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Healthcare systems are complex entities with highly interdependent processes with outcomes dependent upon the extent to which designers have considered the linkages, resources, and roles of those influencing and using the system. Yet variability throughout the system can wreak havoc on leaders and managers intent on establishing a system with sufficient stability to reliably provide the type of care needed in order to meet these broad goals. Variable demand for services, variable availability of productive inputs, and variable quality of inputs can lessen the healthcare organization’s ability to adequately plan for and deliver the type of healthcare services needed to provide care that is both customer focused and business sensitive.
The achievement of quality healthcare through health information technology (HIT) is a broad goal for any healthcare organization. The challenge for healthcare organizations lies in the translation of these goals into strategies that efficiently address a diverse and competing set of demands. The translation requires establishment of measurable objectives and use of methods that allow the organization to determine the optimal means of achieving objectives. The translation of this broad goal into strategy should ideally prevent errors in decision-making, not only related to the design of and investment in new systems, but also in the redesign of existing systems and processes.
The idea that HIT has the potential to improve healthcare performance is reflected in large scale efforts to develop strategies and resources to increase utilization of HIT (United States Government Accountability Office (GAO), 2005a). Over the past few years, several countries, including Canada, Denmark, New Zealand, and the United States, have developed national-level strategies to leverage HIT to improve efficiency and quality of care (United States Government Accountability Office). Strategic goals established through these types of initiatives are ultimately effective to the extent that they are translated into action.
Exhortations to achieve quality goals or exceed industry benchmarks are meaningless if the organization can neither define quality nor uncover the causes for failure to meet some specification or exceed specifications that other organizations are apparently achieving. Similarly to Wheeler’s (1993) observation of error-prone decision-making behavior in leadership, it is the thinking that some course of action (say, HIT implementation) is the answer to a particular problem without truly understanding what the problem is in the first place. Organizations could be making costly errors by missing key opportunities for improvement if an organization either jumps to the conclusion that HIT is the solution without understanding the problem or fails to observe that HIT could be the solution because changes in process that would benefit from HIT are not detected.
Through use of statistical principles and methods typically found in statistical quality control, healthcare organizations can begin to understand how HIT applications can facilitate achievement of quality and efficiency-related goals and objectives. Coupling rigorous inquiry about the relationships between inputs, outputs, and processes with organizational commitment and support to the process of inquiry within a robust improvement framework inquiry would be one means of spanning and translating broadly stated goals into meaningful objectives and the Lean Six Sigma (LSS) program is an ideal framework that incorporates this approach to quality improvement. Because the program is process focused, the use of the program in analyzing HIT applications that influence the process of care is particularly attractive. This paper provides a brief introduction to LSS and the define-measure-analyze-improve-control (DMAIC) framework, discusses utilization of the program in terms of healthcare and health information technology, and concludes with the key implications for HIT design and redesign with respect to use of LSS.