Use of Six Sigma to Improve the Safety and Efficacy of Acute Anticoagulation with Heparin

The recent Institute of Medicine report, Crossing the Quality Chasm: A New Health System for the 21st Century [1], highlighted the need to improve the reliability of basic processes in health care. One way in which health care has addressed this need is through the implementation of continuous quality improvement techniques. Six Sigma is a process improvement approach widely adopted in industry [2] that is beginning to be used to improve quality of care and patient safety in health care organizations [3–5]. Originally developed by Motorola in the 1980s, Six Sigma is a methodology that helps organizations focus on developing and delivering near-perfect products and services. Six Sigma uses the DMAIC approach: Define, Measure, Analyze, Improve, and Control (Table 1). There is a strong focus on customer expectations. Six Sigma holds that the customer experience (called the “Y”) is the result of process factors (called the “Xs”). In traditional process improvement approaches, process results are measured, but the drivers of these results may not be carefully examined. In Six Sigma, statistical analysis is used to relate process drivers to the customer experience. Effective change requires that the Xs be accurately measured, their causes identified, and the process modified so that the customer expectations are almost always met. This article describes the use of Six Sigma to improve acute anticoagulation services in a community hospital.