Mar

Volume 3
Special Edition 1
The Six Sigma Supply Chain in Healthcare

2002
In This Issue...
By Don Redinius, Managing Partner, Six Sigma Qualtec
Six Sigma was born nearly twenty years ago and, like all new
The Promise of Six things, it has evolved and matured. Through its various
Sigma: “Getting experiences, Six Sigma has been shaped into one of the most
Better Faster” powerful problem solving, business and quality improvement
Page 3 methodologies available today.

Implementing Six The first businesses to experience Six Sigma were in the high-
Sigma to Achieve tech manufacturing industry. The industry’s complex product
“Breakthrough” problems provided a formidable testing ground for the new process.
Later it was applied with great success to administrative, or transactional, processes.
Results
Today, Six Sigma can be found in most fields of economic endeavor.
Page 7
Healthcare systems, in their drive to improve quality, reduce costs and enhance financial
Six Sigma Without
performance, have discovered Six Sigma and its long history of performance in other
Tears
U.S. industries. Healthcare is traditionally defined as the delivery of treatment and
Page 8
services to people in need of medical attention. Yet the industry’s performance is heavily
reliant on a vast and complex supply chain of companies working to design, produce,
Six Sigma: Using deliver, and manage a wealth of health and medical related products and services.
Statistics to Reduce Although doctors, nurses and hospitals are at the center of this massive and complex
Process Variability industry, they represent only a small portion of its influence.
and Costs in
Radiology A number of companies within the healthcare supply chain have already implemented
Page 11 Six Sigma and are discovering impressive results. Perhaps the most publicized company
is General Electric that adopted its Six Sigma agenda in 1995. Other notables include
North Shore - Long GlaxoSmithKline, McKesson and Johnson & Johnson. In addition, hospital systems
Island Jewish Health like Mount Carmel Health System, Commonwealth Health Corporation, Order of Saint
System Teams with Francis, Charleston Area Medical Center, Yale-New Haven, North Shore Long Island
GE & Harvard Jewish Health and Froedtert Memorial Lutheran (to name a few) have implemented, or
Page 19 are in the process of implementing, Six Sigma.

Commonwealth Mount Carmel Health System of Columbus, Ohio has successfully implemented Six
Health Corporation, Sigma after years of trying a variety of “more traditional” health care quality improvement
the Healthcare programs with varying degrees of success. Mount Carmel has produced positive margins
Pioneer of Six Sigma in recent years. But, like all hospitals, it faced declining reimbursements and rising
Page 22 expenses. Mount Carmel leaders sought an initiative that would significantly improve
its operational processes and enhance its financial performance, eventually settling on
Operational Six Sigma in July 2000.
Excellence- be the
benchmark Mount Carmel leaders don’t view Six Sigma as just another quality program. Rather,
Page 23 they consider it a business management system that not only improves quality, but
also improves employee morale and reduces expenses. Last year, the system

Supply Chain continued on page 17

 ΣXTRAOrdinary
Pr esident’
esident’ss Corner
President’
Sense
By Roxanne O’Brasky, President, ISSSP PUBLISHED BY
International Society of Six Sigma
Dear Members: Professionals

7678 East Greenway Road

Welcome to a special edition of EXTRAOrdinary Sense. In ISSSP’s Scottsdale, AZ 85260
continued pursuit of its mission to educate and advance the Six Sigma
methodology, we’ve dedicated this issue to a focused initiative that represents a significant Tel 480-368-7083
Fax 480-585-0640
milestone in the history of quality management in business. www.isssp.com

The health care industry has long been plagued by a wealth of obstacles. Few industries have Editor-in-Chief:
Heather Redinius
faced the sheer volume of challenges – both internal and external – that limit the ability to
Editor@isssp.com
evolve and improve. This dynamic has offered a formidable opportunity for healthcare industry
management and traditionally accepted quality initiatives alike. With it’s lengthy high technology President: Roxanne O’Brasky
and broad industry track record, Six Sigma has come to healthcare in recent years, bringing RoxanneO@isssp.com

with it limitless potential for improved efficiency, productivity and service delivery, not to mention Chief Technology Officer:
the great potential for cost savings passed to customers like you and I. Ken Kaplan
KenK@isssp.com
The challenges that healthcare represents for Six Sigma sets the stage for ISSSP’s newest Vice President Business Services:
educational and development campaign. This effort represents the first time our organization Robert Swagerty
has brought together players from all facets of the healthcare industry. Pharmaceutical BobS@isssp.com
companies, equipment manufacturers, suppliers, providers and practitioners alike will share
Information Management Director:
their experience, their concerns, and their ambitions in an exciting forum for the benefit of our Edna Cribb
collective membership. EdnaC@isssp.com

Membership Director:
While such opportunities will be exhibited through insight-filled programming — including Jeannette Kesmarki
roundtables and workshops like the upcoming Healthcare Symposium on April 29 — the overall JeannetteK@isssp.com
vision for this campaign is unveiled in the pages that follow. Special thanks to our corporate
Creative Director:
sponsors for the support they have shown for this new program. If your company represents
Heather Redinius
healthcare interests and you would like to get involved with this exciting new campaign, please HeatherR@isssp.com
don’t hesitate to contact ISSSP. We’d love to have you on board.
ΣXTRAOrdinary Sense is the official
publication of the International
This program is only a small taste of what is to come from ISSSP in the coming months. In Society of Six Sigma Professionals.
order for us to continue to provide this sort of best-in-class association content, ISSSP launched All rights reserved.
a formal membership campaign last month. We are confident that you will find the small
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Don’t forget to mark your calendar for the 3rd Annual Leadership Conference June 23—26 in Submissions
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Since our inception in Jan 2000, we have been learning from more than 10,000 members about
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2 ΣXTRAOrdinary Sense March 2002

The Pr omise of Six Sigma: “Getting Better FFaster”
Promise aster”
By Ian R. Lazarus, FACHE and Beatriz Stamps, MD MBA
How can you tell when an investment in quality
improvement has truly paid off? Quality
improvement consultants have suggested that
“quality is like pornography…you know it when
you see it.” But chief executives and senior
managers clearly need more tangible
measures for their investments in quality
improvement and management effectiveness.
Six Sigma, on the other hand, has done more
than demonstrate improvements in quality; the
techniques and philosophy of Six Sigma have
fundamentally changed the way healthcare
executives view their business. According to
John Desmarais, CEO of Commonwealth
Health Corporation (Bowling Green, KY), “it’s
the single most important thing we have done
in the history of our organization.” Indeed, when a quality
improvement initiative has truly impacted the entire organization
as it did at Commonwealth, the payoff is everywhere you look.
Six Sigma provides both the framework and tools to “get better
faster,” a combination of statistical tools and project management
techniques that enable managers to clearly define problems,
measure and analyze them, and reach sustainable improvements
in practice. Six Sigma recognizes that “variation is the enemy of
best practices,” and it targets excessive variation and waste within
the system to achieve its intended goal of reducing defects,
improving profits, and delighting customers. It has been credited
with saving literally billions of dollars among the manufacturing
sector, including such heavyweights as General Electric, Motorola,
Honeywell and Allied Signal.
That Six Sigma has a home in healthcare has already been amply
demonstrated by pioneering CEOs like John Desmarais from
Commonwealth and Joe Calvaruso at Mount Carmel Medical Center
in Columbus OH. The commitment of CEOs to the process also
sends an important message to future proponents: Six Sigma will
not work without a commitment from the top, and without it, there
is no point in ever getting started. Senior management commitment
to Six Sigma is critical because the process will invariably cut
across department lines and change job functions. It will also
require that the organization take its best people out of comfortable
roles and into the front lines of new initiatives.
The popularity of Six Sigma in healthcare was clearly evident at
the second annual Six Sigma Leadership Conference, held last
October in Scottsdale AZ. Sponsored by the International Society
of Six Sigma Professionals, the conference featured six
3 ΣXTRAOrdinary Sense
presentations by health system executives, even though the event
represented both manufacturing and service industries. “The
healthcare industry, which has focused so much effort on the
development of best practices, has a tremendous opportunity to
gain from the application of Six Sigma principles,” notes Roxanne
O’Brasky, President of ISSSP.
A new compass. Most Six Sigma projects begin with a definition
of healthcare deliverables that are critical to quality, delivery and
price (see illustration). These tie inevitably to existing functions
within the enterprise, and can be measured through the rate of
defective procedures, length of stay, and cost. All too often,
healthcare organizations find that their processes were designed
around the convenience of their staff and physicians, and not the
customer or patient. Ironically, physicians become strong
proponents of Six Sigma programs once they understand the
scientific basis and practical benefits of the methodologies.
Six Sigma Aligns Patient Goals
with Strategic Goals
Patient
Satisfaction
Quality
Price/
Delivery
Value
Length
Outcome Cost
of Stay
Hospital
Goals
Six Sigma applies customer-driven measures to process improvement;
Customers can be patients, physicians, and employees.
CHC
Creative Healthcare USA
It’s hard to ignore the potential and broad appeal of Six Sigma
Cost
when talking to its proponents. Dr. Glenn Crotty, MD and COO of
the Charleston Area Medical Center insists that “Six Sigma quality
is more than a goal. It is a commitment woven deeply into the
fabric of everything we do.” The changes caused through Six Sigma
are “awesome and exciting” according to Lisa Thomerson, Six
Sigma Corporate Champion at Commonwealth Health Corporation
in South Central Kentucky. “Our CEO as well as our senior leaders
Promise continued on page 4
March 2002
Promise continued from page 3
CAMC. CAMC has moved forward on many additional Six Sigma
are fully behind it. John Desmarais is full of passion. His projects, with stunning results (see illustration).
commitment is tremendous.” To date, Commonwealth has invested
about $900,000 and has realized improvements well in excess of Out of control. In Six Sigma jargon, a process is said to be “in
$2.5 million. control” when it operates within acceptable specification limits.
At Scottsdale Healthcare (AZ), the process of “Bed Control” was
Spare parts. There are multiple day-to-day applications of Six decidedly “out of control.” The process of locating a bed and
Sigma in the healthcare and managed care setting. Typical projects transferring a patient from the Emergency Department to the
include billing office, supply chain management, emergency inpatient unit consumed fully 38% of the total time within the
department, operating room, high volume DRGs and analysis of department. Six Sigma consultants defined this problem as a
high cost admitters. Charleston Area Medical Center (CAMC), a “defect” and through additional analysis, found that the problem
919-bed three campus medical center in Charleston, West Virginia, was not locating a bed, but reducing the number of steps required
focused on supply chain management to test the potential of Six to make the transfer possible. The hospital employed the use of
Sigma methodologies. Upon reviewing and identifying this project an Administrative Nurse to perform “inspections” by locating beds
they found a $1.7 million opportunity within the inventory of surgical on different floors, and this process actually complicated the
equipment that remained in storage for over a year. Over 50% of process rather than expediting it.
this inventory were in orthopedic trays. Further analysis revealed
that old items were not being removed from shelves when new The process at Scottsdale Healthcare violated two arguments of
products replaced them. Once Six Sigma techniques were utilized Six Sigma: that inspection is fundamentally unproductive, and
to assess improvements from more rapid turnover of inventory, the more interim steps you add to a process, the more you reduce
specific team members were assigned to negotiate with each the potential yield on that process. As a result of eliminating the
principal vendor. Administrative Nurse position and through related streamlining
techniques, the hospital reduced the cycle time for bed control by
Requests for immediate refunds or “forward sales arrangements” 10%, increased ED throughput by an estimated 0.1 patients per
were made that included no future requirement for bulk purchases. hour, and produced nearly $600,000 in incremental profit. The
The medical center also initiated more rigorous inventory review hospital system is now considering the application of Six Sigma
procedures as part of Six Sigma’s “control process.” Today, there in improving the performance of specific DRGs.
are plans for a just-in-time inventory system with a centralized
Culture Shock. Beyond obvious financial measures, the most
procurement database for all 3 hospitals. Although the initial
savings in this project was merely $163,410 (from returned significant change across these profiled institutions has been the
merchandise), future cost avoidance is estimated to be $841,540,
development of performance improvement cultures. But what makes
Six Sigma different from previous quality management programs?
according to Beverly Begovich, a fulltime Six Sigma Black Belt at
Ms. Thomerson from Commonwealth suggests
“staff and involved physicians are buying it
Six Si Sigmgm
gma a Pr
Proo jec
ject t Po tential
Potential because it is data-driven, and is based on
statistical analysis. It points to specific
One Hospital’
Hospital’ss Experience problems. Physicians understand and support
this analytical approach to problem solving and
Project Validated Savings LT Cost Avoidance improvements. They practice it everyday.” “Six
Supply Chain Management $163,410 $841,540 Sigma gives practical applications to get
“Captain of the Ship” 519,000 790,000 projects started and to get them done quickly.
People are tired of forever committees,” adds
Denials 232,637 425,000
Ms. Begovich from CAMC.
Results Reporting 367,621 341,000
Medication Safety 31,774 242,777 Commonwealth Health Corporation’s, Six
Sigma vision (posted plainly on their website)
ED Wait Time 100,000 202,428
is that “by the year 2004, we will be proudly
HR Recruitment 32,000 124,430 recognized by our employees, patients, clients,
Physician Satisfaction 39,780 66,000 community, physicians and payors as the
unquestioned leader in care and service,
CHC
Creative Healthcare USA Promise continued on page 5

