Get Well Soon

Health care systems can reduce errors through Six Sigma.

Medical errors became a national issue in 1999, when the Institute of Medicine issued a widely published report stating that medical errors in the United States contribute to up to 98,000 deaths annually.

According to the Oct. 8, 2003 issue of The Journal of the American Medical Association, which quoted an Agency for Health Care Research and Quality study from 2000, the most common medical injuries during hospitalization are:

• Postoperative sepsis infections, which result in a 22-percent higher risk of death, an additional cost of $57,727 and an extra 11 days of hospitalization

• Reopening surgical wounds, which results in a 10-percent higher risk of death, an additional cost of $40,323 and an extra 10 days of hospitalization

• Infection due to medical care, which results in a 4-percent higher risk of death, an additional cost of $38,656 and an extra nine-and-one-half days of hospitalization

Although the information above relates to it, the U.S. health care system is still one of the best in the world, and its error rate is far less than average worldwide. In some developed countries, the health care error rate is more than twice that of the United States; for developing countries, the error rate is much higher.

We need to start measuring our health care failures in deaths per million, not deaths per hundreds or thousands. Even deaths per million isn't a good enough measure for a health care system. The required standard should be measured in deaths per billion and errors per million. This is where proven preventive approaches such as Total Improvement Management and Total Six Sigma can provide real benefits. Both approaches have been refined in other industries, and they're now ready to lift the health care industry to a higher level of performance.

Although process capability techniques have been used extensively in manufacturing for more than 50 years, a breakthrough occurred when Motorola applied them to its business support functions as a logical extension of its manufacturing quality initiatives. In just two years, Motorola's business processes showed improvements of 10 to a 100 times what they'd been. In 1988, when Motorola won the Baldrige Award, the company credited its groundbreaking Six Sigma program as the primary driver of improvement. During the first part of the 1990s, Motorola continued its Six Sigma program, and it slowly spread into other organizations. In 1998, GE estimated that it saved about $750 million through Six Sigma techniques.

Six Sigma projects are designed to reduce error rates to a maximum of 3.4 errors per million exposures (or "opportunities") by using statistical analysis techniques, problem solving and quality principles. The typical health care organization has error rates of between 67,000 and 309,000 errors per million opportunities (or 3 and 2 sigma, respectively). Individuals, departments, projects, functions, plants or entire organizations can use this approach.

Because health care is about people as well as processes, the methodology behind Six Sigma is even more important than specific measurements of error rates. The Six Sigma process forces hospitals to measure elements that are important to the business of health care: quality, mortality, and customer and employee satisfaction. If a hospital says it's a patient-focused organization, what does that mean? If it claims to be patient-centered, then how does it measure that? If the hospital says it can't measure that claim, then is it really important to the organization? Most companies limit their measurement mechanisms to traditional accounting measurements such as income and expenses, but medical mistakes typically aren't measured and are generally underreported due to the threat of malpractice suits and the tendency to penalize individuals who report errors.

Using a Six Sigma methodology, the hospital will find ways to measure what's important to it by tracing and analyzing what it values most and how that it relates to the internal or external customer's needs. Organizations that can't measure what they say they value can't improve.

Although many health care organizations have attempted process improvement during the last 20 years, most initiatives have ended in disappointment. The discipline of the Six Sigma approach to quality through process improvement--as opposed to isolated quality attempts such as inspection and post-mortem reviews of errors--could be the medical industry's best opportunity to address lingering issues of quality and the resulting real costs that are added to any system, as well as and even more important, increased mortality rates when poor quality is the rule rather than the exception.

About the author
H. James Harrington is CEO of the Harrington Institute Inc. and chairman of the board of Harrington Group. He has more than 55 years of experience as a quality professional and is the author of 22 books. Visit his Web site at www.harrington-institute.com.