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Lessons from Sweden’s first large-scale implementation of Six Sigma in healthcare

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Abstract

The Skaraborg Hospital Group (SkaS) has implemented a variety of quality management initiatives in the last 20 years in accordance with its strategy of excelling at quality development to fulfill the needs and expectations of its patients. One such initiative is Six Sigma, which has contributed to more than 40 completed improvement projects. Using an action research approach, this article describes the lessons that were learned from the first 22 Six Sigma projects, completed between 2006 and 2008 and having a success rate of 75%. We further describe how these insights have contributed to other ongoing quality improvement activities at SkaS. In particular, the paper presents some key points not earlier described in other Six Sigma healthcare applications.

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References

  • Aagaard Nielsen K, Svensson L (eds) (2006) Action research and interactive research. Shaker Publishing, Maastricht

    Google Scholar 

  • Adams R, Warner P, Hubbard B, Goulding T (2004) Decreasing turnaround time between general surgery cases. J Nurs Adm 3:140–148

    Google Scholar 

  • Antony J, Downey-Ennis K, Antony F, Seow C (2007) Can six sigma be the “cure” for our “ailing” NHS? Leadersh Health Serv 4:242–253

    Article  Google Scholar 

  • Arndt M, Biegelow B (1995) The implementation of total quality management in hospitals: How good is the fit? Healthc Manag Rev 20:7–14

    Google Scholar 

  • Bahensky JA, Roe J, Bolton R (2005) Lean sigma—will it work for healthcare? J Healthc Inf Manag 1:39–44

    Google Scholar 

  • Bergman B, Klefsjö B (2003) Quality – from customer needs to customer satisfaction. Studentlitteratur, Lund

    Google Scholar 

  • Berwick D, Nolan T (2003) The Breakthrough series—IHI’s collaborative model for achieving breakthrough improvement. IHI, Cambridge, MA

    Google Scholar 

  • Boaden R, Harvey G, Moxham C, Proudlove N (2008) Quality improvement: theory and practice in healthcare. NHS Institute for Innovation and Improvement, Coventry

    Google Scholar 

  • Bradbury H, Reason P (eds) (2008) The Sage handbook of action research. Sage Publications, London

    Google Scholar 

  • Chakravorty SS (2009) Six sigma failures: An escalation model, Oper Manag Res. In press. doi:10.1007/s12063-009-0020-8

  • Cherry J, Seshadri S (2000) Six sigma: Using statistics to reduce process variability and costs in radiology. Radiol Manag nov/dec:42–45

  • Clifford L (2001) Why you can safely ignore six sigma. Fortune 143:140

    Google Scholar 

  • Cronemyr P (2007) Six sigma management. Dissertation, Chalmers University of Technology

  • Dahlgaard JJ, Dahlgaard-Park SM (2006) Lean production, six sigma quality, TQM and company culture. TQM Mag 18:263–281

    Article  Google Scholar 

  • Dean JW Jr, Bowen DE (1994) Management theory and total quality. Improving research and practice through theory development. Acad Manag Rev 19:392–418

    Article  Google Scholar 

  • Deming WE (1986) Out of the crisis. MIT Press, Cambridge

    Google Scholar 

  • Eriksson N (2005) Friska vindar i sjukvården (’Fresh breezes in healthcare’). Dissertation, Förvaltningshögskolan

  • Fillingham D (2007) Can lean save lives? Leadersh Health Serv 20:231–241

    Article  Google Scholar 

  • Fraser S (2002) Accelerating the spread of good practice: a workbook for health care. Kingsham Press, Chichester

    Google Scholar 

  • Frings GW, Grant L (2005) Who moved my sigma? Effective implementation of the six sigma methodology to hospitals. Qual Reliab Eng Int 21:311–328

    Article  Google Scholar 

  • Goh TN (2002) A strategic assessment of six sigma. Qual Reliab Eng Int 18:403–410

    Article  Google Scholar 

  • Harry M, Schroeder R (2000) Six sigma—the breakthrough management strategy. Doubleday, New York

    Google Scholar 

  • Hasselbladh H, Bejerot E, Gustafsson RÅ (2008) Bortom new public management—institutionell transformation i svensk sjukvård (’Beyond new public management—institutional transformation in Swedish healthcare’). Acadameia Adacta, Lund

    Google Scholar 

  • Hellström A, Eriksson H (2007) Among fumblers, talkers, mappers and organizers—four applications of process orientation. Appended paper in Hellstrom A (2007) On the diffusion and adoption of management ideas. Dissertation. Chalmers University of Technology

  • Hellström A, Lifvergren S, Quist J (2010) Process management in healthcare—investigating why it’s easier said than done. J Manuf Technol 21:499–511

