencein leadership development, knowledge and skills, including themanagement processes with the very successful Six Sigma.

Harvard University’s academic reputation is unsurpassed, and theHarvard School of Public Health has designed courses forphysicians and healthcare executives that are highly regarded inthe healthcare industry. “ Harvard University, runs the world’s morerenowned leadership education programs. Executives wait yearsto get into these programs,” according to Dowling.

GE and Harvard provide LIJ with the best of the corporate sectorand academia, along with expertise and experience in assistinglarge, complex healthcare organizations.

Implementing ChangeThe Center’s leadership has long echoed the sentiments of thehealthcare industry regarding the system’s endless battles. Thenagging question has always been: what to do about them.

“Employees are the greatest asset any organization has. It(healthcare) is about people taking care of people; it is about humanrelationships; it is about continuity of human interactions, “ saysDowling. Positioned as the driving force that transforms the healthsystem into a learning organization, the basis for the Center’smission is a three-tiered employee-centered approach:

• To create an environment that facilitates learning andprofessional growth

• To develop employees knowledge, skills, attitudes thatconsistently support business and strategic goals.

• To create leaders at all levels of the organization, right downthrough the organization.

As part of the Center for Learning and Innovation, GE MedicalSystems Healthcare Services will lead a 36-month initiative to bringGE’s approach to leadership development and change managementto LIJ. Specifically, GE will provide courses on “fast track decisionmaking” for solving organizational problems, “change acceleration”processes for breaking down barriers to change and helpingemployees embrace new concepts, and “Six Sigma” managementprocesses that have been widely recognized in the corporate sectorfor more than two decades.

“We’re pleased that Six Sigma is a major component of thissystem…that trust is the centerpiece of the system,” says Shore.“Healthcare, by definition, requires a level of trust.”

The all-encompassing vision of the Center and its resulting programsis designed to touch employees at virtually every level – physicians,nurses and other healthcare professionals, administrators, supportstaff and other non-clinical workers, including volunteers andtrustees. And, although representing a significant overhaul incurrent North Shore – LIJ processes, all current learning programswill not be altogether abandoned, but brought under The Center forLearning umbrella.

Realizing ChangeAt the completion of the GE partnership in three years, LIJ willestablish its own Six Sigma organization. By that time, about 175key health system employees are expected to be proficient in SixSigma management skills. In addition, the health system willhave completed about 60 Six Sigma projects devoted to improvingprocess efficiencies in areas such as patient wait time, billing,admissions and bed availability. Other initiatives will be phased inover three years.

Developing a corporate university in healthcare and creating alearning culture improves the working environment, the quality andcapacity of the workforce, and therefore the quality of the care andservices delivered to patients. Some of the courses taught throughthe Center will involve teaching VOC (voice of the customer)methodology and understanding customers CTQs (Critical toQuality elements) both of which will be designed to enhance servicequality and patient satisfaction. Some of the Six Sigma projectsmay be clinical in nature and will more directly impact patientprocesses and outcomes.

Also, as employees acquire vital change management skills, theywill be empowered to solve long-standing problems or prepare forfuture challenges. Removing the redundancies and inefficienciesthat can become part of any job helps to improve productivity and


Continued from page 19

North Shore continued on page 28

Commonwealth Health Corporation, the Healthcare Pioneer of Six SigmaCommonwealth Health Corporation, the Healthcare Pioneer of Six SigmaCommonwealth Health Corporation, the Healthcare Pioneer of Six SigmaCommonwealth Health Corporation, the Healthcare Pioneer of Six SigmaCommonwealth Health Corporation, the Healthcare Pioneer of Six SigmaBy Lisa Thomerson, Six Sigma Corporate Champion, Commonwealth Health Corporation

Commonwealth Health Corporation’s Six Sigma initiative was launched in March 1998 after President and CEOJohn C. Desmarais listened intently to Jack Welch tout the amazing success General Electric (GE) had experiencedby implementing Six Sigma. Welch had proven globally that Six Sigma was the way to improve process design andreduce costs. The encounter of these two executives led to a partnership between GE and CHC, in which GEMaster Black Belts trained a diverse group of CHC executives and managers in Six Sigma methodology. This initialGreen Belt training designated Commonwealth Health Corporation as the pioneer in healthcare to become a SixSigma organization.

