Title: Commonwealth Health Corporation, “The Healthcare Pioneer of Six Sigma”Author: Lisa Thomerson, Six Sigma Corporate Champion, Commonwealth Health CorporationDate: March 2002Published In: ΣXTRAOrdinarySense

Commonwealth Health Corporation’s Six Sigma initiative was launched in March 1998 after Presidentand CEO John C. Desmarais listened intently to Jack Welch tout the amazing success General Electric(GE) had experienced by implementing Six Sigma. Welch had proven globally that Six Sigma was theway to improve process design and reduce costs. The encounter of these two executives led to apartnership between GE and CHC, in which GE Master Black Belts trained a diverse group of CHCexecutives and managers in Six Sigma methodology. This initial Green Belt training designatedCommonwealth Health Corporation as the pioneer in healthcare to become a Six Sigma organization.

Presently, CHC’s Six Sigma team develops training materials, teaches the Six Sigma methodology,and mentors Green Belts and Black Belts as they progress through the various levels of projects.These projects represent a variety of processes within the organization, both operational and clinicalservice lines. Projects are selected based on a variety of considerations: benchmarking, peer groupdata, and/or invaluable suggestions or ideas from employees, patients, and physicians. Althoughthere are many challenges inherent in applying the Six Sigma methodology in a healthcare setting,CHC has seen many positive results in these ongoing Six Sigma projects.

All projects must impact at least one of the following Critical-to-Quality factors (CTQs): CustomerSatisfaction, Timeliness/Speed/ Convenience, Quality of Care/Service, or Cost. A typical CHC SixSigma project takes four to seven months to complete. Every project is an intense objective study ofa particular process that is driven by data. Neither subjective assertions nor randomrecommendations for improvements are tolerated in the DMAIC process (Define, Measure, Analyze,Improve, Control). Black Belts and Green Belts must prove statistically that a problem exists and theimprovements made within the process have been improved using objective data. One of theinnumerable strengths of Six Sigma is that all projects are approached the same, utilizing each of thefive phases in DMAIC.

Six Sigma Strategy

CHC’s successful implementation of Six Sigma can be directly attributed to the organization’ssteadfast commitment to quality – to continually “raise the bar.” Six Sigma training was mandated forevery employee to become adept at its use within CHC as the vehicle to continually improveprocesses and the delivery of care. It became the focal point of a culture change within theorganization. Part of the lasting culture change, Six Sigma’s methodology and its approach to processimprovement has facilitated a transformation in organizational communication. With that change,CHC’s senior leaders recognize the importance of their employees and understand their invaluablecontribution to improve the “way we work.” At its inception, John C. Desmarais made thecommitment that no one would lose their job due to improvements made by Six Sigma projects. Anyreduction in CHC’s workforce would be through attrition.

Black Belts are selected as the full-time project leaders who drive process improvements to meetCHC’s strategic organizational goals. Green Belts are Directors and Managers who lead projects part-time and incorporate Six Sigma methodology within their respective departments. These “Belts”consist of a wide array of employees leading projects on project teams. They discuss their projectsdirectly with executive management at each phase (Review) of their projects. Reviews are the forumutilized to improve the flow of information to ensure the Black Belt, Green Belt, project team, andmembers of executive management are current on project developments. Black Belts and GreenBelts, reinforced with management’s unequivocal support to the Six Sigma initiative, criticallyexamine processes within their respective departments. The value of applying Six Sigma’smethodology to solve problems and improve processes is viewed as the mechanism to enhance theireveryday work. This can only result in improved customer satisfaction, reduced costs, more efficientprocesses, and improved quality as CHC produces more and more Green Belts and Black Belts whohave completed Six Sigma training.

Intensive Six Sigma Training

Senior leaders fostered their commitment to Six Sigma by identifying individuals who would becomeCHC experts in Six Sigma methodology and would provide internal training to employees. Theseindividuals, Master Black Belts, developed healthcare-related training material for classes, a tool kit,and project simulation for learning. Additionally, they provide all levels of training for CHC employeesas well as coaching and mentoring for Green Belts and Black Belts.

