Six Sigma adds new dimension to quality management processes.

The North ShoreLong Island Jewish (L1 J) Health System quality management program is based on database development and the quality theories developed in the 20th century by thinkers such as W. Edward Deming, Walter A. Shewhart, Joseph Juran, and Phillip Crosby. The methodology traditionally usedPlan, Do, Check, Act (PDCA)-was developed by these industrial quality improvement innovators to reduce variation and promote excellence. With its reliance on objectivity, multidisciplinary planning teams, careful monitoring of services and continuous data analysis, this model has been effectively and productively adapted to healthcare. In 2002 when Michael J. Dowling, president and CEO of the 17-hospital North Shore-LIJ Health System, introduced Six Sigma, another industrial methodology often associated with improving organizational performance and increasing revenue, he approached it not only as a method that would create efficiencies in various processes throughout the health system, but also as a strategic tool that could change organizational culture. Six Sigma was introduced along with other change management methodologies to create a multifaceted approach to problem solving. The other methodologies, Change Acceleration Process and Fast Track Decision-Making, incorporate numerous tools that drive the decision-making down to frontline employees. Education and deployment of Six Sigma were introduced through the North Shore-LIJ Health System‘s “corporate university,” the Center for Learning and Innovation (CLI). Six Sigma projects were chosen specifically to align strategically with the business goals and objectives of the North Shore-LIJ Health System. The projects tie directly into one or more of the health system’s strategic metrics: operational performance, financial performance, quality, service excellence, and workforce development. The results of the projects are rigorously measured against these metrics. Because the North Shore -LlJ Health System’s quality management philosophy embraces new methods of improving care, it was clear that Six Sigma methodology could function along with existing quality management methodology with good results. Over time, members of the quality management department were educated in Six Sigma; one became a project leader, a ’%lack belt,” and three others became team members, “green belts. ” There are enough similarities between PDCA and Six Sigma, such as defining a problem, analyzing processes, and using data to measure improvements, that staff members were comfortable and familiar with its precepts. But there are also enough distinctions between the two processes to make both useful, especially when used to complement each other in a performance improvement effort. Both methodologies are included in the CLI educational curriculum, because healthcare professionals should be able to analyze processes from different angles and in different ways. Six Sigma methodology is useful for eliminating variability in a defined process (e.g., bed turnaround time), with the goal of streamlining the process and eliminating errors, thus making the process more efficient. The PDCA methodology allows analysis of large processes, such as emergency room care, in a more global way, from beginning to end. Like Six Sigma, though, it identifies key drivers and targets flaws and risk points through root cause or failure mode and effects analyses. Both methods are crucial to reducing length of stay (LOS) and improving patient throughput. The two methodologies may be used together with positive change results. The PDCA examines overall processes and prioritizes opportunities for improvement. The Six Sigma methodology focuses on specific target processes to decrease variability, thereby creating a tighter process. As efficiency increases, quality also increases because efficient operations affect overall quality of care. For example, when the PDCA method was used to analyze LOS in one of the health system’s community hospitals, it was found that patients who were being discharged to levels of care other than home tended to stay longer because they had complex medical problems. The outcome of the PDCA was to develop a