Presently, CHC’s Six Sigma team develops training materials, teaches the Six Sigma methodology, and mentors Green Belts andBlack Belts as they progress through the various levels of projects. These projects represent a variety of processes within the organization,both operational and clinical service lines. Projects are selected based on a variety of considerations: benchmarking, peer group data,and/or invaluable suggestions or ideas from employees, patients, and physicians. Although there are many challenges inherent inapplying the Six Sigma methodology in a healthcare setting, CHC has seen many positive results in these ongoing Six Sigma projects.

All projects must impact at least one of the following Critical-to-Quality factors (CTQs): Customer Satisfaction, Timeliness/Speed/Convenience, Quality of Care/Service, or Cost. A typical CHC Six Sigma project takes four to seven months to complete. Every projectis an intense objective study of a particular process that is driven by data. Neither subjective assertions nor random recommendationsfor improvements are tolerated in the DMAIC process (Define, Measure, Analyze, Improve, Control). Black Belts and Green Belts mustprove statistically that a problem exists and the improvements made within the process have been improved using objective data. Oneof the innumerable strengths of Six Sigma is that all projects are approached the same, utilizing each of the five phases in DMAIC.

Commonwealth continued on page 24


Operational Excellence is fundamentally changing the way in whichGlaxoSmithKline’s Global Manufacturing & Supply business (GMS)operates, which is a worldwide organization with over 40,000 peopleworking to manufacture the quality medicines and consumerproducts on which GSK patients and customers depend.

In GMS, Operational Excellence is engaging and developing thefull potential of our people throughout the organization, by deliveringa unique blend of five components:

• LeanSigma – a methodology to eliminate wasteand drive efficiency throughout the GMS organization

• Knowledge Management – to enable thesharing of ideas, information, knowledge, goodpractices and experience to systematically createvalue for business benefit

• Common Language and Global Processes –identifying and applying global processesconsistently across GMS

• Performance Management and Benchmarking- robust Performance Management methods andtools to continuously measure and improveperformance, benchmarked against the best internaland external standard.

• Education and Training – developing a range ofeducation programs and activities, delivered via avariety of media from traditional classroom eventsto self-paced e-learning modules, to enable deliveryof all components of Operational Excellence.

In GMS, LeanSigma is viewed as a methodology for sustained,customer-focused business improvement, based on theimplementation of a powerful combination of two provenmanagement approaches – Lean thinking and Six Sigma. Thecentral themes of Lean thinking are the elimination of waste andthe simplification of processes, minimizing activities that are non-value adding to the customer. Six Sigma provides tools to eliminatevariation and drive robustness in order to deliver highly reproducibleprocesses.

The LeanSigma program has been successfully embedded in GMSby means of a systematic deployment program. This commencedwith gaining leadership commitment from the executive level down,

combined with detailed training of designated individuals whooperate in an ‘expert’ role. An Expert Certification Process hasbeen introduced to formally recognize this key resource. Our targetis to have at any one time one percent of the GMS organizationactively practicing as LeanSigma Experts. Beyond this anunderstanding of the principles is driven down to all levels of theorganization by means of ‘Advocate’ training. The whole processis underpinned and sustained by a group of LeanSigma InternalConsultants who provide specialist teaching, mentoring and projectsupport.

