Posted by: knightbird | June 7, 2011

Prior Bullets

I have blogged about consultant led improvement programs a number of times, and I am constantly looking for proof that such programs are sustainable and achieve the results they seek. ThedaCare, as with many healthcare systems, “enjoyed the attention of many reputable consulting firms.” [i] They describe these efforts in Toussaint and Gerard’s book on the ThedaCare Lean transformation, One the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry. Consultant led change was expensive and not sustainable.

After implementing lean thinking, ThedaCare has sustained improvements, innovative thinking and continuous improvement. Other organizations come to them for their secrets. What is fascinating to me is their description about other leaders who come to see the reasons for this transformation. When these leaders see that there is no “Silver Bullet,” only every day continuous improvement carried out by line staff, they lose their excitement. We seek quick fixes, instant solutions, and rapid improvement.

Of particular interest to me is the description of ThedaCare’s six sigma efforts. I looked seriously at six sigma when looking at Lean, and chose Lean. Six sigma appears to me to be a series of one off efforts. Each belt is a consultant. You identify huge variation in a process through a green belt working under a black belt. Scientific rigor finds the variation in a process, and the process is redesigned to eliminate the variation. Variation becomes the enemy as they seek to reduce defects to the rate of 3.4 per million opportunities. It takes months to tackle one process. It takes weeks, and thousands of dollars, to train a green belt. And the focus becomes the process being analyzed, not necessarily the change that needs to happen.

While Jack Welch claimed great success using six sigma at GE, an analysis of 58 large companies who adopted six sigma did not fare as well. [ii]  91% of the companies trailed the S&P 500 after adopting six sigma. I have yet to hear of a successful six sigma program in health care. When I ask other executives, they point out healthcare systems, which I investigate. I see a healthy dose of lean thinking in the systems pointed out. And if I can find further information of the transformation, a small part of it can be attributed to six sigma. I point this out to our tribal health system, and I now have a reputation as a “six sigma basher.”

Hospitals have thousands of complex processes. I remember seeing a pharmacy spaghetti diagram that had over 700 steps. A six sigma project tackling pharmacy will make improvements, but leave the project without empowered leadership for continued improvement, and without incentive for further change. Innovation stagnates because the only trusted innovators are green belts and black belts.

“Innovation is “a meta-stable entity,” says Vishva Dixit, vice president for research of Genentech (Charts), who oversees 800 scientists at a company that has created some of the most revolutionary anticancer drugs on the market. “Nothing will kill it faster than trying to manage it, predict it, and put it on a timeline.”[iii]

My employees have proved to me day in and day out that they want the challenge of improving their workplace to create more and more value for their patients. We are tackling hundreds of processes annually, some small and some large. Our innovation is growing. One of my managers emailed me today about being 6 years ahead of the state of Alaska in one of our programs. The reason, what we did created value for our customers. I will take the Lean system over consultant led change  because of its sustainability. And I will take it over six sigma because of the empowerment it gives to my bright and capable line staff.


[i] Toussaint, John and Gerard, Roger A., On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry, p. 63, Lean Enterprise Institute, Inc. (2010)

[iii] ibid.

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