News & Events

The truth about ‘Six Sigma’ — it should be called Sick Sigma

From the Massachusetts Nurse Newsletter
November/December 2010 Edition

By Mary Crotty
Associate Director in Nursing

In the last year, the Massachusetts Hospital Association, and many of the hospitals represented by MNA, have been touting and/or implementing their adoption of the “Six Sigma” or “Toyota Lean” production methods as a means of improving quality, cutting costs and as a new tool for coping with the challenges posed by health care reform.

There is nothing new about these strategies, and there is nothing good that come from them for nurses who are forced to work under the conditions fostered by these techniques. This is just a remake of an old horror movie the MNA and our members were forced to watch during the last round of health care reform, a time when consultants were selling hospital administrators similar efforts—TQM, Patient Focused Care, Re-engineering—to cut costs at the expense of patient safety. The result was hundreds of thousands of patient deaths, the exodus of thousands of nurses from the profession and a decade’s worth of research that shows that these strategies were not only wrong-headed, but deadly.

At Tufts Medical Center and Boston Medical Center, administrators have championed Six Sigma and spent hundreds of thousands of dollars on consultants to cut staffing levels and services. For the nurses at Tufts, Six Sigma has transformed that facility from being the best staffed hospital in the city of Boston to the worst, has led to forced floating of all nurses, and a dramatic increase in unsafe staffing reports.

At UMass Memorial, Six Sigma and Toyota Lean have led to the closing of a 28-bed medical surgical floor a month after the hospital declared an internal disaster because there were no beds available to take care of patients. They did this after posting more than $160 million in profits.

Nurses need to be aware of Six (or what we call Sick) Sigma and what it could mean to your practice and your patients.

What is ‘Sick’ Sigma?

Six Sigma is the nickname for a business management strategy developed by Motorola in 1981. It is one of several similar quality improvement methods (TQM, Lean, Zero Defects, etc.) intended by manufacturing companies (with debatable or even miserable results) to reduce the number of defects in products.

The term “Six Sigma” is a statistical reference. It refers to the goal of limiting the number of defective products to a rate that is at least six standard deviations from normal, which would translate to 99.99966% of products manufactured free of defects (or 3.4 defects per million). Motorola set a “Six Sigma” goal for all its manufacturing operations, and this engineering practice has become a buzzword for quality improvement.

Motorola and any number of consultants, universities and online programs have spun fortunes training businesspeople in Six Sigma, developing levels certifications, etc. Interestingly there is no central certification body so this is cowboy country—the Wild West, both in methods and certainly in results.

Here is the type of spin (from Web sites for colleges offering Six Sigma certification) that companies—and now hospital executives—are hearing from their golfing buddy consultants:

Villanova University: A major enterprise reduced labor costs by 5 percent after instituting a time clock system that only allows associates to clock in or out three minutes from their scheduled shift for a total annual benefit of $21 million. —BusinessWeek

Target Corp. claims more than $100 million in savings over the past six years due to its Six Sigma program. —BusinessWeek

Purdue University: “Financial managers, plant managers, floor supervisors, and administrators who are seeking a proven method for drastically improving the organization’s financial performance.”

The results are another story. A Fortune magazine article stated that “of the 58 large companies that have announced Six Sigma programs, 91 percent have trailed the S&P since.” Another BusinessWeek story says that the introduction of Six Sigma at 3M may have stifled creativity, citing two business school professors who claim that Six Sigma led to “incremental innovation at the expense of … blue-sky work.”

Statistician Donald J. Wheeler has dismissed Six Sigma tactics as “goofy” and “arbitrary.”

One of our most perceptive sources, Dilbert (the cartoon) has discredited Six Sigma, also pointing out that Six Sigma companies trail the Standard & Poor 500 index.

In the 2009 business downturn, companies which embraced Six Sigma like General Electric, Caterpillar and Motorola did no better than the companies that ignored it. Reuters has analyzed leading Six Sigma companies to also show that they did not outperform the stock market as a whole. In copiers and printers, Xerox ranks lower in quality than competitors Canon, Toshiba and Hewlett-Packard, yet it proudly trumpets its Six Sigma legacy back to the 1980s.

In fact, in his book Enough, John Bogle, a legendary investor and founder of the Vanguard group, partially blames Six Sigma’s approach for the disastrous business decisions that led to the current economic crisis.

Tom Peters, the management guru, has also said, “You can measure everything except what’s important” and it was what could not be quantified “that got us in this trouble.”

Toyota is perhaps one of the best known companies to have implemented the similar “lean” methods only to fall completely on its face. A recent Wall Street Journal article blamed lean manufacturing and its focus on lean and mean, reducing waste, eliminating efficiencies, over-streamlining and focus on market growth and performance for contributing to Toyota’s downfall.

There is a lesson for hospitals here. It is terribly dangerous—and appalling—for auto companies to be playing with our lives. If our washing machine blows up, or our radio stops playing, we have a financial loss. However health care is different and it is far past time for this country to acknowledge this. Hospitals exist to save lives, and they have a special ethical and moral duty to function with that in mind.