from

the
editor

All for the Best

By A. Blanton Godfrey
godfrey@asq.org

he recent healthcare reform debates have stirred up many discussions on best practices. Time magazine and others have pointed
out that if we all could get our healthcare from Mayo Clinic or
similar institutions, we could cut healthcare costs drastically while
receiving better care.1
In The New Yorker, Atul Gawande, M.D., described how widely costs vary
in the United States for similar care, with higher costs in locations such as
McAllen, TX, actually resulting in worse care than a similar city in Texas that
spends half as much:
Most Americans would be delighted to have the quality of care in found
in places like Rochester, MN, or Seattle, WA, or Durham, NCall of which
have world-class hospitals and costs that fall below the national average,
Gawande wrote. If we brought the cost curve in the expensive places down to
their level, Medicares problems (indeed, almost all the federal governments
budget problems for the next 50 years) would be solved.2
For years, teams at Dartmouth College have studied the variation in healthcare outcomes and costs in the United States. In a 2003 study, a Dartmouth
team led by Elliott Fisher, M.D., studied treatment given to elderly Americans
diagnosed with colon or rectal cancer, a hip fracture or a heart attack. The
costs varied widely, but often the patients receiving the higher-cost care
fared worse.3
In July, 10 representatives from regions with high-quality, low-cost healthcare went to Washington, D.C., for a special sharing session titled, How Do
They Do That? Low-Cost, High-Quality Health Care in America, hosted by
the Institute for Healthcare Improvement. The organizations were selected
from more than 70 regions in the United States that provide higher-quality
care at significantly lower costs than average. If the median cost of care in
the United States was the same as these regions, 16% of the costs would be
taken out of the healthcare system.4
Something completely different
These debates on best practices, how to learn from them and how to implement these practices in our organizations should be quite familiar to all
readers of this magazine.
For years, we heard the strongly vented statement, We are different.
In every organization, the division leaders are quick to point out the differences between their divisions and the ones achieving superior results.
CEOs and presidents describe in great detail what is so unique about their
organizations that its impossible to get the same results as others. For
years, executives at General Motors, Chrysler and Ford explained why the
manufacturing practices at Toyota and Honda would not work in their
companies.
Many of these arguments are correct. Each organization is unique, and
best practices from another organization can rarely be imported with 100%
success. But that just means best practices must be studied, adapted and
modified substantially to fit an organizations structure and culture.
six sigma forum magazine

August 2009

from
the
editor

(cont.)

Another challenge we face is the continuing belief

in the silver bullet. Somehow, we all want to believe
there is one solution for myriad complex problems.
We now have many, many years of experience that tells
us this is not true.
One of the strengths of lean Six Sigmaand of
continuous quality improvement and total quality
management before thatis that launching hundreds
or even thousands of projects leads to hundreds and
thousands of working solutions. The more brains we
put into play, the more ideas we get, and the more
workable solutions we discover.
Thats why leading Six Sigma practitioners value
having almost every member of the organization working as Black Belts, Green Belts or team members. The
ability to choose from hundreds and thousands of
solutions gives us many chances to tailor the solutions
to each unique part of the organization.
The challenges for healthcare reform, like the challenges for many other crises organizations face today,
will not be solved by one grand plan. We need numerous solutions, experiments and learning opportunities.
We need to understand what is working now, how to

improve even the best practices and how to tailor these

solutions to many different situations and environments. Six Sigma gives us many of the tools we need
to plan these experiments, analyze the resulting data
and understand what is working best.
The value of reading Six Sigma Forum Magazine and
similar publications is learning how organizations have
solved problems, whether by using new methods, by
applying standard methods in new ways or by creative
leadership. Case studies help us learn by example.
Company summaries and overviews help us understand
the implementation of Six Sigma more widely. The hard
part is when we try to use what we have learned in our
own organization. But that is where the payoff is.
References
1. Michael Grunwald, How to Cut Health-Care Costs: Less Care, More
Data, Time, June 23, 2009, www.time.com/time/politics/article/
0,8599,1905340,00.html.
2. Atul Gawande, The Cost Conundrum, The New Yorker, June 1, 2009,
www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande.
3. Dartmouth College, More health care isnt better health care, Feb. 18,
2003, www.dartmouth.edu/~news/releases/2003/feb/021803.html.
4. Steve Sternberg, Broken health system can learn from heart treatment, USA Today, Aug. 2, 2009, www.usatoday.com/news/health/
2009-08-02-hospital-quality-cost_N.htm.

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