4 ΣXTRAOrdinary Sense March 2002

Promise continued from page 4

providing flawless quality never before achieved in the healthcare Black Belt Training
industry.” Their dependence on these techniques to deliver such March 25 - 29, 2002 (Measure Phase)
April 22 - 26, 2002 (Analyze Phase)
impressive results is a testament to The Promise of Six Sigma.
Minneapolis, Minnesota
Provided By: Breakthrough Management Group Inc.
“Shaken, not stirred.” If the culture of an organization can be Visit www.bmgi.com for more information!
described as a product of its “corporate DNA,” then Six Sigma
aims to reshape the DNA of the organization, and to create a Lean Six Sigma Executive Roundtable
highly effective organism in the process. Its promise of “disruptive March 14, 2002
Atlanta, Georgia
innovation” is cause for optimism and hope in an environment of
Provided By: George Group
regulatory and market constraints that are stifling in its effects. Visit http://www.georgegroup.com/events/events.asp
But CEOs considering Six Sigma must be careful not to push too
hard or too fast. As with any cultural change, the process of ToolMaster
introducing Six Sigma must be approached with patience and March 18 - 21, 2002
leadership. Minneapolis, Minnesota
Provided By: Breakthrough Management Group Inc.
Visit www.bmgi.com for more information!
Although the development of knowledge workers has been
recognized as one of the most impactful competitive strategies Lean Six Sigma Executive Roundtable
available to service industries, implementing such a strategy in a March 19, 2002
healthcare enterprise can feel like trying to boil the ocean. Houston, Texas
Because change is uncomfortable, CEOs can expect initial Provided By: George Group
Visit http://www.georgegroup.com/events/events.asp
resistance and anxiety in connection with these efforts. If not
addressed early on, any of the following conditions can ultimately Lean Six Sigma Executive Roundtable
lead to a failed attempt at implementing Six Sigma methodologies: March 22, 2002
Dallas, Texas
Lack of understanding of Six Sigma principles Provided By: George Group
Ambivalent involvement of senior management Visit http://www.georgegroup.com/events/events.asp
Lack of broad participation and involvement
Lean Six Sigma Executive Roundtable
Dependence on consensus-based decisions April 4, 2002
Initiatives too broad or too narrow in scope Chicago, Illinois
Failure to attack cultural impediments Provided By: George Group
Visit http://www.georgegroup.com/events/events.asp
Ultimately, the CEOs job in implementing Six Sigma is to engineer
Champion Training
a cultural change first that recognizes the moral imperative of the
April 9 -11, 2002
organization to forge new ground in performance improvement. Buffalo, New York
Attitudes that suggest “we are the best we can be” must be Provided By: Breakthrough Management Group Inc.
replaced with “we must get even better.” Constant monitoring to Visit www.bmgi.com for more information!
ensure quality must be replaced by systems and controls that
make defects nearly impossible. On one hand, it may seem that Lean Six Sigma Executive Roundtable
April 18, 2002
Six Sigma demands as much from the organization as it delivers
Detroit, Michigan
in return. This may be a valid observation, but you do not hear Provided By: George Group
any of its proponents expressing anything but enthusiasm and Visit http://www.georgegroup.com/events/events.asp
anticipation from the promise that Six Sigma can offer them.
ISSSP Six Sigma in Healthcare Symposium
Reprinted with permission from the January 2002 issue of Managed April 29 - May 1, 2002
Healthcare Executive. No reproduction permitted without express St. Louis, Missouri
written consent of authors and publisher. All rights reserved. Provided By: ISSSP
Visit www.isssp.com/symposium01.htm for more details!
Ian R. Lazarus, FACHE and Beatriz Stamps, MD MBA are principals
with Creative Healthcare USA (www.creative-healthcare.com) a ISSSP 3rd Annual Six Sigma Leadership Conference
consulting firm providing strategic advisory services, including Six June 23 - 26, 2002
Sigma consulting, to healthcare providers and suppliers. You may Chantilly, Virginia
contact either Mr. Lazarus or Dr. Stamps at 1.888.376.8652.
Provided By: ISSSP
5 ΣXTRAOrdinary Sense March 2002
13th Annual National Forum on Quality Improvement in Health Care
By Bob Swagerty, VP Business Services, ISSSP
Our ISSSP team returned in December from the Institute for
Healthcare Improvement Conference in Orlando, Florida and
quickly assessed the impact that Six Sigma can have on the
healthcare industry in the coming months and years. We
presented our sponsoring Affiliates and spoke with hundreds
of attending physicians, executives and quality leaders from
all across the world. Our learnings were significant.

First, there is a real and verified interest in Six Sigma methodology, within the Healthcare industry, to provide industry wide solutions
and help solve the mounting problems of inefficiency and patient dissatisfaction. This was expressed in the Six Sigma session, “Six
Sigma: Is it for Us? From Experiment to Strategy”, presented by Randal Linton, MD, President and CEO Elect, Luther Midelfort - Mayo
Health System, and later reiterated by the many attendees that visited our booth over the two days.

Secondly, Healthcare groups seem to be in an exploratory phase and need answers to questions concerning the Six Sigma methods
and best practices. How can it help them? Who can they go to for answers? At what level are they able to enter and reap the benefits
of process thinking across their operation.

As a result of our learnings derived from our conference presence, we have developed our Six Sigma in Healthcare Campaign that will
help organizations throughout the Healthcare supply chain investigate the power of the Six Sigma solution. This campaign will provide
the many healthcare providers interested in Six Sigma a platform to acquire answers to their questions. All of this leading up to our Six
Sigma Healthcare Symposium - “Six Sigma in Healthcare: Exploring the Opportunities”, scheduled for St Louis, April 29 - May 1,
2002.

CHC
Creative Healthcare USA
Creative Healthcare brings
Six Sigma performance to the healthcare industry.

We are the only services firm specializing in Healthcare consulting,

Six Sigma projects and Medical Staff management.

Change Management is tough enough! Don’t compromise on the fit...trust your

engagement to Healthcare Specialists
with 100 years of collective experience.

Call today for our Free Guide...A Primer on Six Sigma for Healthcare Providers
Creative Healthcare USA
www.creative-healthcare.com
info@creative-healthcare.com
1.888.376.8652