    Article  Google Scholar 

  • Hood C (1991) A public management for all seasons? Public Adm 69:3–19

    Article  Google Scholar 

  • Hyer NL, Wemmerlöv U, Morris J, Shtub A (2003) Cellular manufacturing in health care: the case of a trauma unit. In: Spina, J et al. (eds) One world? One view of OM? The Challenges of integrating research & practice. EurOMA–POMS Conference, Como, Italy, 16–18 June, Vol I:913–917

  • Institute of Medicine (2001) Crossing the quality chasm. National Academy Press, Washington

    Google Scholar 

  • Ishikawa K (1982) Guide to quality control. Asian Productivity Press, Tokyo

    Google Scholar 

  • Kammerlind P, Kollberg B (2007) Kvalitetsmetoder inom svensk hälso- och sjukvård (’Quality methods in Swedish healthcare’). In: Elg M, Gauthtereau Witell L (eds) Att lyckas med förbättringsarbete (’To succeed with improvements’). Studentlitteratur, Lund

    Google Scholar 

  • Kaplan RS, Norton DP (1992) The balanced scorecard—measures that drive performance. Harv Bus Rev 10:1–31

    Google Scholar 

  • Kaplan RS, Norton DP (2001) The strategy-focused organization. Harvard Business School Press, Boston

    Google Scholar 

  • Kollberg B, Elg M (2006) Exploring the use of balanced scorecards in Swedish health care organizations. The Asian J Qual 2:1–18

    Google Scholar 

  • Langley GJ, Nolan KM, Nolan TW (1992) The foundation of improvement. Silver Spring, MD

  • Lifvergren S, Chakhunashvili A, Bergman B. Docherty P (2008a). Online statistical monitoring of critical patient data increases patient safety. PICMET-conference, Proceedings, Capetown

  • Lifvergren S, Edin M, Rentzhog O, Tullberg S (2008b) Six Sigma i hälso- och sjukvården (‘Six Sigma in healthcare’). Sveriges Kommuner och Landsting (SALAR), Stockholm

  • Lifvergren S, Chakunashvili A, Bergman B (2009a) Using scientific problem solving methods to improve healthcare processes and increase patient safety. EurOMA-Conference, Proceedings, Gothenburg

  • Lifvergren S, Huzzard T, Docherty P (2009b) A development coalition for sustainability in healthcare. In: Docherty P, Kira M, Shani AB (eds) Creating sustainable work systems: developing social sustainability. Routledge, London

    Google Scholar 

  • Lindgaard Laursen M, Gertsen F, Johansen J (2003) Applying lean thinking in hospitals exploring implementation difficulties. Center for industrial production, Aalborg University

  • McNulty T, Ferlie E (2002) Reengineering health care: The complexities of organizational transformation. Oxford University Press, Oxford

    Google Scholar 

  • Nembhard IM, Alexander JA, Hoff TJ, Ramanujam R (2009) Why does the quality of health care continue to lag? Insights from management research. Acad Manag Perspect 23:24–42

    Google Scholar 

  • OECD (2007) OECD Health Data: Statistics and indicators for 30 countries. OECD, Paris

    Google Scholar 

  • Olsson J, Kammerlind P, Thor J, Elgh M (2003) Surveying improvement activities in health care on a national level—the Swedish internal collaborative strategy and its challenges. Qual Manag in Healthc 12:202–216

    Google Scholar 

  • Øvretveit J (1997) A comparison of hospital quality programmes: lessons for other services. Int J Service Ind Manag 3:220–235

    Article  Google Scholar 

  • Øvretveit J, Gustafson D (2002) Quality improvement research—evaluation of quality improvement programmes. Qual and Saf in Healthc 11:270–275. doi:10.1136/qhc.11.3.270

    Article  Google Scholar 

  • Øvretveit J (2009) Does improving quality save money? A review of evidence of which improvements to quality reduce costs to health service providers. The Health Foundation, London

  • Plsek P (1998) Worldwide complexity: Strategic planning for a non-profit healthcare organization—“non-business" plan approach to pursuing an international opportunity. IHI, Boston

    Google Scholar 

  • Prabhushankar GV, Devadasan SR (2008) The origin, history and definition of six sigma: a literature review. Int J Six Sigma Compet Advant 4:133–150

    Article  Google Scholar 

  • Radnor Z, Walley P (2008) Learning to walk before we try to run: Adapting lean for the public sector. Public Money and Manag 28:13–20

    Google Scholar 

  • Revere L, Black K (2003) Integrating six sigma with total quality management: A case example for measuring medication errors. J Healthc Manag 48:377–391

