‘Operational Excellence’ employs new techniques

Six Sigma, CAP used at Providence

Under the banner of a comprehensive initiative called “Operational Excellence,” employees at Portland, OR-based Providence Health System are working to help their organization meet its strategic goals, says Nancy Roberts, regional director for integrated performance and Six Sigma champion. Access issues — including projects aimed at reducing outpatient wait times and enhancing patient throughput — have played a prominent role in the process improvement effort, she says.

Key among techniques being used to improve the efficiency and effectiveness of its business and clinical processes is the quality improvement and process-improvement strategy Six Sigma, Roberts explains. “Many times [to solve a problem] you gather people in a room and say, ‘What do we need to do?’ That’s the expert-driven approach. In Six Sigma, you might start there, but then you look for data to support what you need to do.”

A methodology with its roots in the manufacturing industry, Six Sigma has been used in health care only in the past six or seven years, she says. “It’s a very vigorous [methodology] to reduce errors in any kind of process. The key elements are the strong use of data to drive decision making and that it’s very customer-focused.”

Using the concepts “define, measure, analyze, improve, control,” commonly referred to as DMAIC, Six Sigma works “in quite a linear way,” Roberts explains. “Six Sigma is helpful in analyzing existing processes to find why they’re not producing the desired results and analyzing data to determine what you need to fix.”

At the same time, Providence is using a change management tool that is designed “to help organizations be better at incorporating and implementing short-term and long-term effective change,” she adds. “We’ve meshed it together with our use of Six Sigma.”

Although it’s easier to get results in the early phases of a project “when there’s a lot of attention on it, a lot of monitoring,” Roberts points out, the challenge is in maintaining the change over time. Providence is using a change management tool from General Electric called Change Acceleration Process (CAP), but there are a number of others available, she says. “Basically, the theory behind CAP is that in order to effectively move to an improved future state, both people and teams need to work through stages.”

It’s about “creating a shared need” by asking “Why do we need to change?” and shaping a vision by asking “What does the future look like?” she adds. “You make sure people are getting feedback on how the new world is working, and some of it is control charts and graphs,” Roberts says. “We are, in fact, doing this, and it is having the impact we wanted.”

Unlike Six Sigma, she notes, “the CAP model is not linear. You can loop back around when you’re doing change management work.”