Six Sigma Methodology to Reduce Hospital Length of Stay
This paper examines the application of Six Sigma methodology to the challenge of reducing patient length of stay in hospital settings while simultaneously improving financial and health outcomes. Beginning with an overview of Six Sigma's origins at Motorola and its adaptation to healthcare, the paper reviews empirical and theoretical literature on its effectiveness in hospital environments. It then proposes specific measurement frameworks — spanning business value, patient satisfaction, clinical outcomes, and employee metrics — to guide a Six Sigma initiative. The paper also addresses the practical challenges of measuring health outcomes after patient discharge and offers creative solutions, such as patient surveys and readmission rate tracking, to overcome these difficulties.
- Introduction: Six Sigma as a tool for reducing hospital stays
- Literature Review: Six Sigma in Healthcare: Origins, principles, and healthcare adoption of Six Sigma
- Reducing Length of Stay: Evidence and Approaches: Empirical evidence and practical strategies for shorter stays
- Measuring Outcomes, Assessment, and Research: Proposed metrics and measurement challenges for Six Sigma
- Conclusions: Summary of potential, limitations, and next steps
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What makes this paper effective
- Clearly anchors a quality-improvement framework (Six Sigma) to a concrete clinical problem (length of stay), making the theoretical application immediately practical.
- Balances literature review with original analytical synthesis, critically noting the lack of statistical rigor in existing studies while still building a reasoned case for Six Sigma's potential.
- Proposes a structured, multi-dimensional measurement framework (financial, patient, employee, learning) rather than relying on a single metric, demonstrating nuanced thinking about organizational performance.
Key academic technique demonstrated
The paper exemplifies applied literature synthesis: it does not merely summarize sources but uses them to build an argument. Evidence of Six Sigma's general effectiveness is layered with healthcare-specific studies and then translated into actionable measurement recommendations. The author also models intellectual honesty by acknowledging where data are thin or where challenges with operationalization exist, strengthening rather than weakening the overall argument.
Structure breakdown
The paper follows a clear problem-framework-evidence-application-conclusion structure. The introduction identifies the clinical and administrative problem. The literature review is split into two components: a conceptual overview of Six Sigma and a targeted review of length-of-stay evidence. The measurement section operationalizes the framework in practical terms. The conclusion honestly assesses limitations while affirming the initiative's potential. An appendix summarizes the proposed measurement categories in table form.
Introduction
One of the challenges for hospital administrators is to improve the efficiency of their facilities while simultaneously improving patient outcomes. There are certainly instances where these goals go hand-in-hand, such as with advances in surgical techniques that lower the intrusiveness of surgeries and shorten post-operative stays. But there are other means as well by which efficiency can be improved while also improving health outcomes. Knowing that there are increased risks associated with longer hospital stays — such as the risk of infection — reducing the length of those stays would appear to be a means by which hospital administrators can improve health outcomes while at the same time improving efficiency, throughput, and the financial sustainability of their facilities.
One means of reducing stays is Six Sigma, a concept that emerged in production management at Motorola but has since been adapted to a multitude of contexts, including health care. This paper examines the role Six Sigma can play in reducing the length of hospital stays.
What is required of such an initiative is a means by which outcomes can be measured and assessed. This is an important part of the Six Sigma process, which relies on continually reducing error rates. Error rates require having measures against which progress can be tracked. For the Six Sigma strategy to work, those measures must be related to the outcomes that the strategy is designed to achieve. Thus, special care and attention must be paid to the development of outcomes to be measured.
Literature Review: Six Sigma in Healthcare
The Six Sigma philosophy was developed at Motorola and applied to engineering, in particular to the reduction of defects. When Six Sigma was adopted at General Electric, it became more widely known, and since then the program has been professionalized and applied to a wide range of organizations. The Six Sigma advocacy website iSixSigma.com describes it as "the implementation of a measurement-based strategy that focuses on process improvement and variation reduction through the application of Six Sigma improvement projects" (iSixSigma.com, 2016). There are guidelines for the selection of these improvement projects. The more expertise one acquires in Six Sigma and its techniques, the higher one advances on the Six Sigma hierarchy, which is structured like karate belts, with the black belt being the highest designation.
