Defining the Right Project Scope for Six Sigma in Healthcare

The Project Management Body of Knowledge and Project Scope

The Project Management Body of Knowledge (PMBOK) defines scope as "the process of developing a detailed project scope statement as the basis for future project decisions," while Juran defines scope as a "problem scheduled for solution." It is crucial to have the appropriate scope for the project in the define phase of the DMAIC process. Teams that rush through this critical step of the DMAIC process often get frustrated as they move to the other phases and get bogged down for a variety of reasons. Some of the issues resulting from poor project scope include: the project not being linked to the strategic goals of the organization/division/department, not having clear metrics that track progress, improper use of process improvement tools, not staffing teams with the right skills needed for the project, changes to the team charge (scope creep), to name a few.

The Triple Constraints: Project Resources, Project Duration, Project Scope

A good understanding of the triple constraints of a project is essential to ensure successful project initiating, planning, executing, controlling and closing out. The triple constraints are: resources, duration and scope of the project. The triple constraints influence each other and the quality/outcome of the Six Sigma project. For example, if the duration of the project is changed, the resources and/or project scope needs to be adjusted to maintain the outcome and quality of the Six Sigma project. Similarly, if the resources allocated are removed (budget, manpower, etc), the project scope needs closer scrutiny or the duration of the Six Sigma project might have to be extended.

Six Sigma Project Scope for Healthcare

The healthcare industry is made up of compassionate, well-intentioned individuals wanting to fix the problem once and for all. Often healthcare projects start off as "boiling the ocean" or "solving world hunger." This is especially true when no true solution is apparent for the problem at hand, and one would like to include anything and everything in the project scope. In healthcare, the key role of the Black Belt or the Six Sigma project manager is to ensure that the project scope of the Six Sigma initiative is manageable. Failing to do so will result in frustration for the team members and loss of credibility for the Six Sigma program. A rule of thumb I use is that the Six Sigma project for healthcare should be completed in a three to six month time frame.

Can the Project Scope be Too Narrow?

In my experience I have not come across a project that was too narrow in scope for the resources or duration allocated for the project. So, if you are starting on a new Six Sigma project in your organization, my recommendation is to start small. Gear your team to succeed, even though it might seem to be a very easy project or problem to solve. If it indeed turns out to be a small project, you can always finish it sooner than planned, and the team will thank you for that. The following healthcare case study will illustrate fine tuning the project scope.

A Healthcare and Six Sigma Case Study

I worked with the human resources team on a healthcare Six Sigma project to help them improve the recruitment process for the physicians. In the initial meetings, we decided on what to improve (reducing hand offs). The team was challenged to further narrow down the project scope (internal residents, external physicians, researchers, physicians from abroad, etc.). The team did some preliminary analysis and decided to work on the segment that had the most hand-offs and work-arounds. By focusing narrowly on their biggest source of error/frustration, the team was able to develop metrics (number of hand-offs, number of staff handling application). The team decided to develop and implement solutions in 60 days (duration) to make the process improvements, and the goal was a 50 percent reduction in hand-offs and the number of staff involved in handling the application (outcome). Based with these three key inputs of scope, duration and outcomes, the team was formed (resources). Using DMAIC process, the team achieved the goal in less than 45 days, and the team then used the remaining time to work on the next biggest source of hand-offs. Had we not narrowed down the project scope adequately, the team would have had a very broad project scope with various issues not pertaining to the biggest contributor to the problem (such as INS, verification of foreign degrees, etc.) and would not have come up with solutions for majority of their issues. The detail of the DMAIC framework used by this team is subject of another article.