In GMS the LeanSigma methodology is being used effectively inconjunction with the other elements of Operational Excellence todeliver step change improvements in the way we do business.“The powerful combination of the five components of OperationalExcellence will enable us to meet business challenges in the waythat is most effective for the business”, says Jean-Paul Reynaud,Vice-President, Operational Excellence. Jean-Paul is also keento point out that Operational Excellence is a global initiative, whichcan be applied to all technical and business / transactionalprocesses within GMS to enable optimum effectiveness. “It ishelping GMS to learn and work as one team, so that good practice,breakthroughs and successes are shared and applied rapidlythroughout our global network”.

The GMS philosophy is that Operational Excellence should not beviewed only in terms of tools and techniques, but more as a majorcultural change initiative designed to deliver significant benefits tothe business. It provides a blueprint to help build a world-classmanufacturing and supply organization. This will serve to realizethe vision of GMS in being the benchmark in the pharmaceuticalindustry in five years and in all industries in ten years.

Operational Excellence - be the benchmarkOperational Excellence - be the benchmarkOperational Excellence - be the benchmarkOperational Excellence - be the benchmarkOperational Excellence - be the benchmarkBy GlaxoSmithKline

GSK Corporate Offices, Philadelphia, Pennsylvania, US


Six Sigma Strategy

CHC’s successful implementation of Six Sigma can be directlyattributed to the organization’s steadfast commitment to quality –to continually “raise the bar.” Six Sigma training was mandatedfor every employee to become adept at its use within CHC as thevehicle to continually improve processes and the delivery of care.It became the focal point of a culture change within the organization.Part of the lasting culture change, Six Sigma’s methodology andits approach to process improvement has facilitated a transformationin organizational communication. With that change, CHC’s seniorleaders recognize the importance of their employees andunderstand their invaluable contribution to improve the “way wework.” At its inception, John C. Desmarais made the commitmentthat no one would lose their job due to improvements made by SixSigma projects. Any reduction in CHC’s workforce would be throughattrition.

Black Belts are selected as the full-time project leaders who driveprocess improvements to meet CHC’s strategic organizationalgoals. Green Belts are Directors and Managers who lead projectspart-time and incorporate Six Sigma methodology within theirrespective departments. These “Belts” consist of a wide array ofemployees leading projects on project teams. They discuss theirprojects directly with executive management at each phase(Review) of their projects. Reviews are the forum utilized to improvethe flow of information to ensure the Black Belt, Green Belt, projectteam, and members of executive management are current on projectdevelopments. Black Belts and Green Belts, reinforced withmanagement’s unequivocal support to the Six Sigma initiative,critically examine processes within their respective departments.The value of applying Six Sigma’s methodology to solve problemsand improve processes is viewed as the mechanism to enhancetheir everyday work. This can only result in improved customersatisfaction, reduced costs, more efficient processes, and improvedquality as CHC produces more and more Green Belts and BlackBelts who have completed Six Sigma training.

Intensive Six Sigma Training

Senior leaders fostered their commitment to Six Sigma by identifyingindividuals who would become CHC experts in Six Sigmamethodology and would provide internal training to employees.These individuals, Master Black Belts, developed healthcare-relatedtraining material for classes, a tool kit, and project simulation forlearning. Additionally, they provide all levels of training for CHCemployees as well as coaching and mentoring for Green Beltsand Black Belts.

CHC made a remarkable organizational commitment to the successof Six Sigma by training all employees in Six Sigma methodology.By the end of 2001, over 2000 employees had attended at leastone full day of Six Sigma training (“Awareness”). This Awarenesstraining offers an introduction to basic concepts of the methodology,and each person who attends this training receives knowledge ofthe Six Sigma process and becomes a valuable contributor to aproject team. The commitment to train every employee standsfirm.

“Lite” training is the next level of exposure to Six Sigma’smethodology. Department Directors and Clinical Managers identifyhigh-potential employees who will be most involved in projects.These individuals, typically supervisors, attend an intense three-day session that is designed to familiarize the Lite-trainee with theaspects of the methodology. These employees build on the basicknowledge of Six Sigma in order to assist the Green Belt withinthe many facets of a project.

