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DEPARTMENT OF………..
A RESEARCH PROPOSAL BY:
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TITLE: Six-Sigma Implementation in Healthcare.
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I declare that the work I am submitting for assessment contains no section copied in whole or in part from any other source unless explicitly identified in quotation marks and with detailed, complete and accurate referencing.
Contents
1.3 The Objectives of the Study. 5
3.3 Data collection techniques. 12
3.4 Issues of Reliability and Validity. 13
3.6 Definitions of Key Terms, Concepts and Variables. 16
3.7 Data Analysis and Interpretation. 16
3.8 Ethical considerations. 17
3.8.3 Provision of debriefing, counseling and additional information. 18
The health care sector has been operating its businesses by utilizing the traditional methodology, which tends to ignore vital emerging factors within the industry. These include liability, malpractices involving insurance cost, increasing healthcare costs, patient safety, insurance payment, and the use of Diagnosis-Related Group (DRG) for Medicare (Aboelmaged 268). These factors have currently become more prevalent with competition between hospitals intensifying. Progressively, the need for actualizing their goals through strategies, such as meeting the patients’ care expectation and understanding the critical need of being able to control their operational costs triggered the health care sector to apply quality management strategies into the industry (Schroeder, Linderman, Liedtke, and Choo 48). Currently, there have been drastic competitive forces within the healthcare sector, as many organizations and hospitals are looking for new strategies through which they can survive in the industry. Most organizations have shifted their business strategic, operational and organizational practices including providing the best medical care at considerably low costs. This is indeed a good step though most hospital administrators lack adequate knowledge on how they can reduce health care costs without compromising quality (Shirazi, Babak, Fazlollahtabar, and Mahdavi 867).
The increased scope, complexity and organizational roles of hospitals in the health care industry are increasingly becoming more critical to most organizations ability to compete. Traditionally, the healthcare sector is multifaceted with various activities, management and resources, of which have been important to hospitals. Nonetheless, the need to manage the diverse facets of the healthcare sector more effectively and efficiently has gained more importance due to the increased competition. In order to solve such issues, some hospitals are embracing other quality management techniques such as the Total Quality Management (TQM) and the Continuous Quality Management (CQM) to improve health care provision (Andersson, Roy, Henrik and Torstensson 284). Under the current environment and status within the healthcare sector, which contains many forces including steeper competition, increased client expectations and government pressures, implementation of the six-sigma approach would help improve the quality and productivity of the health care delivery.
Currently, the government has come up with various strategies, which can help improve the delivery of healthcare services. Conversely, the management of the industry is ineffective to some degree. Agreeably, the policies put in place benefits every individual in the country though to some extent there care is too much. Health care cost is meant to serve and run projects, which are relevant in the industry. However, approximately one-third to a half of the total cost is unnecessary and overused, accounting for thousands of billions of dollars (Binder 1). Additionally, half-a trillion yearly is attributed to disability and lost productivity. According to the American college of Gynecologists and Obstetricians, the March Dimes, Association of Women’s Health, Obstetric and Neonatal Nurses and Childbirth Connection, the elective deliveries, which have been repeated for over thirty years are unnecessary. As a result, billions of dollars, which comes from the taxpayer’s money is wasted on such costs. For instance, according to the American Journal of Obstetrics and Gynecology, approximately $1 billion is spent on human early elective deliveries, which are unnecessary (Binder 1). This problem arises from mismanagement issues. A good management system should be able to understand the repercussions of certain actions and work towards maximizing and utilizing the provided resources accurately in order to ensure quality health care.
Conventionally, health care is regarded as a significant determinant in supporting the general well-being, mental and physical health of individuals in the world. Additionally, healthcare is a broad field of study that involves the lives of people, the clinician as well as other bodies such as the government. The aim of the study is to identify the different ways through which the management of the healthcare systems is made to be much better than they currently are. With the integration of the six-sigma model, the study would help in solving the problems of poor management and misuse of healthcare revenue. Furthermore, health care is one of the few sensitive fields to study (Stamatis 81). Therefore, testing new ideas and making great adjustments and improvement is rather risky unless the proposed alterations are guaranteed and approved by relevant authority. In this effect, the project cannot be done on the ground but rather accomplished through experimental design.