CHC made a remarkable organizational commitment to the success of Six Sigma by training allemployees in Six Sigma methodology. By the end of 2001, over 2000 employees had attended atleast one full day of Six Sigma training (“Awareness”). This Awareness training offers an introductionto basic concepts of the methodology, and each person who attends this training receives knowledgeof the Six Sigma process and becomes a valuable contributor to a project team. The commitment totrain every employee stands firm.

“Lite” training is the next level of exposure to Six Sigma’s methodology. Department Directors andClinical Managers identify high-potential employees who will be most involved in projects. Theseindividuals, typically supervisors, attend an intense three-day session that is designed to familiarizethe Lite-trainee with the aspects of the methodology. These employees build on the basic knowledgeof Six Sigma in order to assist the Green Belt within the many facets of a project.

Green Belt training is an action-based learning model where trainees actually complete projects. Thistraining is a 13-day course presented in five phases (D-M-A-I-C) over a six-month period. Each stepof the DMAIC process is presented by Master Black Belts in a classroom setting, and the traineeapplies these principles to an ongoing project. CHC has 120 Department Directors and Managerstrained as Green Belts. Each will be expected to complete one project every nine months. TrainingGreen Belts at this level assures that Six Sigma is intertwined within every department.

Additionally, all vice presidents, members of the senior management team, and CHC’s President andCEO have received Green Belt training and “shadowed” a Green Belt through a Six Sigma project.

CHC’s Corporate Champion is responsible for the deployment throughout the organization andensures necessary resources are obtained when needed improvements are recommended.Additionally, the Champion eliminates any barriers experienced within a Black Belt or Green Beltproject. The Champion also communicates the organization’s Six Sigma successes internally andexternally as well as manages the strategy’s acceptance.

Six Sigma’s Triumph

Tangible benefits of process improvements utilizing Six Sigma methodology projects are beingexperienced throughout the fabric of our organization. The first Green Belt class focused onprocesses in Radiology, engaging a cross-functional group of employees to enhance the corporate-wide implementation. As a result of these projects, costs per procedure have been significantlyreduced. Exam results are distributed to ordering physicians faster, patients receive treatments moretimely, and physical workspace has been re-designed to increase employees’ efficiency. Other GreenBelt classes have focused on other areas of the organization: Maternal care, specific PulmonaryDRGs, Admissions, Billing processes, Documentation/Charge Entry, Human Resources, Staffing,Managed Care, and Surgery processes. Each project represents a significant opportunity to improveaspects of the services provided by CHC, and Green Belts are beginning to realize the extent to whichthey can positively impact the way CHC does business. As training objectives are met, processesthroughout CHC will continue to improve as the organization continues its journey to become a SixSigma organization.

Along this journey, the American Productivity and Quality Center (APQC) named CHC a Six Sigma“Best Practice Partner”. CHC was among only a few others in the nation to receive this award:American Express, Iomega, DuPont and Raytheon. CHC executives have also had many opportunitiesto share this approach to quality improvement with several organizations. In March 2001, CHC wasprofiled at the Association for Quality and Participation’s 23rd annual spring conference in Chicago. InMay 2001, CHC hosted healthcare executives from Japan. Additionally, CHC executives have deliveredpresentations to the American Society for Quality’s Annual Quality Congress; Healthcare FinancialManagement Association’s conferences; International Quality and Productivity Center’s Six SigmaConference; International Society for Six Sigma Professionals’ Leadership Conferences; numerousHealthcare Symposiums; and, a Six Sigma Conference hosted by Marcus Evans. Along with numerousother presentations, CHC’s experience with Six Sigma has been featured in various publicationsincluding Strategic Finance, Radiology Management, Modern Physician, Managed HealthcareExecutive, Hospitals and Health Networks, and Diagnostic Imaging.

Since beginning in 1998, CHC invested approximately $900,000 through the course of thisimplementation. Improvements have resulted in savings well over $3 million in 2001 alone. To date,the cumulative savings have exceeded $7 million.

