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Six Sigma in Healthcare

What is Six Sigma? How Six Sigma works? Six Sigma as a Metric. Six Sigma as a Process Improvement Methodology. Characteristics of Six Sigma Impact of Six Sigma. Why Six SIGMA Works? Six Sigma in Healthcare. Benefit from Six Sigma Six Sigma in Hinduja Group. Some successful projects in Healthcare industry. Six Sigma Application in Healthcare. Need for using Six Sigma in Healthcare.

What is Six Sigma?

Sigma is a yardstick on which the performance of the process and improvements can be gauged upon.

Six Sigma is an Improvement methodology which uses a structured approach to drive business improvement. Six Sigma is a

Measure for Quality

Process For Continuous Improvement Enabler for Culture Change.

Six sigma is a business strategy which deploys various set of tools,

techniques & methodologies to bring in

1) Rapid & Breakthrough process improvement. 2) Enhanced customer focus. 3) Data & Fact based decision making. 4) Creating culture for continuous & tangible improvements. 5) Structured problem solving.

How Six Sigma works?

The outcome Y is a function of inputs Xi,
Traditional approach towards Problem solving is to approach the problem directly and try to identify a solution for it. Six Sigma challenges that school of thought and advocates a detailed Root Cause analysis to identify the factors impacting the problem, validating them using statistical tools and then finding

Y = f(Xi)

solutions for the significant causes.

A six sigma project accelerates the performance of the CTQ in a comparatively smaller span of time.
CTQ Performance

The unit of deployment of six sigma

in an organization is the number

of six sigma projects. A six sigma project is executed in a time frame

of 5-6 months by a task force type

Current Performance

Six Sigma Project

Future Performance

team of 4-5 members.

CTQ The parameter chosen to make improvement through a Six Sigma project

Six Sigma as a Metric

Sigma is a measure of spread of a process s is the standard deviation
of the process (variation in performance of the process), Sigma value z is the measure of the capability of the process. Lower the standard deviation the better the process is, Higher the sigma value better the process is.

As s Standard Deviation decreases Sigma Value z increases




As variation in the process decreases, it results in reduction of standard deviation & data points lying closer to the mean. The Z value increases. Z value is the measure of process capability.

Z = 6, 99.9997%

Z = 5, 99.97%
Z = 4, 99.3% Z = 3, 93.3% Z = 2, 69%

Six Sigma as a Process Improvement Methodology

Six Sigma is a structured problem solving tool which deploys Brainstorming & Statistical tools to identify the vital root causes and finding a solution so as to optimize the Output. It follows DMAIC approach for problem solving.
Define the project ( Assignment ) goals and customer (internal and external) deliverables.

Measure the process to determine current performance.

Analyze and determine the root causes of the defects.

Improve the process by working on the validated root causes

Control the improved process performance to ensure sustainable results.

The extensive focus on customer requirements

Characteristics of Six Sigma Approach

The direct link to business strategy and financial results

The required commitment of top leadership up-front. Each project delivers bottom line results in a short time The disciplined improvement methodology based on measurement and analysis Full-time Six Sigma team leaders who are extensively trained in statistical thinking as well as team and project skills The integration of Six Sigma thinking into the business infrastructure

through incentives and rewards

Impact of Six Sigma

The Classical View of Quality 99% Good (3.8s)
20,000 lost articles of mail per hour Unsafe drinking water almost 15 minutes each day seven months

The Six Sigma View of Quality 99.9997% Good (6s)

Seven lost articles of mail per hour One minute of unsafe drinking water every

5,000 incorrect surgical operations per

week 2 short or long landings at most major airports daily

1.7 incorrect surgical operations per week

One short or long landing at most major airports every five years

200,000 wrong drug prescriptions each


68 wrong drug prescriptions per year

One hour without electricity every 34

No electricity for almost 7 hours each month


Why Six Sigma works?

Top Management Commitment

Use of Statistical & Problem Solving Tools

Six Sigma Project

Disciplined Approach

Support from Highly trained BBs & MBBs

Six Sigma in Healthcare

Six Sigma has been successfully deployed by many Healthcare organizations across the globe, some of them are:
Commonwealth Health Corporation GE Healthcare Hinduja Group, Bombay. Apollo Hospitals

Benefits from Six Sigma

Benefit to Hospitals Translating to fewer errors Better processes Increased patient satisfaction & care. Increased physician satisfaction Reduce cost/ cost savings. Benefit to Individuals Structured problem solving methodologies. How to apply statistical analysis tools to problem solving Team Management & Leadership skills. Six Sigma Certification.

Example - 1
Example 1: Projected Savings from a project reducing turnaround time per operation / theatre by 15 minutes. No of operations that can be done in a 12 hr day (assuming each operation takes 60 minutes.) = 12 No of operations that can be done (assuming revised turnaround time of 45 minutes.)= 16 Increased revenue per day= 4x5000= 20000. Increased revenue annualized = 20000 x 26 x 12 = Rs 62,40,000

*Assumption: Approximate cost per operation = Rs 5000. Operation TAT was earlier 60 min which has been reduced to 45 min

Example 2
Example 2: Projected Savings from a project reducing patient discharge time by 2 hrs for a 100 bed hospital. Using Six Sigma tools we may reduce the bed waiting time by 2 hrs. Then No of hrs saved in a day = 2 x 100 = 200 hrs/day No of hrs saved in a year= 200 x 26 x 12 = 62400 hrs/year. No of days saved in a year= 62400/24= 2600 days Cost of 1 bed per day= Rs 1000 Savings in a year = 1000 x 2600 = Rs 26,00,000. *Assumption:
Every bed gets a new patient every day. Approximate cost of 1 bed/day = Rs 1000.

Six Sigma in Hinduja Group

Hinduja Group deployed six sigma to improve patient satisfaction, physician

satisfaction and reduce costs. They conducted a brainstorming and came up

with over 70 ideas for improvement and took some of them up as projects, the areas that were improved upon are: Turn around time for laboratory reports Patient discharge time OPD waiting time

TAT for blood availability

Patient satisfaction index Turnover time for rooms and beds Prescription accuracy

Some successful projects in Healthcare industry

Outpatient blood lab reduction in 10 weeks of process time from an average of 19 minutes to 4.2 minutes. Pre-admission testing reduction by 38% of avoidable testing procedures, resulting in savings of >$116,000. Improved process to reduce bed turnover time, savings of >$100,000. Reduce number of medication errors from 81 to 9 for a three month period. Increased speed of delivery of medications to floor by 20%

Reduce average time to get radiology reports by over 25%

130% increase in surgical procedures. Reduce operating room setup time between surgeries by 40%. Reduce unnecessary length of stay by over 25%

Six Sigma Application in Healthcare

Beyond the areas listed on the previous slide, six sigma can be applied to

many more areas in the :

Ease of registration

Prescription accuracy
Number of infections post operations Success rate of operations Noise level in pre-operative care OT Supplies support time taken to provide supplies OPD waiting time Patient discharge time

Need for using Six Sigma in Healthcare

In a country like India, bed availability per 1000 people is one of the lowest in

the world. Millions of people suffer from problem due to lack of proper
healthcare infrastructure, so as to provide healthcare facilities to maximum people we need to utilize the available resources in the most optimum manners and that is where well proven methodologies like Lean and Six Sigma can be of great help.

Also, in the wake of developing medical tourism to India, the healthcare service providers need to improve their utilization of resources, patient satisfaction, quality of healthcare and many more so as to develop medical tourism as an industry.

Thank You