Ian R. Lazarus, FACHE Daniel Gee, MD, MBA Beatriz Stamps, MD, MBA
6 ΣXTRAOrdinary Sense March 2002
Implementing Six Sigma to Achieve “Breakthrough” Results
By Jeffrey Burnich, M.D., and Tammy Weidner, R.N., MBA, Mount Carmel Health System
In the spring of 2000, Mount Carmel Health
System -- a three-hospital system in Colum-
bus, Ohio with 7,300 employees and a medi-
cal staff of 1,200 physicians -- was experi-
encing severe financial challenges like many
healthcare systems nationally.
The senior management team realized that
we needed to drastically improve our finan-
cial performance, and that incremental im-
provement wasn't going to be sufficient -- we
needed a breakthrough level of improvement.
At about that time, Mount Carmel's CEO and
its Chief Quality Officer each began reading
about Six Sigma without the other's knowl-
edge. They both came to the conclusion that
Six Sigma had the potential to help the orga-
nization achieve breakthrough results.
Mount Carmel selected Breakthrough Management Group (BMG),
Scottsdale, Ariz., to help facilitate our deployment of Six Sigma
throughout the organization, a process that began in the summer
of 2000.
Leadership Buy-In And Infrastructure Development
Our deployment began with a two-day broad overview of Six Sigma
system for the senior management team, ensuring buy-in and sup-
port for the implementation. The Chief Quality Officer was se-
lected to provide executive oversight of the deployment, and a vice
president's position was converted into the dedicated role of Vice
President of Six Sigma to direct the day-to-day implementation
activities.
Next, an in-depth, week-long training session was held for those
within the organization who would likely become Six Sigma Cham-
pions responsible for identifying and overseeing Six Sigma projects.
This group mostly included the senior management team as well
as vice presidents (we currently have 16 active Six Sigma Champi-
ons).
Then, a Six Sigma core team was formed with the responsibility of
developing the infrastructure necessary for the successful deploy-
ment of Six Sigma at Mount Carmel. The core team was cross-
departmental, including representatives from finance, human re-
sources, information technology, communications, as well as learn-
ing and education. The core team received a full week of training
and met for two-day working sessions every month during the early
7 ΣXTRAOrdinary Sense
stages of deployment, with additional committee work as needed.
The responsibilities of the core team included developing job de-
scriptions and a compensation program for Six Sigma black belts
(which the organization prefers to call Six Sigma Guides); prepar-
ing the strategy for training black belts; ensuring the information
technology resources necessary to track Six Sigma projects; de-
veloping the tools and metrics for measuring and validating the
financial returns of Six Sigma projects; and preparing a strategy for
communicating Six Sigma to Mount Carmel's internal stakehold-
ers -- especially managers, employees, and physicians -- as an
important new strategic initiative the organization was undertaking
as an investment in its future.
Black Belt/Brown Belt Strategy And Training
We selected a total of 44 employees from among the organization's
best staff in two training waves to serve as black belts, and an
additional four employees to serve as brown belts (which Mount
Carmel prefers to call Six Sigma Scouts). While black belts as-
sume their positions on a full-time basis in working on Six Sigma
projects, brown belts retain their functional responsibilities and ful-
fill their brown belt responsibilities part-time in helping scope projects.
We are now in the process of implementing a green belt strategy to
train select employees in the Six Sigma methodology so that they
can pursue less complex Six Sigma projects in their functional
areas of responsibility and/or assist black belts on their projects
on a part-time basis.
To avoid adding unnecessary labor expense, only a few of the black
belts' previous positions were back-filled. We knew that this ap-
proach would cause some consternation in affected departments
since we were taking one of their best employees our of their role -
- and asking the remaining employees to absorb the workload among
themselves. We acknowledged the sacrifice we were asking them
to make, and promised them that they eventually would begin to
see positive benefits as these black belts helped fix problems in
work processes that were a source of frustration and dissatisfac-
tion for them.
The black belts and brown belts received four weeks of intensive
training, one week each month for four months, while spending the
other three weeks applying what they were learning by working on
an actual Six Sigma project during the training period. The first
wave of black belts graduated in March 2001, and the second wave
in July 2001
Organization-Wide Deployment
Rather than limiting the implementation of Six Sigma to one de-
Breakthrough continued on page 9
March 2002
Six Sigma Without Tears:
Tears:
How Healthcare Providers can Effectively Integrate Six Sigma into CQI
By Rick Tucci, President, Leap Technologies, Inc.
Picture this: A meeting of the senior staff at a
regional integrated healthcare provider after
attending the recent IHI Quality Improvement
in Healthcare Conference in Orlando, Florida.
COO, Administrative Services…“There
seemed to be a lot of attention around Six Sigma
at the conference. The results being reported
by a number of our peers are impressive. Maybe we should
consider launching a Six Sigma initiative. What do you think?”
Director of Patient Care…“I’m all for getting a bigger return on
our CQI (Continuous Quality Improvement) initiative, but I’m worried
about the time commitment required. Where will these full time
Black Belts that Six Sigma relies on come from? We’re short
staffed as it is!!”
Director of Engineering Services…“I’ve had a number of QATs
(Quality Action Teams) launched in my department since we started
CQI. For the time and resources committed, I haven’t seen the
return. If Six Sigma will get us some concrete cost savings, I’ll
support it. But I wonder if it’s overkill. A lot of the safety and cost
problems we have require basic blocking and tackling.”
Manager, CQI…“I’d be crazy to say no to anything that will improve
our CQI effort. But, I’m very skeptical about our ability to take on
any new quality tools or programs. The fact is we have trouble
today getting consistent participation on our CQI councils and
QATs. We’ve invested in quality tools training, including SPC. It
feels like Six Sigma is a solution to the symptom, not a response
to the root causes of our CQI problems.”
COO, Administrative Services…“I appreciate everyone’s
concerns and will admit that we’re in no position to spend a million
dollars on anything right now. Nonetheless, I’d sure like to be able
to tell our Board that we aren’t sitting here with our heads in the
sand when it comes to CQI.”
The Six Sigma “Cross Roads” for Healthcare Providers
The fictional conversation described above is in fact taking place
in the executive offices of many healthcare provider organizations.
The debate about Six Sigma is a critical one, because the stakes
are high – both in risk and return.
8 ΣXTRAOrdinary Sense
What’s clear is that making real breakthroughs in quality
performance is more likely with Six Sigma versus conventional
TQM methods. The discipline of the DMAIC model, the dedication
of highly trained full-time project leaders (Black Belts) and the
emphasis on improving performance measurement systems has
produced faster and bigger gains over other quality improvement
methods.
What’s much less clear, however, is how to go about implementing
Six Sigma in healthcare provider organizations without adding
greater burdens to an already overtaxed workforce; without
disenfranchising the internal CQI staff; and without busting the
budget.
Taking a Balanced Approach
A real-world recent experience with a regional healthcare provider
offers a useful case example of what to do and what not to do in
“crossing the road” to Six Sigma.
Lesson One: Don’t Buy the Whole Six Sigma Farm
Once on the radar screen, Six Sigma can take on an “all or
nothing” or “nothing else works” aura. The message from some
Six Sigma consultants seems to say, “You’re not serious unless
you train everyone on Six Sigma philosophy, build a critical mass
of Black Belt project leaders, invest in a special Six Sigma support
infrastructure and do it all fast with a big budget commitment.”
This approach can pay dividends in giant multi-national companies
where the potential for cost savings justifies the large, upfront
investment.
However, for the majority of companies, this approach is simply
not affordable or smart business.
At the aforementioned healthcare provider, for instance, the
executive team rejected proposals for an organization-wide Six
Sigma launch with price tags starting at $500,000. Instead, the
team chose a focused project approach that offered a just-in-
time, pay as you go plan for deploying Black Belts as each Six
Sigma project opportunity emerged.
Tears continued on page 15
March 2002
Breakthrough continued from page 7
partment, Mount Carmel adopted an organization-wide deployment.
All business units across the organization have been expected to
use the Six Sigma methodology and the black belt resources to
tackle business problems that drag down financial performance
and act as a source of patient, employee, and physician dissatis-
faction.
Additionally, Six Sigma is now the established methodology in the
organization's Performance Improvement Plan which is reviewed
by the Joint Commission on Accreditation of Healthcare Organiza-
tions.
"Soulful" Six Sigma
We read in the Six Sigma literature that as
a result of efficiencies achieved through Six
Sigma, an organization could save money
by eliminating positions. Early on in our
implementation, the senior management
team committed to a more “soulful” approach to deploying Six
Sigma at Mount Carmel by taking into account the potential impact
of Six Sigma projects on employees.
We didn’t think that our corporate culture would accept or embrace
any other approach to implementing Six Sigma, and we needed
the enthusiastic support and cooperation of our managers and
employees to make the deployment successful and realize the
expected benefits.
If positions are eliminated because we have removed inefficiencies
through Six Sigma projects, we have pledged that affected
employees will receive training and have an opportunity to move to
other open positions within the organization. That is why we refer
to our deployment as “Soulful Six Sigma.”
Project Selection
During the first year of our deployment, Six Sigma champions
selected business problems that were their biggest operational
headaches. Now in our second year of implementation, we are
taking a more strategic approach by selecting Six Sigma projects
based on key business themes. We expect our projects to achieve
an average financial return of $100,000.
During the strategic planning cycle for our next fiscal year beginning
July 1, 2002, our Six Sigma champions have identified six key
business themes on which our Six Sigma projects will concentrate
— revenue enhancement, bad debt reduction, patient throughput
in all operational units, labor/right staffing, labor retention and
recruitment, and patient safety.
Breakthrough continued on page 28

isssp INTERNATIONAL SOCIETY OF SIX SIGMA PROFESSIONALS

Six Sigma In Healthcare

Attend the Symposium!
The Symposium is a 2 1/2 day program designed for Healthcare executives and
practitioners. One full day is focused on lessons learned and deployment case
studies targeted to Healthcare leadership. One and a half days are focused on best
practices, advanced educational sessions and project case studies demonstrated by
Six Sigma Experts, Practitioners and Deployment Leaders.
April 29 - May 1, 2002 - St. Louis, Missouri

Purchase the ISSSP Six Sigma In Healthcare Video!

This video represents featured speakers from the
2nd Annual Six Sigma Leadership Conference
Key Topics Include:
• Creating a Six Sigma Culture in Healthcare
• Clinical & Operational Six Sigma Projects
• Reducing Cycle Time & Improving Productivity in Hospital ER’s
• Open Discussion on Six Sigma Related Healthcare Issues
• Six Sigma in Pharmaceutical Manufacturing
Sign up for the Educational Program!
isssp
Learn from the experts in the field. ISSSP provides
the platform that allows you to take the first step in
learning how Six Sigma can help your organization
find the improvement solution that will fit your
specific need. Our industry experts will take you
through "Six Sigma from A to Z."

9
isssp Visit www.isssp.com or call 480-368-7083 for more information!

ΣXTRAOrdinary Sense March 2002

Six Sigma Affiliates Six Sigma Affiliates
The Six Sigma Affiliates Program - a program
developed for the benefit of ISSSP Six Sigma providers. ISSSP is proud to recognize the following
companies as Six Sigma Affiliates:
Our members regularly request information on the products and services available from the
various providers, ranging from software to full deployments. This program enables Six Sigma Air Academy Associates
providers to share, learn, network and market their Six Sigma products and services. We look Breakthrough Management Group
forward to serving you.
Convergence Corporation
e-ZSigma, Inc.
George Group
Convergence Corporation offers clients Six Sigma Global Learning Systems
Quality Business Management Consulting and
Global Productivity Solutions
Seminar services. Focus: provide clients with the
insight, tools & methods to implement Six Sigma Hertzler Systems, Inc.
Business Process Management and Process Improvement Methodology: DMAIC. Vision: enable Human Capital Associates
clients to increase corporate profits, invigorate corporate culture, and achieve corporate
Excellence! iGrafx, a product of Corel
Institute for International Research
Rath & Strong/Aon Management Consulting is a
leading provider of customized global Six Sigma International Institute for Learning
solutions and a pioneer of many concepts JMP, A Business Unit of SAS
proceeding Six Sigma. Provides a
Leap Technologies Inc.
comprehensive, flexible range of Six Sigma
consulting services and training for leading companies, specializing in combining leadership Minitab
and people issues with Six Sigma methods. Creators of the best-selling Six Sigma Pocket Movaris
Guide.
Oriel Inc.
Six Sigma Qualtec is a premier provider of training and
implementation services that drive measurable financial Pivotal Resources
results. The Six Sigma Qualtec methodology is an ProActivity
integrated deployment of training and tools for achieving
PROSPERO LLC
breakthrough performance including dramatically reduced
cycle times, defects and costs. This approach has significantly improved productivity, efficiency PwC Consulting
and customer satisfaction with clients worldwide.
The Quality Group

Six Sigma Qualtec continues to expand its client base, worldwide involvement, portfolio of Rath & Strong
service offerings, and client services delivery capacity while exceeding our client’s expectations. Sigma Breakthrough Technologies Inc.
Our company works with leaders in both the public and private sectors throughout North America,
Asia, and Europe, and across all industry and government segments, leading them to increased Six Sigma Qualtec
profitability. Six Sigma Qualtec world headquarters is located in Tempe, Arizona with offices in Smarter Solutions
Tokyo, Japan and Oxfordshire, UK.
StatSoft
Y-change
Y-change offers an internet-based, enterprise-wide strategy and project
management application that ensures strategic initiatives are efficiently
deployed down to the individual project level. Y-change’s unique Project/
ISSSP thanks you for your continued
Portfolio Management allows managers to track the progress of multiple
support! For more information on the
Six Sigma projects in real-time. With y-change, Six Sigma initiatives Six Sigma Affiliates Program, please
can now be centrally coordinated and monitored leading to faster, more visit www.isssp.org.
efficient deployments.

