Kalra Jay*
Department of Pathology and Lab Medicine, University
of Saskatchewan and Royal University Hospital, Saskatoon, Canada
*Corresponding author: Kalra
Jay, Department of Pathology and Lab Medicine, University of Saskatchewan and
Royal University Hospital, Saskatoon, Canada. Tel: +13066552152; Email:
jak316@mail.usask.ca
Received Date: 26 September, 2018; Accepted
Date: 28 September,
2018; Published Date: 02 October,
2018
2.
Introduction
Quality Improvement (QI) is a promising and necessary
component of improving the quality of care in the healthcare sector. It
represents a systematic approach of implementing and sustaining continuous
improvement. QI includes the use of trained and experienced staff, efficient in
planning and implementing these processes for creating a culture of continuous
quality improvement [1,2]. The quality of care
delivered by clinicians is recognized by the performance standards of the
organization in which they work [1]. Although
the standards of care delivery are dependent on the individual, in the current
scenario, the ability of the organization to prevent medical and diagnostic
errors, to coordinate care and provide seamless flow of information among
practitioners and other caregivers, are considered critical elements in
delivering quality care. Organizations around the world need to revamp their
care delivery systems by measuring outcomes and finding improvement activities
to meet the desired outcome in patient care [3].
Healthcare is a dynamic environment and is in a state
of constant transformation. Therefore, it presents new risks all the time. In
such a scenario, it is not feasible or sufficient to implement traditional QI
tools like Continuous Quality Improvement (CQI) or Total Quality Management
(TQM), which makes it important to identify and implement refined quality
management systems [3,4]. In order for the
healthcare system to operate at its fullest potential and to ensure quality
care, there are six attributes that must be monitored. These are “safety,
effectiveness, patient-centeredness, time, efficiency, and equitability” [5]. To address these attributes, the healthcare
sector should look to industrial-grade measures and methods for improvement.
However, the attainment of industrial-grade quality in healthcare is far from a
reality, as they are far ahead in innovating and enhancing the quality of
delivery as compared to healthcare [6]. The
healthcare industry has been on the frontline of innovation by applying newer
quality control techniques to generate high-quality services with a lower error
rate. On the contrary, the healthcare sector has not invested sufficient effort
in to implementing sophisticated quality control applications. Therefore, the healthcare
sector has been unable to keep pace with industrial innovation in quality care
due to the high volume and complexity of factors involved in the healthcare
environment [7].
The major challenge in adopting QI techniques is in
making QI an integral part of an institution’s initiative to create a culture
of patient safety. To improve quality standards, it is important to train
individuals with experience and expertise. Consultants are very important in
the initial stages of setting up a system. However, QI tools like “Six Sigma”
and “Lean” face resistance from front-line staff who see these initiatives as a
roadblock to their work. Managers are not very cooperative in releasing their
staff to become trained and to participate actively in QI initiatives. Medical
staff might have an ignorant attitude toward these initiatives by considering
QI or Six Sigma as just another monthly human resources activity [8,9]. The complex nature of the profession and the
variability in its processes make it challenging to implement traditional QI
techniques. The dynamic nature of the healthcare environment makes it
challenging to enforce step by step processes and protocols, with precisely
defined steps and guidelines, which is an industry norm [9]. In order to develop a sustainable QI model, it is very
important to train and nurture talent in-house [10].
The success of a project is dependent on two factors, well-trained staff and
acceptance of the QI initiative by all the individuals who are directly or
indirectly affected by it.
The best-tested method to improve quality issues in
the healthcare domain would be the Six Sigma Model, a quality improvement tool
trademarked by Motorola and perfected by industrial and manufacturing
industries [6]. Six Sigma is a quality concept,
however, according to Magnusson et al, it is a business concept [11]. Strategies, organizational structures, processes
and methods are interrelated, and the effective utilization of this
interrelationship makes the Six Sigma strategy effective. Six Sigma has gained
significant interest in statistical and quality improvement analytics circles.
The initiative also has caught the attention of leaders in business and
financial sectors, as well as in the healthcare sector [3,9].
