Deploying Six Sigma within Health Care: A Roadmap to Success

Antz Joseph

Six Sigma, a process improvement methodology, assists with analyzing and breaking down processes in order to detect specific causes or X’s that may adversely impact a process. In health care, these special causes or inefficiencies tie directly to the quality of patient care and therefore cannot be overlooked.

So What about Six Sigma Deployment within Health Care?

If one thinks about it, Six Sigma deployment is a process in itself and is no different than a process for correctly ordering, performing and ultimately obtaining results of an X-ray procedure or test. Proper deployment of a Six Sigma program requires correct implementation, good timing of needed objectives and successful completion of steps prior to moving forward.

I will discuss the steps and challenges that health care providers may face in deploying a Six Sigma or Lean program. To help illustrate a number of these steps, I have used examples from a recent venture in which North Shore/LIJ Health System (NSLIJHS) assisted Michigan-based Hurley Medical Center with deploying Six Sigma and Lean.

Communication of Six Sigma Knowledge throughout All Levels of the Organization

At the beginning of a deployment, CEO involvement is crucial in fostering organizational participation and support, and ensuring that the organization’s leadership receives a clear understanding of why the Six Sigma methodology is needed and what could be expected from its deployment. Overall, Six Sigma initiatives must be communicated to all levels of the organization for its deployment to be a success.

Case Example

To engage the entire organization in Lean and Six Sigma, the medical center set up a series of presentations, meetings, and Q&A sessions for executives, Champions, union leaders, board members and managers. These communications included Six Sigma White Belt courses, which were high level overviews of the Six Sigma and Lean methodologies, and sample project successes experienced at NSLIJHS.

Understanding the Impact of Past Programs

It’s important for a health care organization to understand the successes and challenges of past performance improvement programs. Employees within the organization may have had the experience of participating in a less-than-successful improvement program; this understanding of what worked and what didn’t work in the past is crucial for addressing any concerns these employees may have for the new program.

Determining the Needs of the Organization

The next step is to determine the organization’s current needs, goals and strategic plan, and to ensure that the project selection supports and drives the organization’s goals and mission.

Case Example

The medical center’s goal was to improve processes that would enhance patient/physician satisfaction within the hospital and have the greatest financial impact on the organization. To better address this goal, A Six Sigma committee was developed to help the medical center understand and brainstorm issues facing the hospital. Facilitated by a NSLIJHS Six Sigma Master Black Belt, this committee included the CEO, senior executives, and physicians. The committee used a brainstorming method and a priority/pay off matrix tool to generate a large list of ideas for projects; these ideas were later prioritized using the axes listed below. The first wave of projects was then selected: items boxed in red were identified as Six Sigma projects; items boxed in green were identified as Lean projects. (Click on image to enlarge.)

Black Belt Selection

Black Belt selection is as important, if not more important then project selection, especially for first timers using Six Sigma. Black Belts need not be from the functional area where the problem exists: They only need to know how to use the tools, exhibit leadership skills and have the respect of the organization.

The criteria for selecting Black Belts are:

  • Strong interpersonal skills
  • Able to influence/motivate teams
  • Change agent
  • Analytical/strong problem solver
  • Advanced leadership skills
  • Excellent project leadership
  • Strong coach/mentoring skills
  • Team player
  • Integrates effectively with business teams
  • Demonstrates prioritization ability

Case Example

For the first three projects, the medical center’s leadership identified Black Belt candidates who were well respected in the organization and who provided a cross sectional representation of the organization’s processes. These Black Belts included the vice chairman of the emergency department, a registered nurse and a laboratory supervisor.

Green Belt Selection

Green Belt Selection is important for a different reason. Green Belts, similar to Black Belts, can be from different departments of the hospital. However, it’s more important that the Green Belts on the team represent a cross section of expertise and levels to balance the group. At least one of the Green Belts should be from the functional area where the problem resides; extended team members can be included as the project progresses.

The criteria for selecting Green Belts are:

  • Functional expertise
  • Able to influence/motivate teams
  • Analytical/strong problem solver
  • Ability to work with and influence cross functional teams
  • Team player
  • Demonstrates prioritization ability

Case Example

When the medical center initiated a project to improve lab turnaround time for emergency department patients, it selected as the project’s Green Belts a registered nurse,a lab medical technologist, a health unit coordinator, and a laboratory clerk.