10 ΣXTRAOrdinary Sense March 2002

Six Sigma: Using Statistics to Reduce Pr ocess V
Process ariability
Variability
and Costs in Radiolo gy
Radiology
By Jean Cherry, M.S., FACHE and Sridhar Seshadri,
In many corners of the corporate world, Six Sigma has developed
a reputation as the mother of all quality initiatives. Pioneered at
Motorola Corporation in the 1980s, Six Sigma is a quality initiative
based on rigorous statistical process control. It augments traditional
quality tools with exacting statistical analysis and a systematic
problem-solving approach, targeting the root cause of variations
and redefining processes for long-term results.
The methodology has been used in a variety of settings to solve a
broad array of issues: from improving manufacturing capabilities
to customer service to aircraft design…and everything in between.
It has been used to transform organizations of all types and is now
beginning to be applied in healthcare.
Sigma Defects per million opportunities
1.5 500,000
2.0 308,537
3.0 66,807
4.0 6,210
5.0 233
6.0 3.4
“Sigma” is the Greek letter used by statisticians to define standard
deviation from the norm. A higher sigma indicates a lower rate of
defects and more efficient processes. At Six Sigma, defects are
roughly 3.4 per million opportunities, or nearly error-free. Consider
this: Three Sigma translates into about 5,000 incorrect surgical
procedures each week nationwide, a somewhat less than desirable
ratio.
With excessive variability and medical error rates currently under
the microscope, some healthcare administrators and department
managers are looking for some additional guidance and reliability.
The point of deploying Six Sigma in healthcare is not to diminish
the authority of a radiologist, physician, nurse or other professional,
but to enhance the predictability of positive outcomes, whether
clinical or operational. And it’s an approach that is flexible and
scaleable. It can be used to improve a single process in a single
department within a small, rural medical center, or it can be
deployed throughout an entire multi-hospital system.
11
Executive Summary
• Pioneered at Motorola Corporation in the 1980s, Six Sigma is a
quality initiative based on rigorous statistical process control. It
augments traditional quality tools with exacting statistical analysis
and a systematic problem-solving approach, targeting the root
cause of variations and redefining processes for long-term results.
• “Sigma” is the Greek letter used by statisticians to define standard
deviation from the norm. At Six Sigma, defects are roughly 3.4 per
million opportunities, or nearly error-free.
• The methodology has been used in a variety of settings to solve a
broad array of issues. It has been used to transform organizations
of all types and is now beginning to be applied in healthcare.
• Commonwealth Health Corporation in Bowling Green, Kentucky ,
launched its Six Sigma program in its radiology department. Within
18 months, the culture had been transformed, productivity levels
increased and patient experience improved while eliminating more
than $800,000 in total costs.
• After Six Sigma was implemented, CHC’s radiology cost per pro-
cedure went from $68.13 to $49.55. With over 100,000 procedures
performed each year, the cumulative savings exceeded $1.65 mil-
lion. And most notably, exemplifying the essential quality aspect of
Six Sigma, errors in the MR ordering process were reduced by 90
percent.
• Six Sigma training involves several phases, reaches various lev-
els of expertise, and can extend anywhere from one to 14 days.
Training is always linked to particular projects impacting opera-
tions, giving participants a chance to learn the methodology while
at the same time achieving results within their own work environ-
ment.
• One of the primary keys to unlocking Six Sigma success is solid
commitment from leadership. Since this initiative will compete for
capital and time resources, participants have to be able to count on
unambiguous support from senior management.
• To carry this quality improvement forward at CHC will require
ongoing training and the generation of approximately 120 trained
staff within two years. Every CHC employee will receive a minimum
of one full day’s training.
Radiology Takes the Lead at CHC
Initially implemented in CHC’s radiology department in early 1998,
the program began to spread throughout the organization within
the next two years. Results have been impressive across several
areas: within 18 months, the culture had been transformed,
productivity levels increased and patient experience improved while
Radiology continued on page 13
ΣXTRAOrdinary Sense March 2002
Meet the ISSSP Corporate Sponsors
The ISSSP Healthcare 2002 Corporate Sponsorship Program gives corporate
leaders the opportunity to effectively develop personnel resources, share les-
sons learned with healthcare partners and develop a continuous open forum for
healthcare industry solutions utilizing Six Sigma methodologies.

GlaxoSmithKline - one of the world’s leading research-based

pharmaceutical and healthcare companies - is committed to improving
the quality of human life by enabling people to do more, feel better and
live longer.

Headquartered in the UK and with operations based in the US, the

new company is one of the industry leaders, with an estimated seven
per cent of the world’s pharmaceutical market.

CHC
In 1984, Commonwealth Health Corporation CHC) was formed as a
not-for-profit holding company for The Medical Center and other health
related businesses.

CommoNWeAlTH By the year 2004, CHC will be proudly recognized by its employees,
HeAlTH patients, clients, community, physicians and payors as the
CoRpoRATIoN unquestioned leader in care and service, providing flawless quality never
before achieved in the healthcare industry.

Since the Company’s founding in 1886, Johnson & Johnson

continues to provide innovative health care products that
improve or save lives. Johnson & Johnson has 197 operating
companies worldwide.

A shared system of values, known as its Credo, serves as

a guide for all who are part of the Johnson & Johnson Family
of Companies.

Mount Carmel has been caring for residents of central Ohio for
over 113 years.

Its core values, which underlies everything that it does, are: dignity
of persons, service to others and social justice for all. Mount
Carmel is committed to treat all people with fairness, respect
and compassion and to ensure that everyone has access to quality
healthcare services. Each year, Mount Carmel provides millions
of dollars in free care and benefits to the community.

12 ΣXTRAOrdinary Sense March 2002

Radiology continued from page 11
eliminating more than $800,000 in total costs. After this program
was implemented, CHC’s radiology cost per procedure went from
$68.13 to $49.55. With over 100,000 procedures performed each
year, the cumulative savings exceeded $1.65 million. And most
notably, exemplifying the essential quality aspect of Six Sigma,
errors in the MR ordering process were reduced by 90 percent.
Interestingly, hard times weren’t the impetus for this Six Sigma
project, since CHC was already financially sound and a leader in
their market area. Of course, this comfort level can produce its
own set of challenges, since motivating a team is sometimes more
difficult when things are going well. Also, CHC recognized the
need to maintain their competitive edge, cope with reimbursement
and regulatory issues, and meet rising patient expectations.
Internally, leaders recognized a genuine opportunity to build
teamwork and transform the corporate culture.
Changing the Cultural Landscape
Six Sigma was seen as having the potential to drive quality to new
heights and sharpen the competitive edge for both the radiology
department and the system as a whole. Like most providers, CHC
has had some form of quality initiative in place for years. The differ-
ence is that Six Sigma actually becomes ingrained in work and
Commonwealth Health Corporation
• A not-for-profit integrated delivery network located in Bowling
Green, KY.
• The Medical Center in Bowling Green: 487 beds
• The Medical Center in Scottsville: 157 beds (includes 105
extended care beds at Cal Turner Extended Care Pavilion)
• The Medical Center at Franklin: 50 beds
• Employees: Over 2,000
• Radiology diagnostic technology includes state-of-the-art MRI,
Cat Scan, CT-3D treatment planning and Angiography.
Modalities:
• MRI • Radiology
• Mammography • CT
•Nuclear Medicine • Ultrasound
• Number of procedures per year:
FY’99: 91,055
FY’00: 104,036
FY’01: 108,780*
*estimate based on available ‘01 data
13
thought processes, and instead of simply solving short-term qual-
ity issues, creates a knowledge base to get it right the first time.
But Six Sigma can also be viewed as a catalyst for corporate-wide
transformation of the existing culture. By collecting and analyzing
relevant data, possibilities for improving even the most intransi-
gent processes begin to emerge. Six Sigma relies on a foundation
of methodically collected and analyzed data, rather than manage-
rial experience or expertise. This evidence-based approach makes
it somewhat easier to present the case for change and garner staff
support.
How the Process Unfolded
As is customary when launching any major change initiative, the
Six Sigma project began by assembling key players for a
preliminary strategy session. During this meeting, the team set a
goal to become a Six Sigma organization by the year 2004. With
that target set, the first round of training began.
Six Sigma training involves several phases, reaches various levels
of expertise, and can extend anywhere from one to 14 days.
Training is always linked to particular projects impacting
operations, giving participants a chance to learn the methodology
while at the same time achieving results within their own work
environment.
Through these educational sessions, leaders learn to better manage
strategic change, cultivate support, mobilize constituencies, and
establish systems for long-term results. Employees also learn to
use a problem-solving approach designed to reduce organizational
redundancies. Participants successfully planning and completing
two Six Sigma projects attain what is commonly known as Green
Belt status. The completion of additional projects and achieving
higher levels of accomplishment lead to the attainment of Black
Belt and Master Black Belt status.
CHC’s radiology department was chosen as the launching pad
for Six Sigma. Twelve participants within Radiology used the various
training processes to focus on learning team dynamics, identifying
specific areas of opportunity within the department, and putting
improvement and control mechanisms in place. Making sure that
process changes are built-in and remain as guidance systems for
the long haul differentiates Six Sigma from previous quality initiatives
at CHC.
This radiology-focused phase significantly reduced wait times for
patients, generated faster turnaround times for radiology reports
and increased productivity. In fact, CHC’s team managed to boost
Radiology continued on page 28
ΣXTRAOrdinary Sense March 2002
 Six sigma in Healthcare educational program

Educational Program
isssp
As a leading source of credible information regarding Six Sigma, ISSSP has decided to provide a platform for those who are learning
how Six Sigma can be the best improvement solution for an organization’s need to improve quality, reduce costs, eliminate defects and
enhance financial performance.

To this end, ISSSP, in conjunction with its Affiliates and Corporate Sponsors, is offering a program of educational, one-hour, interactive
webcasts that will take you through the elements of Six Sigma from A to Z. As a registrant of this program, you will have the option to
attend (12) different one-hour sessions. The schedule of sessions currently available represent many different topics within Six Sigma
and will be updated to ensure that participants have the greatest opportunity to learn and the availability to attend a variety of topics
that may meet their individual scheduling needs.