Green Belt training is an action-based learning model where traineesactually complete projects. This training is a 13-day coursepresented in five phases (D-M-A-I-C) over a six-month period. Eachstep of the DMAIC process is presented by Master Black Belts ina classroom setting, and the trainee applies these principles to anongoing project. CHC has 120 Department Directors and Managerstrained as Green Belts. Each will be expected to complete oneproject every nine months. Training Green Belts at this level assuresthat Six Sigma is intertwined within every department. Additionally,all vice presidents, members of the senior management team, andCHC’s President and CEO have received Green Belt training and“shadowed” a Green Belt through a Six Sigma project.

CHC’s Corporate Champion is responsible for the deploymentthroughout the organization and ensures necessary resources areobtained when needed improvements are recommended.Additionally, the Champion eliminates any barriers experiencedwithin a Black Belt or Green Belt project. The Champion also

Commonwealth continued from page 22



HeAlTIoN

CHCCommoNWeAlTH

THCoRpoRA

communicates the organization’s Six Sigma successes internallyand externally as well as manages the strategy’s acceptance.

Six Sigma’s Triumph

Tangible benefits of process improvements utilizing Six Sigmamethodology projects are being experienced throughout the fabricof our organization. The first Green Belt class focused on processesin Radiology, engaging a cross-functional group of employees toenhance the corporate-wide implementation. As a result of theseprojects, costs per procedure have been significantly reduced.Exam results are distributed to ordering physicians faster, patientsreceive treatments more timely, and physical workspace has beenre-designed to increase employees’ efficiency. Other Green Beltclasses have focused on other areas of the organization: Maternalcare, specific Pulmonary DRGs, Admissions, Billing processes,Documentation/Charge Entry, Human Resources, Staffing,Managed Care, and Surgery processes. Each project representsa significant opportunity to improve aspects of the services providedby CHC, and Green Belts are beginning to realize the extent towhich they can positively impact the way CHC does business. Astraining objectives are met, processes throughout CHC will continueto improve as the organization continues its journey to become aSix Sigma organization.

Along this journey, the American Productivity and Quality Center(APQC) named CHC a Six Sigma “Best Practice Partner”. CHCwas among only a few others in the nation to receive this award:American Express, Iomega, DuPont and Raytheon. CHCexecutives have also had many opportunities to share this approachto quality improvement with several organizations. In March 2001,CHC was profiled at the Association for Quality and Participation’s23rd annual spring conference in Chicago. In May 2001, CHC hostedhealthcare executives from Japan. Additionally, CHC executiveshave delivered presentations to the American Society for Quality’sAnnual Quality Congress; Healthcare Financial ManagementAssociation’s conferences; International Quality and ProductivityCenter’s Six Sigma Conference; International Society for Six SigmaProfessionals’ Leadership Conferences; numerous HealthcareSymposiums; and, a Six Sigma Conference hosted by MarcusEvans. Along with numerous other presentations, CHC’sexperience with Six Sigma has been featured in various publicationsincluding Strategic Finance, Radiology Management, ModernPhysician, Managed Healthcare Executive, Hospitals and HealthNetworks, and Diagnostic Imaging.

Since beginning in 1998, CHC invested approximately $900,000through the course of this implementation. Improvements haveresulted in savings well over $3 million in 2001 alone. To date, the

cumulative savings have exceeded $7 million. CHC boasts that allexisting employees have received Six Sigma training – from aprimer in Orientation to Master Black Belt level training. Towardthat end, this includes over 120 trained Green Belts, six BlackBelts, three Master Black Belts, a Corporate Champion, threeCorporate Sponsors, and a CEO who continuously drives thechallenge of becoming a Six Sigma organization. It is evidentthrough continued process improvements that CHC will realizeescalated savings, increased morale and customer satisfaction.As the pioneer for Six Sigma in healthcare, CHC’s leadershipchanged the organization’s approach to problem solving utilizingSix Sigma methodology to deliver absolutely the premium serviceto customers.