Although a sponsor is not an active member of the core Black Belt/Green Belt team, he or she does play an active part in stepping in when the team encounters any road blocks (e.g., bureaucracy in obtaining information, access to critical metrics, participation by departments, etc.). Therefore, the sponsor should be kept informed of the team’s progress. The sponsor needs to be high enough in the organization to be able exert this type of influence.

Case Example

On an emergency department admission to inpatient bed project, the medical center recruited the chief medical officer of the emergency department as the sponsor. The chief medical officer made for a suitable sponsor as he was initially involved as a Six Sigma committee member and understood the role and strength of Six Sigma as a performance improvement methodology.


Once projects are identified, they must be properly scoped in order to ensure that they are aligned with the organization’s goals. Project expectations must be defined, and the scope of the processes being targeted in the project must be evaluated. For instance, the team, sponsor and customer need to agree at which point the process begins and where it ends so the team does not end up looking at too large or too small a portion of the process being evaluated.

There needs to be sufficient preparation, communication, acceptance and alignment in order to beginning project work. Looking at the typical Six Sigma project with teaching time line below, one will see that actual project work does not start immediately in the first month but rather in the third month. In simple terms, a Six Sigma deployment team must GO SLOW in the beginning so it can GO FAST later.

Some notes about the timeline below: R1 through R3 refers to report outs of previous phases’ activities. These reports are performed prior to moving on to the next phase and generally reported to project sponsors and interested individuals in the organization. R4refers to the final report out to the organization’s leadership. Fast Track Decision Making (FTD) refers to courses taken prior to beginning project work; these courses prepare Black Belts and Green Belts with the skills needed to plan and hold effective meetings and lead change. (Click on images to enlarge.)

The Structure

Simple deployment is not enough. The establishment of a Six Sigma/organizational improvement structure is also needed to provide a foundation that will support the quality, operational and financial improvement efforts that are ultimately to come from the deployment. (Click on image to enlarge.)

The structure above is a graphical representation of the pillars of strength that are needed to support the Six Sigma organization; supporting the pillars is a strong foundation of unyielding administrative leadership.

Case Example

Hurley Medical Center began to build this structure by modifying and establishing a Six Sigma Leadership Steering committee, which included a cross sectional team of senior executives, directors, nurses, physicians, patient advisors and board members. These team members had a pulse on the issues that challenged the organization and had an understanding of the medical center’s strategic goals. Led and facilitated by a Six Sigma Master Black Belt, the committee was to identify processes that challenged and impacted services provided by the medical center and then to prioritize their improvement.

The structure and posture that Hurley Medical Center developed was to establish an Organizational Development department poised to address these issues. This department’s primary role was to promote a culture dedicated to excellence, innovation, teamwork, and continuous change. Through continuous learning, employees would develop the necessary knowledge, attitude, and skills to support the organization’s business goals.

As part of the Organizational Development department, the division of Operational Performance was established to enable the medical center’s leaders to effectively manage change and meet the business goals of the organization through data driven decision making — all the while fulfilling the mission to provide quality patient care. The division insured the delivery of improved processes, defect reduction, financial awareness, and improved quality. It also provided the organization with a unique educational opportunity through the use of the Six Sigma DMAIC and Lean methodologies. This education was enhanced with hands on learning and real time implementation of solutions to the business issues.

Continuing the Level of Engagement for Six Sigma and Lean

In the Short Term

In addition to the continued participation of Black Belts and Green Belts, past participants should be encouraged to complete at least two projects to satisfy their certification and teach small sections of a DMAIC or Lean course. Green Belts should be encouraged to use individual Six Sigma and Lean tools within their own department.

Case Example

The medical center followed the steps above, and even encouraged Master Black Belts and Black Belts to seek out speaking engagements and publication opportunities from within and outside the organization.

To assist with this engagement, NSLIJHSdeveloped for employees within the medical center a certification track to reference and follow, as shown in the two images below. (Click on images to enlarge.)

In the Long Term

Master Black Belts and/or Black Belts may sit on already established committees as advisors for validation of data collection activities. In addition, they may assist with data collecting tool creation and look for possible project opportunities that will not only assist in the day-to-day improvement of process inefficiencies, but will also help support the organization’s short and long term goals.

In the long run, it’s not about the projects: It’s about ingraining Six Sigma/Lean tools and thinking into the culture of the organization. These methodologies should become part of the fabric of the health care system. By adding Six Sigma/Lean methods to already established performance methods and not missing any critical step, a health care organization can build a solid foundation that will help support a strong organizational structure.