In the event you've already missed a few sessions, rest assured. ISSSP will continually add new modules and repeat modules to ensure
participants receive the full value of this program. As a registrant, you will receive email notices of any enhancements to the schedule.
Sessions are also recorded and archived. If you miss a session or if there is a particular session that provides you great insight, you
have the opportunity to re-visit those topics that benefited you most.

So sign up now and join us for our next session!

Special Bonus! Networking Program
Our Healthcare Corporate Sponsors invite you to join their networking sessions
Corporate Sponsors To Date where they will present case studies and demonstrate the problem and the
• Commonwealth Health Corporation solution using the Six Sigma methodology. Each one-hour networking session
includes 2-4 project case studies. Registered participants will receive regular
• GlaxoSmithKline
updates and invitations to these networking sessions. Live recordings are
• Johnson & Johnson
available for viewing for those that were unable to attend.
• Mount Carmel Health System

Date Topic ISSSP Affiliates

February 28, 2002 Six Sigma Overview Six Sigma Qualtec

March 7, 2002 The Keys to the Methodology Global Productivity Solutions

March 14, 2002 What is a Six Sigma Project? Breakthrough Management Group Inc.

March 21, 2002

March 28, 2002

Six Sigma Roles & Responsibilities

The Financial Impacts of Six Sigma

L E Six Sigma Qualtec

Six Sigma Qualtec

April 4, 2002

P
Using Action Workout™ as the "on ramp" to Six Sigma in Healthcare Leap Technologies

isssp
M
April 11, 2002 Statistical Analysis for the Healthcare Industry Minitab

April 18, 2002 Six Sigma, The Medical Staff and You Creative Healthcare USA

April 25, 2002

May 9, 2002

May 16, 2002 S TBD

TBD
A
Engaging Your Partners: Including Your Customers and Suppliers PwC Consulting

Smarter Solutions

Pivotal Resources

May 23, 2002 TBD Rath & Strong

For a more detailed description of each session, please visit our website at www.isssp.com.

14 ΣXTRAOrdinary Sense March 2002

Tears continued from page 8
Lesson Two: Refocus and Recharge Internal CQI Staff
CQI managers and quality professionals are often threatened by
Six Sigma. They know that in some Six Sigma companies, the
internal quality staff ends up marginalized and reduced to a
paperwork compliance office.
Of course, some CQI managers persist in spinning the broken
record of “no management commitment” as the cause of failed
CQI efforts in the past and use this as an excuse to block Six
Sigma introduction.
The truth is that CQI efforts in many healthcare provider
organizations have yielded significant benefits by identifying patient
expectations, educating the workforce on quality values and
concepts, and establishing process documentation systems.
The COO of the healthcare provider in our case example made the
wise choice of holding his CQI manager accountable for the success
of Six Sigma. In addition, the COO used the introduction of Six
Sigma to conduct a complete audit of the CQI effort, “sunsetting”
unproductive Quality Action Teams and refocusing the CQI staff
on improving the CQI infrastructure – from satisfaction
measurement to best practices.
Lesson Three: Get More Employees and Managers “Into the
Right CQI Game”
One of the biggest concerns about Six Sigma is captured in a
water cooler exchange making the rounds.
Question: “How many Black Belts do you need to achieve Six
Sigma performance?”
Answer: “A few good ones to do the work and an army of certificate
holders to impress Wall Street.”
Sarcasm aside, the point worth noting is that Six Sigma is not a
backyard sport. Black Belt training is rigorous and not for the
masses because everyone can’t be an expert. Furthermore, there
typically aren’t enough problems worth the dedication of Black
Belts to justify “excess inventory”. Black Belt certification as a
career or stock price booster becomes very expensive.
When Black Belts become a substitute management team for
solving problems that don’t require rigorous statistical analysis,
Six Sigma initiatives spiral down into a game for the elite only.
A better approach is to adopt a simpler, but equally reliable
methodology for getting more participation in quality improvement
15
efforts, just as our example regional healthcare provider chose to
do.
The decision was made to introduce a complementary improvement
process called Action Workout to work in parallel and in support of
the Six Sigma DMAIC process.
Action Workout is the latest generation of the fast change process
first used by Jack Welch at General Electric to “break down
bureaucracy”. Action Workout has evolved over the last decade
into a system for converting employee know-how and creativity
into focused results.
Action Workout is a natural complement to Six Sigma. It uses
the same rigor of business case-based project selection, a
structured improvement process and expert guidance.
What’s different is the nature of the problems Action Workout
attacks and hence, the level of expertise and time required to
succeed. Action Workout fills the gap between the “no-brainer”
fixes made with decisive management action and problems that
can’t be reliably fixed without detailed analysis.
At our regional healthcare provider, Action Workout was used to
attack problems like these:
• Reducing the use of contract nurses through more
effective scheduling and management
• Improving the accuracy of patient treatment records to
smooth claims processing
• Reducing materials and energy waste
• Shortening hiring cycle time and improving employee
retention
These problems were attacked using frontline employees,
supervisors and managers organized into small (five to seven people)
action teams and equipped with an Action Workout Team Kit – an
expert improvement process literally packaged in a box.
Action Workout was chosen over DMAIC or the in-place Quality
Action Team process for two reasons: Speed and simplicity.
Action Workout allowed this particular healthcare provider to
mobilize more than 50 employees to make performance
improvements without classroom training or overtime. Then, they
were turned loose to achieve major financial gains in a 60-day
“sprint” timeframe.
Tears continued on page 17
ΣXTRAOrdinary Sense March 2002
 isssp six sigma in healthcare symposium

isssp
Program Highlights
The Symposium is a 2 1/2 day program designed for Healthcare executives and
April 29- May 1, 2002 practitioners. One full day is focused on lessons learned and deployment case
St. Louis, Missouri studies targeted to Healthcare leadership. One and a half days are focused on
best practices, advanced educational sessions and project case studies demon-
strated by Six Sigma Experts, Practitioners and Deployment Leaders.

Leadership Program (1.5 Days) Full Program (2.5 Days)

• Company leaders of Healthcare organizations present their • Six Sigma Applications and Project Case Study Presentations
deployment strategies, lessons learned and the value of Six • Advanced Educational Sessions
Sigma within their organization • Networking Riverboat Trip
• Networking Reception with Project Storyboards • Member Challenge Game

Day 1 Day 2 Day 3

Companies Featured to Speak
Featured speakers will be from the Healthcare industry Leadership Program
(across the supply chain) and Six Sigma professionals
from across the country.
Full Program (Leadership Program included)
Distinguished companies include:
• GlaxoSmithKline Networking Riverboat Trip Final Round of
• Johnson & Johnson
• Commonwealth Health Corporation Reception with for Full Program Member Challenge
• McKesson Project Storyboards Participants (interactive
• Mount Carmel Health System Six Sigma game)
• GE Medical Systems

Who Should Attend?

• Healthcare Executives Corporate Sponsors Affiliate Sponsors
• Physicians To Date To Date
• Senior Managers
• Deployment Leaders
• Commonwealth Health • Breakthrough Management
• Champions
• Six Sigma Practitioners Corporation Group Inc.
• Johnson & Johnson • Creative Healthcare USA
Hotel Reservations • GlaxoSmithKline • Global Productivity Solutions
Millennium Hotel, St. Louis • McKesson • Leap Technologies
To reserve your room, please contact the hotel • Mount Carmel Health System • Minitab
directly at 866-866-8086. • PwC Consulting
Refer to the ISSSP Six Sigma in Healthcare • Rath & Strong
Symposium to receive the discounted rate. • Six Sigma Qualtec

If you are interested in Speaking Opportunities at this Symposium, please contact Edna Cribb at 480-368-7083 or EdnaC@isssp.com.
If you are interested in Sponsorship Opportunities, please contact Roxanne O’Brasky at 480-368-7083 or RoxanneO@isssp.com.

* All cancelations/substitutions must be received in writing. All cancelations will be subjected to a $150 administrative fee. No refunds will be given after April 12, 2002.