    Google Scholar 

  • Schroeder RG, Linderman K, Liedtke C, Choo AS (2008) Six sigma: Definition and underlying theory. J Oper Manag 26:536–554

    Article  Google Scholar 

  • Shani AB, Docherty P (2003) Learning by design: Building sustainable organizations. Blackwell, London

    Google Scholar 

  • Shani AB, Docherty P (2008) Learning by design. Key mechanisms in organization development. In: Cummings TG (ed) Handbook of organization development. Sage Publications, California

    Google Scholar 

  • Shortell SM, O’Brien JL, Carman JM, Foster RW, Hughes EF, Boerstler H, O’Connor EJ (1995) Assessing the impact of continuous quality improvement/total quality management: Concept versus implementation. Health Serv Res 30:377–401

    Google Scholar 

  • Simmons D, Cenek P, Counterman J, Hockenhury D, Litwiller L (2004) Reducing VAP with six sigma—use quality improvement methodologies to enhance core patient care process. Nursing Manag 35:41–45

    Google Scholar 

  • Smith B (1990) The Motorola story. Lecture by Bill Smith, Senior Quality Manager at Motorola at World Class Quality Event, March 1990, Västerås, Sweden

  • Spear S (2005) Fixing healthcare from the inside, today. Harvard Bus Rev Sept online version: 1–20

  • Stahl R, Schultz B, Pexton C (2003) From incremental improvement to designing the future. Six Sigma Forum Mag 2:17–26

    Google Scholar 

  • Swedish Department of Treasury (2005) Iaktagelser om landsting (‘Observations on counties’) DS 2005:7 (online http://www.sweden.gov.se/sb/d/108/a/41627)

  • Thor J, Herrlin B, Wittlöv K, Øvretveit J, Brommels M (2007) Evolution and outcomes of a quality improvement program. Appended paper in Thor J (2007) Getting going on getting better. Dissertation. Department of Learning, Informatics, Management and Ethics, Karolinska Intitutet

  • Tucker AL, Edmondson AC (2003) Why hospitals don't learn from failures: organizational and psychological dynamics that inhibit system change. Calif Manag Rev 45, no 2 (winter)

  • Tucker AL, Nembhard IM, Edmondson AC (2007) Implementing new practices; an empirical study of organizational learning in hospital intensive care units. Manag Sci 6:894–907

    Article  Google Scholar 

  • van Heuvel J, Does R, Vermaat MB (2004) Six sigma in a Dutch hospital: does it work in a nursing department? Qual Rel Eng Int 20:419–426

    Article  Google Scholar 

  • Westphal JD, Gulati R, Shortell SM (1997) Customization or conformity? An institutional and network perspective on the content and consequences of TQM adoption. Adm Sci Q 42:366–394

    Article  Google Scholar 

  • WHO (2000) World Health Report 2000. WHO Library Cataloguing in Publication Data, Geneva

  • Woodard TD (2005) Addressing variation in hospital quality: is six sigma the answer? J Healthc Manag 50:226–236

    Google Scholar 

  • Yasin MM, Zimmerer LW, Miller P, Zimmerer TW (2002) An empirical investigation of the effectiveness of contemporary managerial philosophies in a hospital operational setting. Int J Healthc Qual Assur 15:268–276

    Article  Google Scholar 

  • Young GJ, Charns MP, Shortell SM (2001) Top manager and network effects on the adoption of innovative management practices: a study of TQM in a public hospital system. Strateg Manag J 22:935–951

    Article  Google Scholar 

  • Zu X, Fredendall LD, Douglas TJ (2008) The evolving theory of quality management: the role of six sigma. J Oper Manag 26:630–650

    Article  Google Scholar 

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Authors and Affiliations

  1. Skaraborg Hospital Group, Kärnsjukhuset Skövde, 541 85, Skövde, Sweden

    Svante Lifvergren & Alexander Chakhunashvili

  2. The Centre for Healthcare Improvement, Chalmers University of Technology, Vera Sandbergs allé 8, 412 96, Gothenburg, Sweden

    Svante Lifvergren

  3. Division of Quality Sciences and the Centre for Healthcare Improvement, Chalmers University of Technology, 412 96, Gothenburg, Sweden

    Ida Gremyr, Andreas Hellström & Bo Bergman

Authors
  1. Svante Lifvergren
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  2. Ida Gremyr
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  3. Andreas Hellström
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  4. Alexander Chakhunashvili
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  5. Bo Bergman
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Correspondence to Svante Lifvergren.

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Lifvergren, S., Gremyr, I., Hellström, A. et al. Lessons from Sweden’s first large-scale implementation of Six Sigma in healthcare. Oper Manag Res 3, 117–128 (2010). https://doi.org/10.1007/s12063-010-0038-y

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