The Manager's Guide to Six Sigma in Healthcare: Practical Tips and Tools for Improvement, by Robert Barry and Amy C. Smith, Milwaukee, Wis: ASQ Quality Press, 2005. 249 pages, softcover, $25.00
In this issue, 2 books representing 2 different approaches to teaching the same management evaluation and improvement system are reviewed. One, Lean-Six Sigma for Healthcare: A Senior Leader's Guide to Improving Cost and Throughput, is addressed to the senior leaders of a health care organization and focuses on strategic initiatives. The other, the subject of this review, is addressed to line managers and focuses on practical tips and tools.
The authors of The Manager's Guide to Six Sigma in Healthcare: Practical Tips and Tools for Improvement tackle their subject briskly, with 6 short major sections plus 6 information-packed appendices. The major sections are "Patient Care," "Patient Service," "Operations," "Systems," "Methods and Tools," and "Senior Management To-Do." Each section is further subdivided into very short chapters addressing specific operational topics. The detailed Table of Contents, featuring explanatory notes under the chapter headings, makes the task of searching for a particular area of interest relatively easy. For any executive, senior or junior, who has to do a lot of occupational reading, this kind of reader-friendly structure is extremely helpful.
In their preface, the authors point out one of the great advantages offered by the Six Sigma approach-that applying it "makes good use of information on hand and does not require outlays for data takers or computer systems."1(pxiii)
Each short chapter starts out with a checklist of objectives and related processes, often couched in preceptorial style. Whether or not the reader likes the style, the material and advice are valuable.
In chapters 7, 8, and 9, the authors explore the issues surrounding capacity, scheduling, and turn-away rates, patient convenience, and staff productivity, all of which bear upon access to care and on the quality of care. They offer a neat description of the effect of the Poisson distribution, which traditionally was used to describe the flow of emergency and obstetrics department patients. Erlang's distributions are also cited as ways of taking account of capacity and occupancy in planning.
Chapter 18, "Lean Operations," dealing with cycle time issues, is especially interesting when you compare it with the approach used in the other volume, Lean-Six Sigma for Healthcare: A Senior Leader Guide to Improving Cost and Throughput. Here, Barry and Smith discuss inventory management, stocking levels, and replenishment practices and reliability. They advise the line manager to focus on cycle time and to avoid the mishaps that can arise from what they call "naive lean inventory management." As they point out, in a hospital a stockout situation can have truly serious consequences. Think pharmacy or blood bank.
The appendices address the vocabulary of statistics, Six Sigma arithmetic, the shape of the hospital's Six Sigma experience curve, the Erlang distributions B and C, queuing, radio frequency identification, and the technique of sequential testing of hypotheses. These appendices would be invaluable to any line manager who is charged with developing and overseeing a Six Sigma application. The authors use their initial checklist device at the beginning of most of the appendices, and then follow up with detailed analysis and discussion of the content material.
Both authors are Six Sigma Black Belts long engaged in Six Sigma consulting and teaching. Robert Barry, PE, PhD, is a principal of Balester Consultants, a management consulting firm. Amy C. Smith, MSN, APRN, BC, is director of outcomes management and research at Sharon Regional Health System, Sharon, Pa. She is a board-certified clinical nurse specialist with interests in clinical performance assessment and improvement.
Jean Gayton Carroll, PhD, Editor
Quality Management in Health Care, Chicago, Ill
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