16 ΣXTRAOrdinary Sense March 2002

Tears continued from page 15
Making the Transition Without Tears
The introduction of Six Sigma into healthcare provider organizations
can be made smoother with attention to three key questions:
• Where are the opportunities for the Six Sigma DMAIC
process and Black Belts to achieve a return that
justifies the investment?
• How to reliably and cost-effectively get more managers
and frontline employees into the CQI game to quickly
solve problems outside the DMAIC domain?
• How to refocus existing CQI activities and redirect
the CQI staff to hold gains from all improvement
projects?
Healthcare provider leadership teams who fully answer these
questions will get “on the Six Sigma bandwagon” at a ticket price
they can afford and experience a smooth ride.
Participate in an online networking exchange of
information and best practices about
Six Sigma in Healthcare!
Post your comments and questions using this state-
of-the-art bulletin board system located on the ISSSP
Members website.
17
Supply Chain continued from page 1
experienced a 23 percent turnover rate. After seven months of
applying Six Sigma, that rate dropped to only 11 percent. The
realized cost savings are also impressive. Since beginning the
implementation of Six Sigma, the organization has seen a financial
return of $2.4 million through the end of 2001. And those returns
are expected to grow as they tackle more Six Sigma projects.
The International Society of Six Sigma Professionals (ISSSP), in
conjunction with its Affiliates and Corporate Sponsors, has begun
a campaign to help tell the story of health care entities that have
experienced great success with Six Sigma. ISSSP’s objective for
this campaign is to provide credible information and expertise in
Six Sigma to quality-minded practitioners in healthcare and its
allied fields. The source of this information comes from the
healthcare industry itself, from outside the industry and from the
healthcare supply chain.
Programs have been developed to equip healthcare professionals
with the knowledge to make informed decisions about the
application of Six Sigma. One specific forum brings together
organizational leaders from the healthcare supply chain and
hospitals to examine a variety of issues facing healthcare.
Programs like this and others have been developed to provide
healthcare professionals with a keen understanding of Six Sigma
and the potential it represents.
The health care industry, with its unique challenges and
opportunities is clearly ready for Six Sigma…but what about you?
ΣXTRAOrdinary Sense March 2002
18 ΣXTRAOrdinary Sense March 2002
North Shor
Shoree - Long Island Jewish Health System Teams with GE and
Teams
Harvard to Launch Center for Learning and Innovation
By Roxanne O’Brasky, President, ISSSP
I had an opportunity – thanks to an invitation from GE Medical
Systems — to attend a special event announcing the launch of an
exciting new venture called “Center for Learning and Innovation.”
This new initiative — a collaborative effort between the North Shore
Long Island Jewish Health System (LIJ), GE Medical Systems
and Harvard University’s School of Public Health – is the largest of
its kind in the healthcare industry to date.
The afternoon program featured four key players, among others, in
the Center’s planning and implementation. They included Michael
Dowling, President and CEO of North Shore - LIJ; David Shore,
Associate Dean Harvard School of Public Health; Paul Mirabella,
President and CEO GE Medical Systems Healthcare Services;
and Jeffrey Immelt, Chairman and CEO General Electric.
As the guest speakers explained, the new Center represents the
first learning initiative ever undertaken by a healthcare organization
in cooperation with these two internationally renowned
organizations.
Created to enhance the health system’s ability to deliver services
in today’s competitive marketplace, this effort signifies a major
step in the healthcare industry that could spark far-reaching
changes. With GE’s business leadership and Harvard’s unparalleled
academic program, the Center aims to transform North Shore -
LIJ’s organizational culture, invest and develop new groups of
leaders at different levels in the health system, and create world-
class learning organizations.
Opportunity for Change
The healthcare industry has long been ripe for implementing a new
management perspective. As one of the most complex and
constantly changing industries, representing more than $10 billion
annually, the healthcare system is synonymous with countless
pressures and obstacles that inhibit ongoing implementation of
quality improvements.
The combination of ongoing financial pressures, discovery of
revolutionary new technologies and medical treatments, more
educated and demanding work force and consumers, nursing
shortages, declining reimbursements, changing patient
demographics, and aging and diversifying populations all contribute
to an industry whose evolution has been stifled by internal and
external limitations. And, what’s more, consider the statistic that
19
medical errors are the 8th leading cause of death accounting for
50,000 per year.
According to David Shore, Associate Dean Harvard School of Public
Health, “In response to the changing demands of patients and
other constituents, organizations and technology are evolving so
rapidly that health care professionals must continually seek new
insights, perspectives and skills that enable them not only to
respond to change, but also to anticipate it.” Jeffrey Immelt,
Chairman and CEO General Electric. Agrees, “In the US, we have
the best technology, best hospitals, best doctors, but healthcare
still isn’t where we want it. I think the missing link is leadership.”
Such common shortfalls have long represented a call to arms for
industry heads to seek out new and better alternatives to manage
the system. In healthcare, there is a prevalent understanding of
the connection between patient satisfaction and employee
satisfaction.
Michael Dowling, President and CEO of North Shore-LIJ adds “We
must invest in our people…by creating an environment that
facilitates learning and professional growth.”
Outside of the health care system, organizations that foster an
environment of professional growth and life long learning among
their employees create a culture dedicated to excellence,
innovation, teamwork, and continuous change. This notion planted
the first seeds for the Center for Learning.
The shift toward a learning organization promotes a culture that is
more productive, delivers improved care and more passionate care,
more services and customer focus, and continues to strive to
streamline work processes throughout the organization. This is
the basis for The Center.
North Shore – LIJ, like many of its industry peers, acknowledges
the success of its traditional educational resources such as joint
programs with local colleges, technical training and internal
management development programs. However, the urgent need
to coordinate, enhance and expand these efforts throughout the
system is obvious. “We have done many things in the past, but
we need to do more,” says Dowling. “We want to be an organization
that people want to come TO and work FOR.”
North Shore continued on page 21
ΣXTRAOrdinary Sense March 2002
 Six sigma in Healthcare Video
isssp
ISSSP is proud to present this 2001 Six Sigma in Healthcare Video. This video represents featured speakers from the
2nd Annual Six Sigma Leadership Conference and we are excited to offer this to you. As you learn from these experts,
you are sure to create energy and commitment for your team, helping you develop a strong and successful
Six Sigma program.

Specific Topics:
• Creating a Six Sigma Culture in Healthcare
• Clinical & Operational Six Sigma Projects
• Six Sigma in Pharmaceutical Manufacturing
• Open Discussion on Six Sigma Related Healthcare Issues
• Reducing Cycle Time and Improving Productivity in Hospital ER’s

Featured Speakers:
Larry Bossidy,
Chairman & CEO
Some of What You Will Hear:
Honeywell
“I have not seen anything that can deliver the sustainable results like Six Sigma.”
John Desmarais,
President & CEO “You have to get the best people you can.”
Commonwealth Health “Leadership is the most critical aspect of any successful program.”
Corporation
“You have to dedicate yourself to a life of learning.”
Tim Tyson, “There's plenty of data that indicates you will get twice your money back in the
Pres. World Wide Mfg. &
Supply Operations first year (of Six Sigma).”
GlaxoSmithKline “Six Sigma takes an organization and shakes it up.”

Jeff Burnich, “Six Sigma has the ability to change an organization...as if by magic.”
CQO & Senior VP. “Six Sigma creates a restlessness within an organization.”
Mount Carmel Health System
“Give Six Sigma constant care, until it becomes part of the culture.”

Title Sponsor: Participating Sponsors:

CHC
Creative Healthcare USA

www.creative-healthcare.com
isssp
480-473-2525

THE GOAL IS RESULTS™

www.BMGI.com www.actionworkout.com
1-800-46-SIGMA 800-254-6805

20 ΣXTRAOrdinary Sense March 2002

Continued from page 19

Leaders of Change
As part of the Center for Learning and Innovation, GE Medical
Over the past three years, Michael Dowling has been
Systems Healthcare Services will lead a 36-month initiative to bring
conceptualizing ways of transforming North Shore – LIJ into a
GE’s approach to leadership development and change management
“learning organization.” The GE Leadership Institute in Crotonville,
to LIJ. Specifically, GE will provide courses on “fast track decision
NY where Dowling attended several leadership programs served
making” for solving organizational problems, “change acceleration”
as a basis for a number of initiatives envisioned for the North Shore
processes for breaking down barriers to change and helping
– LIJ. In March of 2001, Dowling wrote his initial plans for a broad
employees embrace new concepts, and “Six Sigma” management
based learning center at North Shore – LIJ. By June 2001, strategy
processes that have been widely recognized in the corporate sector
committees were established between the health system, GE and
for more than two decades.
Harvard to begin planning and implementation of the Center.

“We’re pleased that Six Sigma is a major component of this

“To achieve our goals, we turned to GE and Harvard to harness the
system…that trust is the centerpiece of the system,” says Shore.
best expertise from the private sector, academia and healthcare,”
“Healthcare, by definition, requires a level of trust.”
says Dowling. GE’s Leadership Institute, is considered one of the
best corporate universities in the business world. The Institute is
The all-encompassing vision of the Center and its resulting programs
a model for promoting organizational change and leadership
is designed to touch employees at virtually every level – physicians,
development at GE while affording the Center to draw on experience
nurses and other healthcare professionals, administrators, support
in leadership development, knowledge and skills, including the
staff and other non-clinical workers, including volunteers and
management processes with the very successful Six Sigma.
trustees. And, although representing a significant overhaul in
current North Shore – LIJ processes, all current learning programs
Harvard University’s academic reputation is unsurpassed, and the
will not be altogether abandoned, but brought under The Center for
Harvard School of Public Health has designed courses for
Learning umbrella.
physicians and healthcare executives that are highly regarded in
the healthcare industry. “ Harvard University, runs the world’s more
Realizing Change
renowned leadership education programs. Executives wait years
At the completion of the GE partnership in three years, LIJ will
to get into these programs,” according to Dowling.
establish its own Six Sigma organization. By that time, about 175
key health system employees are expected to be proficient in Six
GE and Harvard provide LIJ with the best of the corporate sector
Sigma management skills. In addition, the health system will
and academia, along with expertise and experience in assisting
have completed about 60 Six Sigma projects devoted to improving
large, complex healthcare organizations.
process efficiencies in areas such as patient wait time, billing,
admissions and bed availability. Other initiatives will be phased in
Implementing Change
over three years.
The Center’s leadership has long echoed the sentiments of the
healthcare industry regarding the system’s endless battles. The
Developing a corporate university in healthcare and creating a
nagging question has always been: what to do about them.
learning culture improves the working environment, the quality and
capacity of the workforce, and therefore the quality of the care and
“Employees are the greatest asset any organization has. It
services delivered to patients. Some of the courses taught through
(healthcare) is about people taking care of people; it is about human
the Center will involve teaching VOC (voice of the customer)
relationships; it is about continuity of human interactions, “ says
methodology and understanding customers CTQs (Critical to
Dowling. Positioned as the driving force that transforms the health
Quality elements) both of which will be designed to enhance service
system into a learning organization, the basis for the Center’s
quality and patient satisfaction. Some of the Six Sigma projects
mission is a three-tiered employee-centered approach:
may be clinical in nature and will more directly impact patient
• To create an environment that facilitates learning and
processes and outcomes.
professional growth
• To develop employees knowledge, skills, attitudes that
Also, as employees acquire vital change management skills, they
consistently support business and strategic goals.
will be empowered to solve long-standing problems or prepare for
• To create leaders at all levels of the organization, right down
future challenges. Removing the redundancies and inefficiencies
through the organization.
that can become part of any job helps to improve productivity and

North Shore continued on page 28

ΣXTRAOrdinary Sense March 2002
21
Commonwealth Health Corporation, the Healthcare Pioneer of Six Sigma
By Lisa Thomerson, Six Sigma Corporate Champion, Commonwealth Health Corporation
Commonwealth Health Corporation’s Six Sigma initiative was launched in March 1998 after President and CEO
John C. Desmarais listened intently to Jack Welch tout the amazing success General Electric (GE) had experienced
by implementing Six Sigma. Welch had proven globally that Six Sigma was the way to improve process design and
reduce costs. The encounter of these two executives led to a partnership between GE and CHC, in which GE
Master Black Belts trained a diverse group of CHC executives and managers in Six Sigma methodology. This initial
Green Belt training designated Commonwealth Health Corporation as the pioneer in healthcare to become a Six
Sigma organization.

Presently, CHC’s Six Sigma team develops training materials, teaches the Six Sigma methodology, and mentors Green Belts and
Black Belts as they progress through the various levels of projects. These projects represent a variety of processes within the organization,
both operational and clinical service lines. Projects are selected based on a variety of considerations: benchmarking, peer group data,
and/or invaluable suggestions or ideas from employees, patients, and physicians. Although there are many challenges inherent in
applying the Six Sigma methodology in a healthcare setting, CHC has seen many positive results in these ongoing Six Sigma projects.