The Way We Work at CHC

In addition to CHC leadership’s commitment to Six Sigma quality,organizational buy-in is one of the most vital elements of its success.Part of the Champion’s responsibility is to gauge the progressionof Six Sigma and determine its effectiveness from a corporate-wide perspective. Perhaps the greatest measure of this successis to hear from those closest to the pulse of Six Sigma methodology– CHC’s Six Sigma Green Belts. A few of CHC’s over 120 GreenBelts were asked to share their perspective of Six Sigma. This iswhat they said:

“Six Sigma has been a true learning experience for me. I amworking on my third Green Belt project currently. I am finding thisproject particularly interesting since it involves our CorporateWellness program and the results from the Health RiskAssessments. The tools of Six Sigma are proving very beneficialin analyzing the aggregate data from the assessments with theend result being an even stronger, more effective wellness programfor our employees.”Linda Rush, Director of Community Wellness; Green Belt;led project for Health Risk Assessments

“I have found Six Sigma methodology very beneficial. At one timeduring my project, I considered the possibility that there was noreason to proceed to the next phase. I felt there was no way Icould improve the process after analyzing my data. We proceeded,and on my 2nd measurement, I had only one defect. I was able tomake a positive change for all involved and addressed all CTQs(critical-to-quality).”Gary Sullivan, Director of Security; Green Belt; studied theprocess of direct admits from EMS

“I know that Six Sigma methodology can and is making a differencein our organization. It allows us to continually ask ourselves how




we can improve processes as we go about our regular duties. The best part is the ability to hold improved processes in place so we canstrive for further improvement in that process and move toward improving other processes. I’m just glad I’ve been able to be such anactive part of the Six Sigma initiative because I’ve learned so much. It is so valuable in my new position as we look at processimprovement - it’s just such a different way of looking at things.”Lorraine Bormann, Director of Corporate Clinical Facilities; Green Belt; currently leading a project in the process ofmedication charge audits

“The Six Sigma training has spawned a “new and improved” way of thinking not only for myself but for staff within my department. It hasexpanded our thought processes to continually question “why” is a task performed in such a way and question “Is this the best way?”As the Six Sigma approach is expanded throughout our department, we desire to realize and improve upon our weaknesses andcelebrate our strengths.” Cristi Pruitt, Director of Corporate Accounting; Green Belt; member of the Green Belt class studyingprocess of documenting charges

“For me, Six Sigma changes the way that I look at my department, the daily activities of the hospital, and how I do my job. Using theSix Sigma methodologies, each process can be studied and evaluated. Not all projects will reach a “Six” Sigma, but any increase insigma levels can be considered a success. When a project has an increase in the sigma level or improvement noted, then our patientsand the facility will ultimately benefit. Having the tools, such as this methodology, that allow me to look at my processes and improvepatient care, makes my job and career much more rewarding.” Melinda Joyce, Director of Pharmacy; Green Belt; currentlyleading a project studying the crediting process for medication

As you can see by these testimonials, Six Sigma has proven to be not only a way of improving processes but also a method foremployees to achieve stretch goals. These Green Belts are living proof of CHC’s ability to continually seek greater and greater levelsof quality.

Lisa Thomerson became the first Six Sigma Corporate Champion at Commonwealth Health Corporation (CHC) in January 2000. MsThomerson received CAP & WorkOut training from General Electric Medical Systems following CHC’s kick-off of Six Sigma in March1998. In early 2000, she was GreenBelt trained by CHC’s Six Sigma training staff of Black Belts and received Champion trainingthrough Juran Institute. CHC is the first healthcare organization to partner with General Electric, fully integrating Six Sigma into itsculture.




raise the satisfaction level for employees, reducing burnout andunwanted attrition. Well-developed, highly satisfied employeestranslate into higher patient satisfaction and improved healthcaredelivery.

