Six Sigma Program Takes Aim at Medical Errors

In 1999 Froedtert Hospital, the Medical College of Wisconsin and the American Society for Quality (ASQ) formed a partnership to establish Froedtert & Medical College as one of the first medical centers in the country to use a practice called Six Sigma to identify and help eliminate medical errors.

Six Sigma is a process improvement method that focuses on eliminating defects by reducing variation. It relies heavily on statistical analysis of data and strong problem-solving techniques. For more than a decade, companies such as GE, Motorola and Toshiba have used Six Sigma to foster excellence by virtually eliminating errors. Only recently have health care organizations begun applying Six Sigma methods into their operations, and Froedtert & Medical College are pioneers in this implementation.

The focus on Six Sigma was chosen after a study released by the National Academy of Science’s Institute of Medicine (IOM) found that medical errors are responsible for the deaths of 44,000 to 98,000 hospital patients every year. Even if it were the lower number, the report said, it would make medical errors the eighth-leading cause of death in the United States, exceeding causes like motor vehicle accidents, breast cancer or AIDS.

According to the IOM report titled “To Err is Human,” the American health care system is “remarkable for its technological achievements,” but it is also “potentially dangerous – even lethal – in its execution.”

William R. Hendee, PhD, Vice President of Technology and Dean of the Medical College Graduate School of Biomedical Sciences, is keenly interested in reducing medical errors. He is an officer and serves on the board of the National Patient Safety Foundation. William D. Petasnick, President and CEO of Froedtert Hospital, strongly endorses it as well. In fact, he hopes to make Six Sigma standard operating procedure at Froedtert & Medical College.

Complex Systems Increase Human Error
Unintended human error is at the root of many medical errors. Beth Lanham, RN, BSN, Quality Management Six Sigma Coordinator of the Froedtert Six Sigma effort, assessed the problem in an article she wrote for the March 2003 issue of the journal Nursing Economics.

Noting that the IOM report concluded “the problem is not bad people in health care – it is that good people are working in bad systems,” Lanham wrote: “No one questions the fact that health care today is high-risk, highly complex and labor intensive. It has grown far too complex for the model that worked decades ago. The quality of our current care delivery system is, to a large extent, dependent on complex internal systems working smoothly and efficiently together. Froedtert Hospital believes that implementation of Six Sigma methodology is the catalyst needed to successfully combine quality, cost and patient safety.”

Success with Three Initial Projects
In her article, Lanham went on to describe how Froedtert & Medical College have significantly improved patient care and reduced errors after Six Sigma methods were applied to three initial projects:

1. IV drug infusions.
The IV drug project identified three key variables:

• concentrations prepared by the pharmacy
• how physician orders were formatted
• how nurses calculated drip rates

Improvements were initiated, including standardizing of drug concentrations, development of tables to improve the accuracy of drip calculations. Error rates and clinical discrepancies improved significantly.

2. Patient Controlled Pumps for Administering Pain Medications.
In this project, the primary variables were the variety of concentrations available for medication and pump programming errors. Improvements were introduced to specifically address these problems:

• the pharmacy reviewed orders earlier in the process and intervened when non-standard medications were ordered
• medications that were kept in patient areas were standardized and limited
• colored labels were utilized to indicate non-standardized concentrations
• nurses were retrained in the more problematic steps of programming the pump

After these improvements were there were significantly fewer errors, and if errors did occur, they were less severe and were discovered more quickly.

3. Laboratory turn-around time.
In her article, Lanham reported that this project was difficult to complete because its scope needed better definition. Despite that, she wrote, it did succeed in uncovering a variety of obstacles to improvement, such as software and interface issues and the pneumatic tube system, among others.

Lanham and Kristin Hanson, Assistant Director of the hospital pharmacy, have completed one of the highest levels of Six Sigma training, earning certification as “Black Belts.” Black Belts are technical project leaders and they help train others in the organization. Two more Froedtert employees have recently been certified as Black Belts or are completing the process, Lanham says, and another 16 are trained at the introductory level, called Green Belts.

In addition to the three projects Lanham described in her Nursing Economics article, since 2000, Froedtert & Medical College have been applying Six Sigma disciplines to identify and eliminate errors in the following areas:

• Patient falls in the rehabilitation unit
• Reducing the time a physician orders an antibiotic and the patient’s receiving it
• Elapsed time from when a patient diagnosed with a heart attack arrives at the hospital to treatment in the catheterization lab
• Frequency and severity of low glucose readings in insulin recipients
• Post-operative narcotic sedation

Lanham hopes to soon publish the results from these projects. Meantime, three years into the introduction of Six Sigma methodology, how successful has it been for Froedtert and the Medical College physicians’ treatment of patients?

“We strongly believe in the applicability of Six Sigma to health care,” Lanham wrote. “We have found it to be a powerful, data-driven and successful endeavor. Physicians have responded favorably to the Six Sigma methodology, and they have frequently commented that they appreciate its scientific aspects.”

Dr. Hendee concurs: "The Medical College and its physician practice group is pleased to be partnering with the staff and administration of Froedtert in deploying Six Sigma to identify and reduce errors that can cause injuries to patients,” he says. “Improving the quality and safety of health care is a national movement, and it’s gratifying to see Froedtert & Medical College working together as leading institutions in this movement."

Six Sigma Can Also Cut Costs
Other hospitals around the country have begun working with Six Sigma methodology, Lanham says, although only a half-dozen are using it as Froedtert & Medical College has, to reduce medical errors. “Most of the others are applying it for cost reductions,” she says.

According to the IOM report, reducing medical errors can also result in significant financial savings, reporting that total national costs of preventable medical errors resulting in injury account for between $17 billion and $29 billion per year. The study noted that preventable adverse drug reactions can increase average hospitalization costs by $4,700 per admission.

The Six Sigma initiative by Froedtert & Medical College and the American Society for Quality has been mentioned on several occasions by John Torinus, a West Bend CEO who writes a regular column in the Sunday Business Section of the Milwaukee Journal Sentinel. In a recent column he hailed those efforts again:

“Health experts say defects in the medical system cause as much as 30% of all costs,” Torinus wrote. “In the $1.3 trillion health care industry, that means $390 million in waste every year.” Analyzing and measuring the quality of health care is long overdue, he continued. “How can you run an effective system of any kind without keeping rigorous track of outcomes?” Torinus asked. You can’t, he concluded, and organizations like Froedtert & Medical College are working to remedy that problem.

Barbara Abel
HealthLink Contributing Writer

For more information on this topic, see the HealthLink articles Medical Mistakes: How Can They Be Prevented? and 20 Tips to Help Prevent Medical Errors.