Six Sigma: How it’s different
A Six Sigma project is not just another QI initiative, says Richard Beaver, vice president of quality for Heritage Valley Health System, which includes Sewickley (PA) Valley Hospital, Heritage Valley Hospital, 49 physician offices, the Moon Surgery Center, and 14 community satellite facilities.
"It’s a very interesting dynamic," he observes. "If you do TQM or something like that, you’d say, That Six Sigma stuff is the same thing we do.’ Here, they had a five-step TQM process. You defined the problem, applied a quick fix, but no one could tell you the next three steps. The old ways weren’t the closed-loop processes I believe Six Sigma delivers."
In this antibiotic project, Beaver says the surgeons felt they already were doing well.
"But when you see the data that 3% of every case gets it right, that means 97% are getting it wrong. The other thing is, the guidelines did not say anything about the application of two antibiotics; just the timing. Information from the CDC [Centers for Disease Control and Prevention] helped us tell the surgeons about proper antibiotic use." In fact, he notes, after most surgeons had successfully adopted the new procedures, there was one surgeon who kept refusing to change. "He felt it was appropriate to do two or three more days of drug administration," Beaver says.
That’s when the team leader, Sandy Silvestri, RN, BSN, CIC-infection control coordinator, stepped in. "She said, I have a friend at the CDC who will call him to discuss proper administration’; now that’s closing the loop," says Beaver.
Another strength of the Six Sigma approach is the DMAIC (define-measure-analyze-improve-control) methodology, says Beaver. "There is an imaginary wall between A [analyze] and I [improve]," he explains. "You can’t go to the improve phase with Six Sigma until you have presented your data. This tells you that you don’t go into the control phase [sustaining the change] until there’s enough improvement."
The success at Sewickley also shows that, contrary to popular belief, the Six Sigma approach can be applied to clinical process improvement.
"Yes, there is some variation; the patient does provide much more variation than you would find in an industrial system," Beaver concedes. "But our argument is, once you know what the patient has, there are national standards of treatment — like ACE inhibitors upon discharge if not contraindicated. There are data."
Six Sigma also has brought discipline to his entire organization, Beaver says. "People who have seen our projects will write any presentation in DMAIC format," he notes. "And when someone comes in to present to senior management and the executive doesn’t see those slides, they ask why they are not being provided."
The changes at Heritage Valley have been so dramatic that Beaver has spun off a business venture, teaching Six Sigma techniques to other facilities. "The reason we’ve done this is that there is a piece of Six Sigma we don’t think anybody does," he explains. "They don’t teach you how to set up the organization and the students so they are fully energized and have understanding of what Six Sigma means to them."
Beaver’s partner teaches the Black Belt course, injecting real-world examples. "But before he even touches a student, I work with them for two months so that the senior managers and the team are ready," he says. "Most people don’t really talk about the extreme importance of all leaders really being aligned with the flow of what’s coming."