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Taking a Lean Six Sigma Approach to Quality

Quality is a universal concept that spans across everything we do. We have clinical quality, performance quality, process quality, service quality, product quality, experience quality. Given the pervasive nature of quality it is subject to many influences. Who is to say what is good and what is bad? Who is to say what the perceptual and conditional attributes of quality are? There are standards and contradictions to the standards, there are anecdotal comments, there are differences of opinions. For such a universal concept it sure is difficult to pin down. But we need to pin it down to provide direction and focus for our actions and goals. In order to do this we utilize various quality tools. Lean Six Sigma is one tool that we utilize here at Summa.

As many of you may know, Lean Six Sigma has its roots in manufacturing as a methodology for addressing quality opportunities and utilizes tools that are decades old to solve problems. Over the last decade, Lean Six Sigma has become popular in the service industry, healthcare in particular. Lean deals with inefficiencies in your business whereas Six Sigma deals with the effectiveness of your processes. The reason why Lean Six Sigma exists is to provide clarity and a path for solutions to our quality opportunities.

In our healthcare environment, we experience a mix of inefficient and ineffective processes. Some of these are the result of regulations while many more are self inflicted harm. For nearly four years, Summa’s Integrated Innovations team has been promoting and using Lean Six Sigma and other quality improvement methodologies to improve performance and teach our employees how to improve their own processes.

Some of these improvements have led to clinical quality improvements such as the Catheter Associated Urinary Tract Infection reduction led by Nancy Reynolds at Summa Barberton Hospital and decreasing the time from Colorectal Cancer Surgery to First Chemotherapy Session led by Fred Slezak, M.D., Summa Physicians Inc. – Colorectal Surgery. Quality improvements across the system have been much more prevalent due to the utilization of these tools and methodologies.

Since Lean Six Sigma has been primarily used in other industries for various types of quality improvement, it is reasonable to expect that Summa should be focusing these tools on our own clinical quality “opportunities.” Therefore, in December 2014, we started the Clinical Performance Improvement (CPI) initiative using PDSA (Plan, Do, Study, Act) as our engine to drive improvement. PDSA is a quality improvement methodology variation on Lean Six Sigma. You can see Summa’s current list of projects at http://summaworks/cpi .

We have prioritized our hospital-wide improvement activities. From this prioritized list, we are creating project charters to clearly define the problem, goals, scope and timeline of each project. This charter helps the improvement teams stay focused. We are using action registers to track deliverables for each project. Beyond the utilization of these tools, our tool utilization will vary depending upon the project. We use the tools that are necessary to understand customer requirements, establish a baseline performance, ensure that our data is trustworthy, identify the correct root causes of our problems, select the best solution based upon the root cause, and sustain improvements.

What can you do to help?

  1. If you are trying to improve something, create a project charter and have it evaluated by Dave Orr or Chris Powers.
  2. Prioritize your work. It is better to work on one thing and complete it quickly than work on 50 things that never get completed.
  3. Make your projects measureable. If you cannot measure the outcome of your project, how can you claim improvement?
  4. Use action registers to keep track of the tasks.
  5. Work frequently on important projects to drive improvement.
  6. Never be satisfied with your performance as it is.


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