BOX 1. Six Sigma and Process Improvement
• Focus on the patient
• Identify—understand how the patient is processed
• Manage, improve, and smooth the process flow
• Remove non value added steps and waste
• Manage by fact and reduce variation
• Involve, engage, and equip the people in the process
• Undertake improvement activity in a systematic way
final validation of the “to be” process
mapping. The process mapping team has
developed new operating processes and
the entire department has challenged and
validated the “to be” concept. The department is committed to change and to
an implementation plan and timetable.
Do not lose sight of the fact that the department is focused on what they do and
rarely has the lateral thinking insights to
alternatives and consolidation of tasks.
This is normally the role of the project
manager and strong leadership to integrate into the final “to be” processes.
Getting Started
any given component are being manufactured for assembly (eg, a finished vehicle, computer, or MR scanner) must be
minimized to achieve the highest quality
finished product. Ideally, each component will be made in exactly the same
way and exactly to specification. If each
step in the process is precisely repeated
every time then the process is standardized and reproducible and the “output”
should be identical, thus delivering the
quality of result that is required. This is
the key concept from Six Sigma that adds
value to a process improvement project.
“Reproducibility” is also by far the most
important facet to Six Sigma thinking so
far as diagnostic imaging is concerned.
If this is the only facet of Six Sigma that
a radiology department embraces, that
will be fine, because there is great value
to be gained in “reproducibility” and
“standardization” alone—and without
the deep dive into statistical analysis
that is essential in the manufacturing
environment.
The big take-away from Six Sigma
is that quality outcomes are maximized
when processes are standardized and
reproducible. That becomes a goal for
the team during implementation—that
each new process and subprocess must
be completed by department staff in ex-
actly the same way, every time. This is
uncommon in diagnostic imaging, where
the typical department can function in a
very personal way. However, tolerance to
variation must be eliminated throughout
the department and a goal during imple-
mentation should be that new processes
and new working practices will result
in standardization, reproducibility, and
sustained improvements in quality out-
comes. Box 1 gives an overview of the
thought processes to follow at the begin-
ning of a radiology Six Sigma project.
Lean Six Sigma
As Six Sigma is to standardized and re-
producible processes, so Lean Six Sigma
is to cost control. The project manager
leading the implementation project must
always be asking the same question: How
can this process be executed more effi-
ciently and with less cost? This is the
Sometimes it is obvious that a process
mapping and process improvement
project is necessary. Patient satisfaction
survey results, complaints from referring
physician offices, or staff grumbles at the
water cooler are common channels for
communication. The arrival of a new de-
partment director might be another. The
truth is, most departments can benefit
from this approach because it forces an
analysis of what is done, how it is done,
and a healthy line of questioning for the
best approach. Another great tool is to
benchmark against peers in similar facili-
ties and with similar work volumes. Pro-
fessional meetings and discussion groups
(eg, within AHRA) are an ideal starting
point. Box 2 lists processes that might be
ideal starting places for a first project.
BOX 2. Process Improvement Opportunities
• Appointment scheduling—telephone and walk-ins
• Pre-authorization for appropriateness of test and reimbursement
• Front desk operations, copay collection, etc
• Patient management and modality throughput
• Image processing for reading
• Reading and reporting, interface with physicians, transcription
• Charge capture, billing creation, and denials management
• Receivables management and DSO