Dowling is optimistic about his expectations for the Center, saying,“We are doing this because I believe it will enhance the product weare delivering, as well as the business we are running… When wetalk about this with our department heads and employees, youcan absolutely observe the excitement. There is an excitementthat people will improve themselves. Excited about the relationshipwith outside partners.”

Changing Health Care and BeyondAlthough North Shore – LIJ is not the first healthcare organizationto apply Six Sigma methodologies, this project is the largestendeavor to date, according to GE. Currently, it is estimated thatthere are more than 3,000 Six Sigma healthcare projects worldwide,including such organizations as Commonwealth Health Corporationin Bowling Green, KY, Charleston Area Medical Center inCharleston, WV, Virtua Health in Marlton, NJ and NorthwesternMemorial Hospital in Chicago, IL.

The impact that the simple principles of Six Sigma are going tohave on North Shore-LIJ and subsequently the collective healthcare may not be immediate. However, the path of this troubledindustry toward improved process management is something thatall of as practitioners of quality will anxiously follow in the monthsto come.

North Shore continued from page 21

radiology throughput by 25% using fewer resources, whilesimultaneously decreasing cost per radiology procedure by 21.5%.

Keys to Making It Work

One of the primary keys to unlocking Six Sigma success is solidcommitment from leadership. Since this initiative will invariably


Applying Six Sigma to Radiology:Snapshot of Success

• Decreased the time between reports dictation andreport signature

• Reduced patient wait time from arrival in radiology totime of exam

• Reduced time between patient dismissal and dictation completion

• Decreased patient wait time for radiology registrationprocess

• Enhanced radiology scheduling process

• Reduced time from radiologist signature to reportdistribution

•Increased efficiency in the MRI ordering process

• Optimized the content quality and delivery of pre-exam patient education

• Reduced time for dismissal of radiology patients

• Enhanced film jacket retrieval process

• Decreased MRI report turnaround time

• Improved general radiology staff scheduling

• Increased efficiency of Ultrasound exam schedulingand reduced overtime

• Utilized special procedures inventory more efficiently

• Augment radiology exam scheduling and pre-registration process

• Reduce CT order to taken time

• Decreased IVP exam time

• Improve utilization of Nuclear Medicine radio-pharmaceuticals

Measurable improvements in radiology added up to greaterefficiency and better quality. Staffing was reduced by 14 full-time equivalents, entirely through attrition; identification errorswere reduced through bar coding, and processes wereimproved.


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To date, Mount Carmel's Six Sigma projects have included:

• Several claims-processing projects in the organization's Medi-care HMO, employed primary care physician practices, and be-havioral health business• Processing time in central scheduling• Claims denials due to patient type changes and long-stay obser-vations• Discharging throughput to decrease bottlenecks in the emergencydepartment• Implementing of a procedure-based delivery system in the sur-gery area to help ensure supplies are present when needed duringan operation• Enhancing clinical documentation to ensure it matches the ser-vices rendered• Making clinical laboratory results available according to the re-questing physician's needs, enabling the physician to make timelydecisions for patient discharge or continued treatment• Reducing cycle time in various inpatient and outpatient diagnos-tic areas




compete for capital and time resources, participants have to beable to count on unambiguous support from senior management.To be successful, Six Sigma has to be priority #1.

Far more than just a financial engineering effort, the process involvesmeasuring all relevant criteria and making sure the job is doneright the first time, which ultimately has a positive impact on patientcare and satisfaction. The fact that Six Sigma offers a truly evidence-based approach to operational and clinical improvement gives theinitiative greater credibility and makes it easier to get buy-in andresults. Persistence and a clear definition of your objectives arealso important factors. Everyone must understand that this is aphilosophy for doing business and requires active participation.Communicating this vision clearly to the organization is mandatory.