The point of Six Sigma is to institute "systematic innovation efforts" (Koning et al., 2006). Such efforts help hospitals to be more competitive and to improve health outcomes. Part of why Six Sigma is said to work is that the organization is always engaged in projects to improve quality — Six Sigma motivates managers and reduces organizational complacency with respect to quality. This is one of the best features of using measures as benchmarks for performance: an organization always knows where it stands, and it is easier to motivate improvement when progress is visible.
As Koning et al. (2006) note, "some operational inefficiencies are associated with the direct medical service delivery process," and this is especially true in organizations where those processes have never been subject to the kind of scientific, engineering-based analysis that is typical of Six Sigma practitioners. Six Sigma seeks to change the way that the organization thinks about service delivery. Some basic assumptions prevalent in healthcare that Six Sigma seeks to challenge are that mistakes are unavoidable and that hierarchical chain of command is effective (Koning et al., 2006). What Six Sigma promotes instead is a standard set of solutions to common problems and a focus on the customer (Koning et al., 2006).
As Revere and Black (2003) point out, Six Sigma is actually quite compatible with health care, because in health care there is near-zero room for error. In many cases, treatments are routine, as are administrative tasks such as paperwork. There is no particular reason why random defects or errors should exist for most medical functions, yet errors are all too common — and it is organizational culture that allows for this.
The implementation of Six Sigma in the hospital setting has been ongoing for several years, and there are studies that highlight its effectiveness. DelliFraine et al. (2010) found that most studies examining the effectiveness of Six Sigma in health care lacked statistical analysis, which is notable given that Six Sigma specifically relies on statistical rigor. This shortcoming could reasonably be attributed to those conducting the studies rather than to those implementing Six Sigma. Some studies also suffer from incomplete data. Heuvel, Does, and Verver (2005) found cost savings from the use of Six Sigma in Dutch hospitals and linked these to improved quality, but provided limited evidence for the latter claim.
Appendix A: Measures
Business Value (Financial): Activity-based costing; return on investment and cash flow.
Value of Employee: Professional development; employee satisfaction and retention.
Learning and Growth Value: Time to develop new services; quality improvement.
Value of Customer: Patient satisfaction; clinical outcomes; patient length of stay.
References
Allen, T. T., Tseng, S., Swanson, K., & McClay, M. A. (2010). Improving the hospital discharge process with Six Sigma methods. Quality Engineering, 22, 13–20.
DeFrances, C. J., & Hall, M. J. (2007). 2005 national hospital discharge survey. Advance Data, 385, 1–20.
DelliFraine, J., Langabeer, J., & Nembhard, I. (2010). Assessing the evidence of Six Sigma and lean in the health care industry. Quality Management in Health Care, 19(3), 211–225.
Heuvel, J., Does, R., & Bisgaard, S. (2005). Dutch hospital implements Six Sigma. Six Sigma Forum Magazine, February 2005, 11–14.
Heuvel, J., Does, R., & Verver, J. (2010). Six Sigma in healthcare: Lessons learned from a hospital. International Journal of Six Sigma and Competitive Advantage, 1(4), 380–388.
iSixSigma.com (2016). What is Six Sigma? Retrieved April 4, 2016 from http://www.isixsigma.com/new-to-six-sigma/getting-started/what-six-sigma/
Koning, H., Verver, J., Heuvel, J., Bisgaard, S., & Does, R. (2006). Lean Six Sigma in healthcare. Journal of Healthcare Quality, 28(2), 4–11.
Mandahawi, N., Al-Araidah, O., Boran, A., & Khasawneh, M. (2011). Application of lean Six Sigma tools to minimise length of stay for ophthalmology day case surgery. International Journal of Six Sigma and Competitive Advantage, 6(3), 156–172.
McDonald, A., & Kirk, R. (2013). Using lean Six Sigma to improve hospital based outpatient imaging satisfaction. Radiology Management, 35(1), 38–45.
Revere, L., & Black, K. (2003). Integrating Six Sigma with total quality management: A case example for measuring medication errors. Journal of Healthcare Management, 48(6).
Trusko, B. E., Pexton, C., Harrington, J., & Gupta, P. K. (2007). Improving healthcare quality and cost with Six Sigma. FT Press.
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