Identification of the customer’s idea of quality is critical to the development
of standards and processes that constantly and consistently deliver error-free,
high-quality service. Six Sigma utilizes a project management approach for the
implementation of projects, and the benefit of the customer is paramount to the
success of the project.
The Six Sigma model uses defects per unit to measure
quality. A system is performing at a world-class level when it is operating at
the level of Six Sigma, which translates to 3.4 defects per million. Because of
the sheer number of people using health care services, even a small percentage
of error can result in negative health outcomes for many. Currently, the health
care system is operating at only a three sigma level. Not only does the Six Sigma
model help to reduce error, it also helps to reduce costs and improve
efficiency, and results in better client-patient satisfaction. Six Sigma uses
the DMAIC model, which stands for Define, Measure, Analyze, Improve and
Control. Each word is a step in the process of implementing Six Sigma [10]. According to Scalise, the use of the Six Sigma
Model in hospitals reduced emergency room wait times and decreased diagnostic
lab delays, among other positive effects [6].
Some hospitals may be wary of implementing Six Sigma, as the cost of training
is quite high but the downstream benefits and savings greatly outweigh any
initial costs. Appropriate utilization of Six Sigma produces higher efficiency
in operations and a better cost-benefit ratio [9].
In hopes of improving quality care in Sweden, the Six
Sigma model was implemented in the Skaraborg Hospital Group (SKaS) that
consists of four hospitals. The study was completed in a three-year period,
between the years of 2006-2008. SkAS had participated in quality development in
the past. One initiative involved the creation of a process education program
that encouraged staff to report issues in daily operations during the two-day
education program, which resulted in many new projects but did not address
organizational change as a whole. Despite having other quality care initiatives
in place, various projects lacked communication and therefore were unable to
work together toward a long-term goal [2]. To
address these issues, the senior management team and development director
decided to introduce the Six Sigma model with the goal of decreasing error and
improving patient health outcomes. A template with questions was created to
identify areas that were of critical importance. The project managers were
recruited internally, and physicians were recruited as participants in the
project groups. Twenty-two projects were initiated and twenty were completed in
the three-year time frame. The completed projects had a success rate of 75% and
had an average net savings of US $55,300 [2].
Not only did the projects address issues within quality care, they also worked
to save the SKaS hundreds of thousands of dollars, greatly outweighing any
initial costs of implementation.
Other governments wishing to implement Six Sigma can
draw conclusions from areas of success from the SKaS study as a model for how
to implement successful projects. SKaS found that successful projects had
several common factors, including “commitment from clinical management and
steering committees, involving co-workers and physicians in the projects, use
of the DMAIC roadmap, and continued communication of project progress” [2]. The successful projects in SKaS implemented with
the help of Six Sigma show the importance of a team-based approach in
addressing medical error and improving the quality of care. Before medical
errors can be reduced, however, the healthcare system as a whole must undergo
both structural and cultural change. Human error is an unavoidable risk in
healthcare, although with a system overhaul and the introduction of the Six
Sigma Model, medical error can be greatly reduced. The current culture of blame
and hierarchical structure must be replaced by open and honest reporting
systems and a collaborative care team approach. It is important to recognize
the value of the expertise that all types of health care practitioners bring to
the table. With these changes implemented at a federal level, hospitals will
become safer environments not only for patients but for all healthcare
practitioners [8,12].
The Six Sigma concept aims at an overall improvement
in the quality of the process as a fundamental goal in healthcare services,
thereby improving the performance of the process exponentially. The healthcare
industry is still in the nascent stages of using sophisticated quality
improvement tools. Therefore, personnel in the healthcare industry should seek
guidance and training from top management consultants. Executing small-scale
projects successfully will empower practitioners to implement these changes on
a larger scale. The goals of Six Sigma are impressive and set demanding
standards, which appear to be more compatible with patient safety. Quality
improvement using Six Sigma initiatives as a business strategy will enable the
healthcare industry to provide patients with the highest level of service and
care.
3.
Conflict of
Interest
The author declares no conflict of interest exists.
editorial article