Figure 1: One More Patient Per Modality Per Day

**Based on average Medicare reimbursement per modality

If a hospital or diagnostic imaging center decides that Six Sigma is the best way to achieve their goals, a project team is assembled and trained in the methodology, often led by experienced consultants or process improvement experts. To maximize the benefits to the organization, it’s important for the team to examine the entire operation – including service quality, service cycle, service cost and market potential. Existing assets, resources, equipment, staff, scheduling and transport should all be considered for their potential impact on departmental productivity. 

Using the Six Sigma Methodology

With the general areas defined, the team then chooses one or more projects to focus on, depending on the department size. Scoping is an important part of the process, since team organization and effort can often become unmanageable when trying to coordinate more than three project teams within a single imaging department. Projects are selected based on initial findings and are chosen for their alignment with organizational goals and the probability that they will produce results in terms of financial, quality and productivity improvement.

During the Define and Measure phases, it is important to clearly identify critical elements and obtain voice of the customer (VOC) information through stakeholder interviews. Key performance indicators also are gathered, including exam volume, exam duration and room utilization for all modalities; patient, referring physician and staff satisfaction, and staffing to identify current operational performance relative to labor expense, revenue and operational quality metrics. Financial data is pulled from existing systems within the facility and cycle time data needs to be collected manually. Process mapping and sub-process mapping with assigned indicators for selected modalities helps to outline existing procedures within the department.

During the Analyze phase, the project team determines the most critical drivers that may impact the process under examination. Analysis may reveal issues such as slow start-up times in the mornings or scheduling conflicts with physicians. The information also may indicate that a high volume of patients failing to show up for appointments is consuming capacity, or that utilization fluctuates during the day due to bottlenecks in the system or variability in patient arrival patterns. With analysis complete, the team then develops action plans and recommends performance improvement opportunities that are aligned with the organization’s strategic objectives. Moving into the Improve phase often is the most challenging, yet most rewarding part of the project. As process changes are actually implemented, long-standing issues are finally addressed and better processes are put in place – changes that will ultimately improve the overall effectiveness of the facility’s diagnostic imaging services.

The Control phase begins once process changes have been established and appear to be working. The importance of monitoring results during this phase cannot be underestimated. This is one of the most critical keys to long-term success and a differentiating element for Six Sigma. During this phase, control tools are implemented such as “dashboards” or balanced scorecards to monitor key indicators and ensure that project gains remain on track. It also is important during the Control phase to “institutionalize” the wins, celebrate success and instill ongoing change management capabilities through change management tools.

Two Project Examples in Diagnostic Imaging 

Example No. 1: To increase capacity and raise patient satisfaction, Carle Clinic in Illinois needed to improve cycle time for CT exams.

Solutions: Using Six Sigma and change management tools, Carle Clinic uncovered the most critical factors impacting the exam scheduling process and implemented these changes: