Our company has recently implemented a management technique known as Six Sigma that has been generating great productivity results for our firm. Six Sigma is based on the deceptively simple idea that being the best at whatever you do can have a near miraculous impact on a business and the bottom line. In fact, the gains promised by upper level management sounded almost too good to be true. The five basic processes Six Sigma methodology employs are: processes defining, measuring, analyzing, improving, and controlling. Small work teams are formed to address specific challenges, which we believe can be improved, using these methodologies. The teams that are deployed to address these challenges are left to find new and creative ways to improve quality, lower operating costs, decrease repairs and improve customer relations.

The Six Sigma Project is used time and time again by management as a basis for almost all of our business operations. It is up to us as team members to use this process to streamline our work within our group and with our customers. One of our first customers to utilize the Six Sigma system was Robert Wood Johnson Medical Center in New Jersey. The cardiology department is championing the business process at Robert Wood Johnson due largely to the success of other projects run by our company. The problem at Robert Wood Johnson was twofold: first their patient base was growing in large part due to an ever increasing elderly population and secondly the need to provide the same level of quality service or better with a budget that was decreasing.

Administrative managers and board members looked to Six Sigma as a low cost means for survival. The health care providers at this facility are constantly fighting with the realities of managed care and higher costs have been reluctant to get involved in a rigorous and seemingly strange improvement initiative. But in the case of Six Sigma the gain that could be made through implementing our suggestions highly outweighed the costs involved. The traditional approach to such a problem would have been to buy more hardware.

But we were smart enough to realize that this was probably not the best way to solve the problem. An alternative approach employing Six Sigma methodology was proposed by our team. The first action we took was to retain a consultant who trained a cross-section of cardiology personnel, receptionists, nurses and physicians in Six Sigma methodology. The consultant then served as a resource during the various phases of the project. The project had four main goals: Increase capacity, improve technologist morale and create a more pleasant work environment, reduce patients' wait time, which was averaging 60 minutes from when they arrived until they began being processed and eliminate repeat examinations due to technical errors, such as performing the wrong procedure, or losing the reports. The first 6 or 7 months we spent defining, measuring and asking questions about how the cardiology unit really operated, and getting quantifiable answers.

Because Six Sigma is data driven, we needed hard facts. We couldn t make decisions based on the department s perceptions or guess s. The defining and measuring stages proved to be a great more complex and difficult a task for us, but it enabled us to determine what areas we should tackle first, and how to distribute our time and resources. One of the main reasons data gathering proved so troublesome was that input from technologists was critical to understanding work flow, and Robert Wood was experiencing a 50% turnover rate for technologists. We determined that the seasoned technologists were the people we would have to gain most of our information from. We determined through talking with these technologists on a daily basis the hospital needed to provide an environment more conducive to retaining there employee s.

Some moves to make technologists happier involved standardizing procedures to assure consistency, and promoting teamwork, to get them working together, we had to break up the cliques that had developed over time and were a hindrance to cooperation. We were able to implement some changes and make those cliques go away. Technologist education has also been a key priority; working in conjunction with a corporate liaison we were able to develop a more streamlined check in process. In the analysis phase of Six Sigma, we determined that patient handling and not the actual EKG speed was the primary problem.

We looked at the entire process, from the moment a patient arrived and checked in until we had the reports read and the cardiologists report transcribed. New advances in equipment provide the ability to run an EKG on a patient in a couple minutes. But it can take 10 to 15 minutes to get the patient on and off the table. So the number of patients they could handle, not the number of examinations they could perform, became the limiting factor. We have employed Six Sigma to successfully eliminate bottlenecks in the triage department, gaining through the process a 28% increase in patient throughput, the department s assumption was that the bottleneck was a hardware limitation. These goals all have been met or exceeded.

When the project started, the cardiology section, working two 8-hour shifts, was on average performing 207 EKG examinations per day on some 115 patients. Since the Six Sigma changes were put in place on January 1, 2000, the cardiology department with the same amount of equipment has been performing around 300 examinations per day on some 160 patients-a 28% increase in patient throughput and a 45% increase in the number of examinations. With our experience at Robert Wood Johnson we found that you usually have bottlenecks in areas other than the EKG carts. Our Six Sigma process looked at and addressed all of the problems and found the throughput increases we have achieved came from scaling the entire operation, from patient induction through examination interpretation.

We never looked at gaining capacity by only adding equipment. This was shown to be a positive managerial experience.