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Brief History of a Process Improvement Methodology

[By Daniel L. Gee; MD]

The concepts of process improvement [PI] and total quality management [TQM] emerged after WW-II, when the Japanese auto and electronics industries, in a quest to capture the US marketplace, virtually re-coined the term “Made in Japan” from a trademark of inferiority, to a worldwide stigmata of quality and endurance.

First Used in the Automobile Industry

Toyota Motor Company soon became the ideal model to emulate by US companies such as Ford, Motorola and later, General Electric. The Deming model and subsequent Total Quality Improvement/Continuous Improvement [TQI/CI] management initiatives, copied from Japan, evolved with a passion when brought to America. The search for best practices led to the popularity of accolades such as The Malcolm Baldridge Quality Award; an award that became Olympic gold to a company’s marketing campaign.

The quality envelope was pushed further in the 80’s when Motorola Corporation augmented traditional improvement tools with a systematic problem solving method [think problem orientated medical record] based on rigorous statistical analysis. This evolution of a process-oriented problem solving approach soon became the genesis of what is now known as the Six Sigma Methodology.

Goals

The ultimate goal of the Six Sigma model is to find the root causes of variation in a business process, such as healthcare delivery, find the problems that created the variations, determine ways to measure them, and control (or eliminate) the process variations; with the intent of process improvement that has long-term sustainability. The achievement of quality to its greatest extent would be a measured in a quantifiable metric of “sigma”. The greater the sigma level reached, the more efficient the process. 

Six-Sigma Possibilities in Healthcare Delivery

In reaching the six-sigma level, there is almost no variation from the most desired efficient way of doing things. Is this ultimate goal of perfection too ambitious a goal for healthcare? Perhaps!

For service industries in general, and the healthcare industry, specifically, the goal of virtual perfection may be impossible by virtue of the significant number of variables involved.

But, one must consider the implications of a less than almost perfect system.

Mathematical Definition

The term “sigma” is from the 18^th letter of the Greek alphabet and represents the statistical symbol for standard deviation. In statistics, a standard bell shaped normal population distribution, one sigma represents a percentage variation from the mean, and two- sigma represents an even greater variance, and so on.

Variations of Virtual Perfection

In Six Sigma vernacular, the bell shaped curve becomes a representation of variation itself; in other words, achieving a “six sigma” process means virtual perfection in the upper standard limits of being 99.99966% good.

Assessment

And, so is the ideal of six-sigma possible in medicine today; or are there just too many variables in the delivery process? How does your perspective change as a physician, CEO, insurance company or patient?  

In other words: Is medicine really different?

Conclusion

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• INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
• Dictionary of Health Economics and Finance
• Dictionary of Health Information Technology and Security
• Dictionary of Health Insurance and Managed Care

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