The workshop’s first session was devoted to experiences that various institutions have had with quality improvement. Recognizing the wealth of experiences available outside of health care services, the workshop included presenters from outside the health care service industry as well as from inside. This includes discussions from a variety of perspectives: non-health care services, health plans, hospitals, and nursing. It was not possible, however, to include examples from all settings, including smaller physician practice settings and long-term care settings.

Non-Health Care Service Sector

Although improving quality requires the use of specific tools, developing those tools and putting them to use is only part of the challenge. As Scot Webster of Medtronic, a manufacturer of medical devices, explained, the larger part of improvement is actually changing culture and driving change.

Webster focused on three barriers to operating with high quality and efficiency: lead time, external variability, and internal variability. Lead time is the period of time from the beginning to the end of a process. Variability refers to differences in conditions or in how a process is performed; external variability refers to differences that cannot be controlled by the process’s operator, while internal variability refers to processes that can be. Many tools exist to improve quality and to deal with these barriers. Medtronic chose to combine the tools of Six Sigma and Lean in an innovative technique called Lean Sigma, which has positively affected Medtronic’s business. Although it can produce impressive results, Lean Sigma should not be seen as the answer for all quality problems, Webster cautioned. Quality improvement is 30 percent application of various tools and 70 percent working together to create a culture of continual change, he said, and to sustain quality improvement, institutions need to incorporate it into their culture.

Lean Sigma is also not a replacement for creativity or the experience of health care providers, Webster said. While health care has a high ratio of external to internal variability, and external variability is by definition outside of one’s ability to control, Lean Sigma could still be used as a tool to support the performance of health care professionals, he said.

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