CHC boasts that all existing employees have received Six Sigma training – from a primer inOrientation to Master Black Belt level training. Toward that end, this includes over 120 trained GreenBelts, six Black Belts, three Master Black Belts, a Corporate Champion, three Corporate Sponsors, anda CEO who continuously drives the challenge of becoming a Six Sigma organization. It is evidentthrough continued process improvements that CHC will realize escalated savings, increased moraleand customer satisfaction. As the pioneer for Six Sigma in healthcare, CHC’s leadership changed theorganization’s approach to problem solving utilizing Six Sigma methodology to deliver absolutely thepremium service to customers.

The Way We Work at CHC

In addition to CHC leadership’s commitment to Six Sigma quality, organizational buy-in is one of themost vital elements of its success. Part of the Champion’s responsibility is to gauge the progression ofSix Sigma and determine its effectiveness from a corporate wide perspective. Perhaps the greatestmeasure of this success is to hear from those closest to the pulse of Six Sigma methodology – CHC’sSix Sigma Green Belts. A few of CHC’s over 120 Green Belts were asked to share their perspective ofSix Sigma. This is what they said:

“Six Sigma has been a true learning experience for me. I am working on my third Green Beltproject currently. I am finding this project particularly interesting since it involves our CorporateWellness program and the results from the Health Risk Assessments. The tools of Six Sigma areproving very beneficial in analyzing the aggregate data from the assessments with the endresult being an even stronger, more effective wellness program for our employees.”Linda Rush, Director of Community Wellness; Green Belt; led project for Health RiskAssessments

“I have found Six Sigma methodology very beneficial. At one time during my project, Iconsidered the possibility that there was no reason to proceed to the next phase. I felt therewas no way I could improve the process after analyzing my data. We proceeded, and on my2nd measurement, I had only one defect. I was able to make a positive change for all involvedand addressed all CTQs (critical-to-quality).”Gary Sullivan, Director of Security; Green Belt; studied the process of direct admitsfrom EMS

“I know that Six Sigma methodology can and is making a difference in our organization. Itallows us to continually ask ourselves how we can improve processes as we go about ourregular duties. The best part is the ability to hold improved processes in place so we can strivefor further improvement in that process and move toward improving other processes. I’m justglad I’ve been able to be such an active part of the Six Sigma initiative because I’ve learned somuch. It is so valuable in my new position as we look at process improvement - it’s just such adifferent way of looking at things.”Lorraine Bormann, Director of Corporate Clinical Facilities; Green Belt; currentlyleading a project in the process of medication charge audits

“The Six Sigma training has spawned a “new and improved” way of thinking not only for myselfbut for staff within my department. It has expanded our thought processes to continuallyquestion “why” is a task performed in such a way and question “Is this the best way?” As theSix Sigma approach is expanded throughout our department, we desire to realize and improveupon our weaknesses and celebrate our strengths.”Cristi Pruitt, Director of Corporate Accounting; Green Belt; member of the GreenBelt class studying process of documenting charges

“For me, Six Sigma changes the way that I look at my department, the daily activities of thehospital, and how I do my job. Using the Six Sigma methodologies, each process can be studiedand evaluated. Not all projects will reach a “Six” Sigma, but any increase in sigma levels can beconsidered a success. When a project has an increase in the sigma level or improvement noted,then our patients and the facility will ultimately benefit. Having the tools, such as thismethodology, that allow me to look at my processes and improve patient care, makes my joband career much more rewarding.”Melinda Joyce, Director of Pharmacy; Green Belt; currently leading a projectstudying the crediting process for medication

As you can see by these testimonials, Six Sigma has proven to be not only a way of improvingprocesses but also a method for employees to achieve stretch goals. These Green Belts are livingproof of CHC’s ability to continually seek greater and greater levels of quality.

Lisa Thomerson became the first Six Sigma Corporate Champion at Commonwealth HealthCorporation (CHC) in January 2000. Ms Thomerson received CAP & WorkOut training from GeneralElectric Medical Systems following CHC’s kick-off of Six Sigma in March 1998. In early 2000, she wasGreenBelt trained by CHC’s Six Sigma training staff of Black Belts and received Champion trainingthrough Juran Institute. CHC is the first healthcare organization to partner with General Electric, fullyintegrating Six Sigma into its culture.