All projects must impact at least one of the following Critical-to-Quality factors (CTQs): Customer Satisfaction, Timeliness/Speed/
Convenience, Quality of Care/Service, or Cost. A typical CHC Six Sigma project takes four to seven months to complete. Every project
is an intense objective study of a particular process that is driven by data. Neither subjective assertions nor random recommendations
for improvements are tolerated in the DMAIC process (Define, Measure, Analyze, Improve, Control). Black Belts and Green Belts must
prove statistically that a problem exists and the improvements made within the process have been improved using objective data. One
of the innumerable strengths of Six Sigma is that all projects are approached the same, utilizing each of the five phases in DMAIC.
Commonwealth continued on page 24

22 ΣXTRAOrdinary Sense March 2002

Operational Excellence - be the benchmark
By GlaxoSmithKline
Operational Excellence is fundamentally changing the way in which
GlaxoSmithKline’s Global Manufacturing & Supply business (GMS)
operates, which is a worldwide organization with over 40,000 people
working to manufacture the quality medicines and consumer
products on which GSK patients and customers depend.
In GMS, Operational Excellence is engaging and developing the
full potential of our people throughout the organization, by delivering
a unique blend of five components:
• LeanSigma – a methodology to eliminate waste
and drive efficiency throughout the GMS organization
• Knowledge Management – to enable the
sharing of ideas, information, knowledge, good
practices and experience to systematically create
value for business benefit
• Common Language and Global Processes –
identifying and applying global processes
consistently across GMS
• Performance Management and Benchmarking
- robust Performance Management methods and
tools to continuously measure and improve
performance, benchmarked against the best internal
and external standard.
• Education and Training – developing a range of
education programs and activities, delivered via a
variety of media from traditional classroom events
to self-paced e-learning modules, to enable delivery
of all components of Operational Excellence.
In GMS, LeanSigma is viewed as a methodology for sustained,
customer-focused business improvement, based on the
implementation of a powerful combination of two proven
management approaches – Lean thinking and Six Sigma. The
central themes of Lean thinking are the elimination of waste and
the simplification of processes, minimizing activities that are non-
value adding to the customer. Six Sigma provides tools to eliminate
variation and drive robustness in order to deliver highly reproducible
processes.
The LeanSigma program has been successfully embedded in GMS
by means of a systematic deployment program. This commenced
with gaining leadership commitment from the executive level down,
23
combined with detailed training of designated individuals who
operate in an ‘expert’ role. An Expert Certification Process has
been introduced to formally recognize this key resource. Our target
is to have at any one time one percent of the GMS organization
actively practicing as LeanSigma Experts. Beyond this an
understanding of the principles is driven down to all levels of the
organization by means of ‘Advocate’ training. The whole process
is underpinned and sustained by a group of LeanSigma Internal
Consultants who provide specialist teaching, mentoring and project
support.
In GMS the LeanSigma methodology is being used effectively in
conjunction with the other elements of Operational Excellence to
deliver step change improvements in the way we do business.
“The powerful combination of the five components of Operational
Excellence will enable us to meet business challenges in the way
that is most effective for the business”, says Jean-Paul Reynaud,
Vice-President, Operational Excellence. Jean-Paul is also keen
to point out that Operational Excellence is a global initiative, which
can be applied to all technical and business / transactional
processes within GMS to enable optimum effectiveness. “It is
helping GMS to learn and work as one team, so that good practice,
breakthroughs and successes are shared and applied rapidly
throughout our global network”.
The GMS philosophy is that Operational Excellence should not be
viewed only in terms of tools and techniques, but more as a major
cultural change initiative designed to deliver significant benefits to
the business. It provides a blueprint to help build a world-class
manufacturing and supply organization. This will serve to realize
the vision of GMS in being the benchmark in the pharmaceutical
industry in five years and in all industries in ten years.
GSK Corporate Offices, Philadelphia, Pennsylvania, US
ΣXTRAOrdinary Sense March 2002

Commonwealth continued from page 22
Six Sigma Strategy
CHC’s successful implementation of Six Sigma can be directly
attributed to the organization’s steadfast commitment to quality –
to continually “raise the bar.” Six Sigma training was mandated
for every employee to become adept at its use within CHC as the
vehicle to continually improve processes and the delivery of care.
It became the focal point of a culture change within the organization.
Part of the lasting culture change, Six Sigma’s methodology and
its approach to process improvement has facilitated a transformation
in organizational communication. With that change, CHC’s senior
leaders recognize the importance of their employees and
understand their invaluable contribution to improve the “way we
work.” At its inception, John C. Desmarais made the commitment
that no one would lose their job due to improvements made by Six
Sigma projects. Any reduction in CHC’s workforce would be through
attrition.
Black Belts are selected as the full-time project leaders who drive
process improvements to meet CHC’s strategic organizational
goals. Green Belts are Directors and Managers who lead projects
part-time and incorporate Six Sigma methodology within their
respective departments. These “Belts” consist of a wide array of
employees leading projects on project teams. They discuss their
projects directly with executive management at each phase
(Review) of their projects. Reviews are the forum utilized to improve
the flow of information to ensure the Black Belt, Green Belt, project
team, and members of executive management are current on project
developments. Black Belts and Green Belts, reinforced with
management’s unequivocal support to the Six Sigma initiative,
critically examine processes within their respective departments.
The value of applying Six Sigma’s methodology to solve problems
and improve processes is viewed as the mechanism to enhance
their everyday work. This can only result in improved customer
satisfaction, reduced costs, more efficient processes, and improved
quality as CHC produces more and more Green Belts and Black
Belts who have completed Six Sigma training.
Intensive Six Sigma Training
Senior leaders fostered their commitment to Six Sigma by identifying
individuals who would become CHC experts in Six Sigma
methodology and would provide internal training to employees.
These individuals, Master Black Belts, developed healthcare-related
training material for classes, a tool kit, and project simulation for
learning. Additionally, they provide all levels of training for CHC
employees as well as coaching and mentoring for Green Belts
and Black Belts.
24
CHC
CommoNWeAlTH
HeAlTH
CoRpoRATIoN
CHC made a remarkable organizational commitment to the success
of Six Sigma by training all employees in Six Sigma methodology.
By the end of 2001, over 2000 employees had attended at least
one full day of Six Sigma training (“Awareness”). This Awareness
training offers an introduction to basic concepts of the methodology,
and each person who attends this training receives knowledge of
the Six Sigma process and becomes a valuable contributor to a
project team. The commitment to train every employee stands
firm.
“Lite” training is the next level of exposure to Six Sigma’s
methodology. Department Directors and Clinical Managers identify
high-potential employees who will be most involved in projects.
These individuals, typically supervisors, attend an intense three-
day session that is designed to familiarize the Lite-trainee with the
aspects of the methodology. These employees build on the basic
knowledge of Six Sigma in order to assist the Green Belt within
the many facets of a project.
Green Belt training is an action-based learning model where trainees
actually complete projects. This training is a 13-day course
presented in five phases (D-M-A-I-C) over a six-month period. Each
step of the DMAIC process is presented by Master Black Belts in
a classroom setting, and the trainee applies these principles to an
ongoing project. CHC has 120 Department Directors and Managers
trained as Green Belts. Each will be expected to complete one
project every nine months. Training Green Belts at this level assures
that Six Sigma is intertwined within every department. Additionally,
all vice presidents, members of the senior management team, and
CHC’s President and CEO have received Green Belt training and
“shadowed” a Green Belt through a Six Sigma project.
CHC’s Corporate Champion is responsible for the deployment
throughout the organization and ensures necessary resources are
obtained when needed improvements are recommended.
Additionally, the Champion eliminates any barriers experienced
within a Black Belt or Green Belt project. The Champion also
Commonwealth continued on page 25
ΣXTRAOrdinary Sense March 2002
Commonwealth continued from page 24
communicates the organization’s Six Sigma successes internally
and externally as well as manages the strategy’s acceptance.
Six Sigma’s Triumph
Tangible benefits of process improvements utilizing Six Sigma
methodology projects are being experienced throughout the fabric
of our organization. The first Green Belt class focused on processes
in Radiology, engaging a cross-functional group of employees to
enhance the corporate-wide implementation. As a result of these
projects, costs per procedure have been significantly reduced.
Exam results are distributed to ordering physicians faster, patients
receive treatments more timely, and physical workspace has been
re-designed to increase employees’ efficiency. Other Green Belt
classes have focused on other areas of the organization: Maternal
care, specific Pulmonary DRGs, Admissions, Billing processes,
Documentation/Charge Entry, Human Resources, Staffing,
Managed Care, and Surgery processes. Each project represents
a significant opportunity to improve aspects of the services provided
by CHC, and Green Belts are beginning to realize the extent to
which they can positively impact the way CHC does business. As
training objectives are met, processes throughout CHC will continue
to improve as the organization continues its journey to become a
Six Sigma organization.
Along this journey, the American Productivity and Quality Center
(APQC) named CHC a Six Sigma “Best Practice Partner”. CHC
was among only a few others in the nation to receive this award:
American Express, Iomega, DuPont and Raytheon. CHC
executives have also had many opportunities to share this approach
to quality improvement with several organizations. In March 2001,
CHC was profiled at the Association for Quality and Participation’s
23rd annual spring conference in Chicago. In May 2001, CHC hosted
healthcare executives from Japan. Additionally, CHC executives
have delivered presentations to the American Society for Quality’s
Annual Quality Congress; Healthcare Financial Management
Association’s conferences; International Quality and Productivity
Center’s Six Sigma Conference; International Society for Six Sigma
Professionals’ Leadership Conferences; numerous Healthcare
Symposiums; and, a Six Sigma Conference hosted by Marcus
Evans. Along with numerous other presentations, CHC’s
experience with Six Sigma has been featured in various publications
including Strategic Finance, Radiology Management, Modern
Physician, Managed Healthcare Executive, Hospitals and Health
Networks, and Diagnostic Imaging.
Since beginning in 1998, CHC invested approximately $900,000
through the course of this implementation. Improvements have
resulted in savings well over $3 million in 2001 alone. To date, the
25
cumulative savings have exceeded $7 million. CHC boasts that all
existing employees have received Six Sigma training – from a
primer in Orientation to Master Black Belt level training. Toward
that end, this includes over 120 trained Green Belts, six Black
Belts, three Master Black Belts, a Corporate Champion, three
Corporate Sponsors, and a CEO who continuously drives the
challenge of becoming a Six Sigma organization. It is evident
through continued process improvements that CHC will realize
escalated savings, increased morale and customer satisfaction.
As the pioneer for Six Sigma in healthcare, CHC’s leadership
changed the organization’s approach to problem solving utilizing
Six Sigma methodology to deliver absolutely the premium service
to customers.
The Way We Work at CHC
In addition to CHC leadership’s commitment to Six Sigma quality,
organizational buy-in is one of the most vital elements of its success.
Part of the Champion’s responsibility is to gauge the progression
of Six Sigma and determine its effectiveness from a corporate-
wide perspective. Perhaps the greatest measure of this success
is to hear from those closest to the pulse of Six Sigma methodology
– CHC’s Six Sigma Green Belts. A few of CHC’s over 120 Green
Belts were asked to share their perspective of Six Sigma. This is
what they said:
“Six Sigma has been a true learning experience for me. I am
working on my third Green Belt project currently. I am finding this
project particularly interesting since it involves our Corporate
Wellness program and the results from the Health Risk
Assessments. The tools of Six Sigma are proving very beneficial
in analyzing the aggregate data from the assessments with the
end result being an even stronger, more effective wellness program
for our employees.”
Linda Rush, Director of Community Wellness; Green Belt;
led project for Health Risk Assessments
“I have found Six Sigma methodology very beneficial. At one time
during my project, I considered the possibility that there was no
reason to proceed to the next phase. I felt there was no way I
could improve the process after analyzing my data. We proceeded,
and on my 2nd measurement, I had only one defect. I was able to
make a positive change for all involved and addressed all CTQs
(critical-to-quality).”
Gary Sullivan, Director of Security; Green Belt; studied the
process of direct admits from EMS
“I know that Six Sigma methodology can and is making a difference
in our organization. It allows us to continually ask ourselves how
Commonwealth continued on page 27
ΣXTRAOrdinary Sense March 2002
26 ΣXTRAOrdinary Sense March 2002
Commonwealth continued from page 25

we can improve processes as we go about our regular duties. The best part is the ability to hold improved processes in place so we can
strive for further improvement in that process and move toward improving other processes. I’m just glad I’ve been able to be such an
active part of the Six Sigma initiative because I’ve learned so much. It is so valuable in my new position as we look at process
improvement - it’s just such a different way of looking at things.”
Lorraine Bormann, Director of Corporate Clinical Facilities; Green Belt; currently leading a project in the process of
medication charge audits