Onward and Upward

As it has had an impact on other industries, Six Sigma couldpositively affect public perception of healthcare delivery. Societyhas struggled to find a workable methodology to measurequality. Looking beyond the obvious indicators of mortality andmorbidity, it’s tough to gauge. Using the methodology tocarefully gather and analyze data can help providers accuratelyidentify where problems exist and how best to correct them. SixSigma provides a roadmap for process improvement,dashboards to let you know how well you’re doing, and process“cruise control” to keep the improvements on track.

To carry this quality improvement forward at Commonwealth willrequire ongoing training and the generation of approximately 120trained Green Belts within two years. Every CHC employee willreceive a minimum of one full day’s training.

Six Sigma is a sound philosophy of management and quality thatgives companies a chance to reduce cost, increase productivityand improve quality. Effects are evident and long-term, and theapproach can be adapted and applied throughout the organization.

Jean Cherry is executive vice president at Commonwealth HealthCorporation and is a fellow of the American College of HealthcareExecutives. She holds a bachelor of science degree in businessadministration from Western Kentucky University and a master ofscience degree in healthcare administration from the MedicalCollege of Virginia. Cherry has worked in healthcare administrationfor over 13 years. She oversees Commonwealth Health Corporation’ssupport functions which include quality resource management,information technology and facilities management, and is a licensednursing home administrator. Cherry may be contacted at 270/745-1527.

Sridhar Seshadri is vice president and general manager with theHealthcare Solutions Group of GE Medical Systems Information

Suggested Readings

Technologies. He holds a bachelor of science degree in electricalengineering from Bangalore University in India, a master of sciencedegree in electrical engineering from Drexel University, and a masterof business administration degree from the University ofPennsylvania (Wharton) in 1993. He is widely published and hasan extensive background including lead engineer with the Universityof Pennsyvania’s Radiology Department, where he developed andevaluated Picture Archiving and Communication Systems (PACS).Since then, he has held the positions of manager, new businessdevelopment and director, product management and strategicplanning in the medical technologies industry. Seshadri may becontacted at [email protected].

Breyfogle, F.; Cupello, J.; and Meadows, B. 2000. Implementing SixSigma: Smarter Solutions Using Statistical Methods. New York,NY: John Wiley & Sons.

Pande, P.; Neuman, R.; and Cavanagh R. 2000. The Six SigmaWay: How GE, Motorola and other top companies are honingtheir performance. New York, NY: McGraw-Hill ProfessionalPublishing.

Rath & Strong’s Six Sigma Pocket Guide. 2000. Lexington, MA:Rath & Strong, Inc.

Slater, Robert. 1999. Jack Welch and the GE Way: ManagementInsights and Leadership Secrets of the Legendary CEO. NewYork, NY: McGraw-Hill Professional Publishing.

Slater, Robert. 1999. The GE Way Fieldbook: Jack Welch’s BattlePlan for Corporate Revolution. New York, NY: McGraw-HillProfessional Publishing.

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Financial Return And Other Benefits

To date, we have realized a financial return of $3.1 million, and weexpect these financial returns to grow rapidly as more Six Sigmaprojects are completed.

Another key benefit of Six Sigma has been increased employeeand physician satisfaction as we have begun to fix problems inoperational processes that have been a source of frustration anddissatisfaction for these important stakeholders as they do theirjobs. For instance, employee retention has improved, which webelieve is due at least in part to Six Sigma initiatives.

While Mount Carmel has experienced its share of challenges inimplementing Six Sigma, we strongly believe in its potential andvalue in the field of healthcare in improving financial performance,clinical quality and patient safety, and stakeholder satisfaction.

Jeffrey Burnich, M.D. (614.234.5633 or [email protected]) isMount Carmel's Senior Vice President of System Care Manage-ment and Chief Quality Officer. Tammy Weidner, R.N., MBA(614.234.5467 or [email protected]) is Vice President of SixSigma.



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