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Six Sigma

Six Sigma6 is a statistical methodology that organizations use to reduce variations in their processes. Several health care organizations are attempting to apply these techniques combined with Lean (e.g., Virginia Mason Hospital in Seattle) but they have not used TOC. Six Sigma and Lean could benefit from the focusing power of TOC, pinpointing the best opportunities for application.

Undesirable Effects of the Current Health Care System

We now examine the areas in healthcare that need improvement. The health care system is in a crisis in this country and around the globe. To understand the problems of our current health care system better, the differing perspectives of the various stakeholders should be examined. The health care debate in the United States is surfacing an influential “voting public” perspective as people try to affect the direction of government action. However, numerous stakeholders exist. Their perspectives are important and include:

Patients

Doctors

Insurers

Hospitals

Business owners

Government

The current system pits one stakeholder against another on various vital issues.

Patients’ Perspective

From the patients’ perspective, the cost of health care is increasing every year; millions of people are without health care coverage because they cannot afford health insurance. Surprisingly, frequently for those who can afford insurance, the quality of service compared to other service industries is less than desirable, and the response to emergency or urgent care is poor. Patients waste a lot of time in queues waiting to get comprehensive care, being passed from one health care stakeholder to another.

Doctors’ Perspective

Doctors are frustrated with the increases in their liability insurances and the low reimbursements from third-party insurers. Whenever possible, most doctors perform procedures that have low risk despite their training and experience in treating highly specialized high-risk procedures. Several towns and cities have trouble finding specialized trauma surgeons to treat patients with facial bone fractures. Sometimes patients have to wait several hours before being transported to an academic medical center for treatment. In some states a few years ago, obstetricians and gynecologists stopped delivering babies because the courts were awarding millions of dollars (exceeding their malpractice insurance coverage) for poor outcomes in medical malpractice suits. Most surgeons and physicians moved from high-risk states that award high settlements in malpractice suits to low-risk states. Others reorganized their practices to do only low-risk procedures. Most oral and maxillofacial surgeons are highly skilled in facial injuries and reconstructive surgeries. Once they go into private practice, they soon realize both the high risk of performing these procedures and the poor reimbursement from insurance companies. As a result, they limit themselves to low-risk, high-profit, in-office procedures. While treating patients, a doctor has to weigh many variables and interactions of those variables when coming up with diagnosis and treatment plans. It takes years to learn these skills and develop intuition or judgment regarding treatment of complex diseases. The doctors are forced to multitask. They constantly face the conflict of either pleasing the insurance companies by cutting costs by not conducting expensive tests or pleasing the hospitals by ordering expensive tests. They also can refer patients with high-risk surgery to specialists versus performing the surgery themselves and facing malpractice suits if anything goes wrong. Most for-profit health care practices manipulate their mix of patients by focusing only on patients with lower treatment cost and lower risk. These choices further put them in conflict with other medical practitioners or hospitals that end up seeing these high-risk patients in emergency rooms.

Insurers’ Perspective

As medical costs rise, most large insurance companies and regional HMOs