“The Six Sigma training has spawned a “new and improved” way of thinking not only for myself but for staff within my department. It has
expanded our thought processes to continually question “why” is a task performed in such a way and question “Is this the best way?”
As the Six Sigma approach is expanded throughout our department, we desire to realize and improve upon our weaknesses and
celebrate our strengths.” Cristi Pruitt, Director of Corporate Accounting; Green Belt; member of the Green Belt class studying
process of documenting charges

“For me, Six Sigma changes the way that I look at my department, the daily activities of the hospital, and how I do my job. Using the
Six Sigma methodologies, each process can be studied and evaluated. Not all projects will reach a “Six” Sigma, but any increase in
sigma levels can be considered a success. When a project has an increase in the sigma level or improvement noted, then our patients
and the facility will ultimately benefit. Having the tools, such as this methodology, that allow me to look at my processes and improve
patient care, makes my job and career much more rewarding.” Melinda Joyce, Director of Pharmacy; Green Belt; currently
leading a project studying the crediting process for medication

As you can see by these testimonials, Six Sigma has proven to be not only a way of improving processes but also a method for
employees to achieve stretch goals. These Green Belts are living proof of CHC’s ability to continually seek greater and greater levels
of quality.

Lisa Thomerson became the first Six Sigma Corporate Champion at Commonwealth Health Corporation (CHC) in January 2000. Ms
Thomerson received CAP & WorkOut training from General Electric Medical Systems following CHC’s kick-off of Six Sigma in March
1998. In early 2000, she was GreenBelt trained by CHC’s Six Sigma training staff of Black Belts and received Champion training
through Juran Institute. CHC is the first healthcare organization to partner with General Electric, fully integrating Six Sigma into its
culture.

27 ΣXTRAOrdinary Sense March 2002

North Shore continued from page 21
raise the satisfaction level for employees, reducing burnout and
unwanted attrition. Well-developed, highly satisfied employees
translate into higher patient satisfaction and improved healthcare
delivery.
Dowling is optimistic about his expectations for the Center, saying,
“We are doing this because I believe it will enhance the product we
are delivering, as well as the business we are running… When we
talk about this with our department heads and employees, you
can absolutely observe the excitement. There is an excitement
that people will improve themselves. Excited about the relationship
with outside partners.”
Changing Health Care and Beyond
Although North Shore – LIJ is not the first healthcare organization
to apply Six Sigma methodologies, this project is the largest
endeavor to date, according to GE. Currently, it is estimated that
there are more than 3,000 Six Sigma healthcare projects worldwide,
including such organizations as Commonwealth Health Corporation
in Bowling Green, KY, Charleston Area Medical Center in
Charleston, WV, Virtua Health in Marlton, NJ and Northwestern
Memorial Hospital in Chicago, IL.
The impact that the simple principles of Six Sigma are going to
have on North Shore-LIJ and subsequently the collective health
care may not be immediate. However, the path of this troubled
industry toward improved process management is something that
all of as practitioners of quality will anxiously follow in the months
to come.
Breakthrough continued from page 9
To date, Mount Carmel's Six Sigma projects have included:
• Several claims-processing projects in the organization's Medi-
care HMO, employed primary care physician practices, and be-
havioral health business
• Processing time in central scheduling
• Claims denials due to patient type changes and long-stay obser-
vations
• Discharging throughput to decrease bottlenecks in the emergency
department
• Implementing of a procedure-based delivery system in the sur-
gery area to help ensure supplies are present when needed during
an operation
• Enhancing clinical documentation to ensure it matches the ser-
vices rendered
• Making clinical laboratory results available according to the re-
questing physician's needs, enabling the physician to make timely
decisions for patient discharge or continued treatment
• Reducing cycle time in various inpatient and outpatient diagnos-
tic areas
Breakthrough continued on page 29
28
Radiology continued from page 13
radiology throughput by 25% using fewer resources, while
simultaneously decreasing cost per radiology procedure by 21.5%.
Keys to Making It Work
One of the primary keys to unlocking Six Sigma success is solid
commitment from leadership. Since this initiative will invariably
Applying Six Sigma to Radiology:
Snapshot of Success
• Decreased the time between reports dictation and
report signature
• Reduced patient wait time from arrival in radiology to
time of exam
• Reduced time between patient dismissal and dicta
tion completion
• Decreased patient wait time for radiology registration
process
• Enhanced radiology scheduling process
• Reduced time from radiologist signature to report
distribution
•Increased efficiency in the MRI ordering process
• Optimized the content quality and delivery of pre-
exam patient education
• Reduced time for dismissal of radiology patients
• Enhanced film jacket retrieval process
• Decreased MRI report turnaround time
• Improved general radiology staff scheduling
• Increased efficiency of Ultrasound exam scheduling
and reduced overtime
• Utilized special procedures inventory more efficiently
• Augment radiology exam scheduling and pre-
registration process
• Reduce CT order to taken time
• Decreased IVP exam time
• Improve utilization of Nuclear Medicine radio-pharma
ceuticals
Measurable improvements in radiology added up to greater
efficiency and better quality. Staffing was reduced by 14 full-
time equivalents, entirely through attrition; identification errors
were reduced through bar coding, and processes were
improved.
Radiology continued on page 29
ΣXTRAOrdinary Sense March 2002
Radiology continued from page 28
compete for capital and time resources, participants have to be
able to count on unambiguous support from senior management.
To be successful, Six Sigma has to be priority #1.
Far more than just a financial engineering effort, the process involves
measuring all relevant criteria and making sure the job is done
right the first time, which ultimately has a positive impact on patient
care and satisfaction. The fact that Six Sigma offers a truly evidence-
based approach to operational and clinical improvement gives the
initiative greater credibility and makes it easier to get buy-in and
results. Persistence and a clear definition of your objectives are
also important factors. Everyone must understand that this is a
philosophy for doing business and requires active participation.
Communicating this vision clearly to the organization is mandatory.
Onward and Upward
As it has had an impact on other industries, Six Sigma could
positively affect public perception of healthcare delivery. Society
has struggled to find a workable methodology to measure
quality. Looking beyond the obvious indicators of mortality and
morbidity, it’s tough to gauge. Using the methodology to
carefully gather and analyze data can help providers accurately
identify where problems exist and how best to correct them. Six
Sigma provides a roadmap for process improvement,
dashboards to let you know how well you’re doing, and process
“cruise control” to keep the improvements on track.
To carry this quality improvement forward at Commonwealth will
require ongoing training and the generation of approximately 120
trained Green Belts within two years. Every CHC employee will
receive a minimum of one full day’s training.
Six Sigma is a sound philosophy of management and quality that
gives companies a chance to reduce cost, increase productivity
and improve quality. Effects are evident and long-term, and the
approach can be adapted and applied throughout the organization.
Jean Cherry is executive vice president at Commonwealth Health
Corporation and is a fellow of the American College of Healthcare
Executives. She holds a bachelor of science degree in business
administration from Western Kentucky University and a master of
science degree in healthcare administration from the Medical
College of Virginia. Cherry has worked in healthcare administration
for over 13 years. She oversees Commonwealth Health Corporation’s
support functions which include quality resource management,
information technology and facilities management, and is a licensed
nursing home administrator. Cherry may be contacted at 270/745-
1527.
Sridhar Seshadri is vice president and general manager with the
Healthcare Solutions Group of GE Medical Systems Information
29
Technologies. He holds a bachelor of science degree in electrical
engineering from Bangalore University in India, a master of science
degree in electrical engineering from Drexel University, and a master
of business administration degree from the University of
Pennsylvania (Wharton) in 1993. He is widely published and has
an extensive background including lead engineer with the University
of Pennsyvania’s Radiology Department, where he developed and
evaluated Picture Archiving and Communication Systems (PACS).
Since then, he has held the positions of manager, new business
development and director, product management and strategic
planning in the medical technologies industry. Seshadri may be
contacted at Sridhar.Seshadri@med.ge.com.
Suggested Readings
Breyfogle, F.; Cupello, J.; and Meadows, B. 2000. Implementing Six
Sigma: Smarter Solutions Using Statistical Methods. New York,
NY: John Wiley & Sons.
Pande, P.; Neuman, R.; and Cavanagh R. 2000. The Six Sigma
Way: How GE, Motorola and other top companies are honing
their performance. New York, NY: McGraw-Hill Professional
Publishing.
Rath & Strong’s Six Sigma Pocket Guide. 2000. Lexington, MA:
Rath & Strong, Inc.
Slater, Robert. 1999. Jack Welch and the GE Way: Management
Insights and Leadership Secrets of the Legendary CEO. New
York, NY: McGraw-Hill Professional Publishing.
Slater, Robert. 1999. The GE Way Fieldbook: Jack Welch’s Battle
Plan for Corporate Revolution. New York, NY: McGraw-Hill
Professional Publishing.
Breakthrough continued from page 28
Financial Return And Other Benefits
To date, we have realized a financial return of $3.1 million, and we
expect these financial returns to grow rapidly as more Six Sigma
projects are completed.
Another key benefit of Six Sigma has been increased employee
and physician satisfaction as we have begun to fix problems in
operational processes that have been a source of frustration and
dissatisfaction for these important stakeholders as they do their
jobs. For instance, employee retention has improved, which we
believe is due at least in part to Six Sigma initiatives.
While Mount Carmel has experienced its share of challenges in
implementing Six Sigma, we strongly believe in its potential and
value in the field of healthcare in improving financial performance,
clinical quality and patient safety, and stakeholder satisfaction.
Jeffrey Burnich, M.D. (614.234.5633 or jburnich@mchs.com) is
Mount Carmel's Senior Vice President of System Care Manage-
ment and Chief Quality Officer. Tammy Weidner, R.N., MBA
(614.234.5467 or tweidner@mchs.com) is Vice President of Six
Sigma.
ΣXTRAOrdinary Sense March 2002
 ΣXTRAOrdinary Sense March 2002
30