The DMAIC Six Sigma Approach

In the Value of Case Management

By Tina Kowlsen, RN, BS, CCM
Over the last two decades, case management services have spread into many areas of the health
care industry. Because of this expansion, there is a demand for proven quality and value of these
services, as well as compliance with new rules and regulations in health care which have had a
major economic impact on the health care industry. Because of this impact, health care leaders have
responded with quality management strategies such as total quality management (TQM) and lean
management methodologies. Among these methodologies, Six Sigma is the newest approach to
quality improvement that is currently creating a paradigm in the health care industry. In this article,
I will discuss the Six Sigma application of the DMAIC (Define-Measure-Analyze-Improve-Control)
methodology and assess its use to measure the value of case management services in health care
organizations.
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Over the last three to five years, health care companies have begun to implement the Six Sigma
strategy and tools for project improvement initiatives. According to Bryan Carey, "DMAIC is a
process unto itself that can be -- should be -- improved in each organization that uses Six Sigma as a
critical component of continuous improvement and quality initiatives" (Carey, 2010, p. 1). Recently,
the Six Sigma strategic approach has demonstrated a transformation in the culture, vision, goals and
process improvement methodologies of several health care organizations where it has been
implemented.
The DMAIC is a problem-solving course of action that involves defining the problems of a process,
measuring the available data involved in the process, analyzing the process's performance and
identifying associated issues, selecting solutions to the root cause of the problem, and implementing
a control plan that demonstrates how standards and improvements can be sustained and risks
managed. This method is primarily based on the application of statistical process control, quality
tools, and capability analysis, and is used to help design and redesign a process improvement.
As case management services continue to evolve with the transformation of the health care industry,
the DMAIC methodology is a proactive approach that can establish industry standards and
measurements for quality, as well as cost-effective process and performance improvements of case
management services in health care.
One important step in estimating the value of DMAIC methodology is scoping the DMAIC project.
According to D. Lynch, S. Bertolino and E. Cloutier, "This step is a vital part of the define phase and
can have a long-term impact on a Six Sigma program's ultimate success. Six Sigma projects should
contain quantifiable metrics intrinsic to organizational performance. The metrics are used to track
the progress of the project. Thus, one of the most critical aspects of a Six Sigma project is to provide
a measurable benefit in terms of cost, quality and timing" (Lynch, P., Bertolino, S., and Cloutier, E.,
2003, p. 1-2). Additionally, the DMAIC process provides the highest benefit-to-cost ratios in the
shortest period of time through analyses of data, process, and root-cause.
The use of process maps, pareto charts, histograms, and brainstorming techniques also provides
opportunities to reduce variations, yet gain higher predictability in the case management process.
According to Donald Lighter, "Because sigma represents the standard deviation, it provides a
measure of variation in the process that leads to nonconforming output." (Lighter, 2011, p. 292)
Thus, the DMAIC approach has tremendous value for measuring case management productivity,
financials and quality outcomes in health care organizations.
Another benefit of the DMAIC Six Sigma approach is the ability of company executives operating in
this approach to generate considerable cost savings. This benefit further justifies the use of DMAIC
methodology and Six Sigma calculations to assess the value of case management services. Case
management programs have always held value based on cost savings and return on investment. With
the DMAIC Six Sigma approach, case managers can showcase their value through highlighting the
timing of specific processes, cost benefit/savings analyses, return on investment (ROI) calculations,
and customer satisfaction reporting.
According to Tushar Desai and Dr. R. L. Shrivastava, "Six Sigma propagates that all-round quality
performance is bound to result in the attainment of the desired business excellence in terms of
reduction, cost of production, maximization of productivity, customers' (external as well as internal)
satisfaction, profitability and ROI by achieving reduction in cost of production and processing by
continuous process improvement, reduction and elimination of wastages, rework and excess
consumption of resources" (Desai, T. and Shrivastava, R.L. [WCECS], 2008, p. 6). Hence, have
leaders of case management programs started to use the DMAIC Six Sigma approach? If the answer
is no, then the next question is why not? The DMAIC Six Sigma approach in the health care industry
has been tested, used, and has the opportunity to advance case management process improvements
and cost savings methodologies which will establish standards of value for case management
services. ?
Tina Kowlsen, RN, BS, CCM, is a Care Manager at Aetna in the Aetna In Touch Care Program, a
national case management/ disease management program. Tina is a past founding member of CMSA
and currently serves as a member on the National Board of Directors for CMSA.
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B. (2010). Continuous Improvement Should Apply to DMAIC Itself. Retrieved from www.
isixsigma.com/new-to-six-sigma/dmaic/ continuous-improvement-dmaic.
Desai, T. and Shrivastava, R.L. (October 22-24, 2008). Six Sigma - A New Direction to Quality and
Productivity Management. World Congress on Engineering and Computer Science, ISBN: 978-98-
-98671-0-2.
Lighter, D. E. (2011). Advanced Performance Improvement in Health Care Principles and Methods.
Sudbury, Mass: Jones and Bartlett Publishers.
Lynch, P., Bertolino, S., and Cloutier, E. (2003). How To Scope DMAIC Projects. Retrieved from
http://asq.org.