Introduction
The Define-Measure-Analyze-Improve-Control (DMAIC) is a six sigma problem process typically applied to a problem with an existing steady-state process, service or product offering. The main aim of the process is to eliminate variation. The approach works well for any process or service line that possesses measurable response variables such as healthcare where customer satisfaction, service cost, service level, and clinical excellence are some metrics that can be utilized in the DMAIC process. A major objective for the healthcare industry is to completely eliminate errors, not just them; thus, a proper process management system is required that offers quality improvement professionals the ability to improve process efficiency while removing non-value adding work.
In this regard, the National Quality Forum (NQF), a private, standard-setting organization, aims to provide consistent, high quality, effective, and efficient healthcare to all Americans through a standardized system of performance measurements and reporting that is based on evidence from various healthcare organizations. The organization's goal, through collaborations with different healthcare stakeholders, is to improve healthcare quality by introducing routine measures and higher standards through evaluations and endorsement of standardized performance measurement, preferred practices, and frameworks tools (The National Quality Forum). It is because of such tools that some quality improvement professionals feel that the quality performance measures established by the National Quality Forum (NQF) should substitute the Define and Measure phases of the DMAIC process.
The Define and Measure phases are key elements in the DMAIC process and are critical to the success of the six sigma methodology. The Define phase involves the definition of the problem to be fixed. A high-level map of the process is created that assists in understanding the needs of the customers from the process. This phase is critical as it outlines the focus of the project. The Measure phase assesses the current performance of the process and determines the magnitude of the problem. In this phase, assessments activities performed as part of the process are recorded, the ability of the process to meet customer specifications are assessed and the frequency of the problems and their causes are analyzed (Lighter, 2011).
On the other hand, the NQF only provides a forum for standardized performance measurement. This approach, if employed by healthcare providers as a substitute for the Define and Measure phases, would limit a healthcare organization from leverage information specific to the organization to target improvement efforts of issues unique to the organization. Consequently, relying only on NQF tools for the Define and Measure stages would lead to a less focused process improvement effort and increase in the cost of improvements (Lighter, 2011). Additionally, although the NQF offers high-quality process measures that can assist an organization to institute their desired quality improvements, it does not provide the precise and individualized outcomes obtained from the completion of the whole DMAIC process.
In the Define phase, the major characteristics of the customer are the focus of the improvement project throughout the quality improvement process. Also, the Measure phase allows the identification of critical measures, which become the targets of the Improve and Control phases of the DMAIC process. Consequently, in the same way that all patients cannot be treated the same based on summarized evidence from various healthcare providers, the measures developed by the NQF are more standardized and may lead to ignoring individual differences of various healthcare organizations. Thus the Define and Measure phases are critical as substituting them would hinder performance improvement measures consistent with a specific organization's customer demands.
References
Lighter, D. (2011). Six Sigma: Principles and Applications in Health Care. In D. Lighter, Advanced Performance Improvement in Health Care: Principles and Methods (pp. 287-326). Burlington: Jones & Bartlett Learning.
The National Quality Forum. (n.d.). Improving Healthcare Quality . Retrieved from The National Quality Forum: http://www.qualityforum.org/Home.aspx
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