Incorporating this study into the health care system has potential contributions in the industry. Through the six-sigma approach, the quality of health care services would improve since it would help in identifying and eliminating the causes of errors in the spending. Additionally, the technique utilizes a set of management techniques such as statistical methods. Through such methods, the study would help minimize the overuse of healthcare costs. Ideally, the study is feasible and reasonable. Health care revenue is attained from the taxation of every individual in the nation. This means it captures the attention of most individuals, who can help in actualizing the goals of the study. Additionally, discussions on how the six-sigma methodology can be implemented into the health care system are possible as long as the proposal behind it is valid (Stamatis 83).
1.3The Objectives of the Study
Following the identification of the purpose of the study, understanding and recognizing the objectives is vital. Objectives complement the purpose of the study by offering a more direct outline of the specific areas to be achieved. In this study, the objectives are as follows:
- To test the implementation and integration of the six sigma in Health care systems
- To utilize experimental design in the six-sigma implementation
- To identify a method of testing the new solutions and adjustments
- To identify the potential benefits of utilizing the six-sigma methodology
- To identify the possible risks associated with the implementation of the six-sigma methodology.
- To establish how the possible risks associated with the new solutions can be avoided and eliminated
In line with the objectives of the study, the research questions serve two distinct purposes. These include determining the kind of research that is being written and identifying the objectives addressed in the research. The research questions are:
- How would the integration and implementation of the six-sigma approach in health care systems be tested?
- How would the six-sigma implementation be utilized in experimental design?
- What method would be used to test the new solutions and adjustments?
- What are the potential benefits of utilizing the six-sigma approach?
- Are there any possible risks associated with the implementation of the six-sigma methodology?
- How can the possible risks associated with the new solutions be avoided or eliminated?
Since its inception, the six-sigma approach has been used by various organizations in order to improve their quality. Developed by the Motorola Company in 1986, the approach was created in order to improve the quality of its processes by identifying and eliminating defects while minimizing the business process and changeability in manufacturing. Six sigma bases on the quality and depends on statistics with an approximate 3.4 defects found per million opportunities. The six-sigma approach is not a new technique; various industries have employed it in the past, and it has managed to evolve from continuous improvement and scientific management theories into a fine combination of the two (Babak, Fazlollahtabar, and Mahdavi 868). Literature on the utilization of the six-sigma approach and the implications in the future presents a rather neutral ground with which the implementation of the technique in the health care systems can be evaluated.
According to Galvin Robert at Motorola Inc, there is a significant six-sigma DMAIC quality improvement methodology, which involves a five-step process of solving problems within an organization. Defining is the initial stage involving the grouping and identifying as well as defining who are the clients, service providers, the project process and the efforts towards improving the project. This step is followed by the measurement step where quality characteristics are measured against product performance and customer satisfaction (Schwalbe, Kathy, and Furlong 110). From this stage, the data collected is used in formulating the strategies in improving the services.
Analyzing is the third stage in which analysis of the data acquired is conducted using analytical tools including the process flow diagram, Pareto analysis, statistical flow charts and fish-bone diagrams. The results obtained are used to process and design modifications used in achieving performance objectives and customer satisfaction. At this stage, the analyzed data undergoes some improvements. Additionally, it is at this stage where resources needed for the implementation of the design are allocated. Finally, the control step falls last. The whole process is monitored using quality management means such as statistical process control charts and Pareto chart, which work by ensuring the quality and performance are improved and maintained (Schwalbe, Kathy, and Furlong 112).
According to a past research on the implementation of a six-sigma approach into an organization, there were several benefits and challenges incurred. The research involved optimizing radial forging operation variables. Radial forging involves the process used in the forging or tubular or round components with precision(Six Sigma Based Approach 128). Similar to the current research, the project was aimed at reducing the costs while increasing their service provision in order to maintain a good profile in the increasing competitive market. Among other quality management techniques, which have been used by industries in the past, the six-sigma model proved to be the most efficient in this research. With its major focus placed on minimizing the costs, the process involved the interaction of the critical parameters with the Taguchi experimental design in order to actualize its goal. Further adjustments were made in the methodology by integrating the Response Face Methodology (RSM) to make the results and analysis cost effective and more precise (Lighter and Donald 91). Finally, the optimized parameters obtained from both methodologies were put into test in industries, and there were potential benefits observed.
Notably, in the health care sector, there are potential benefits associated with the use of the six-sigma approach. In this case, patient care and machinery create a diverse variability, which is subtle since the human element is involved, thus, making it hard to quantify. Despite the potential benefits associated with the utilization of the six-sigma approach, there are various challenges accompanying its use. For instance, finding a way to leverage the data obtained from the approach into human behavior presents a rather difficult task. Additionally, in the health care industry, the six-sigma approach can only be beneficial if there is a combination with cultural strategies involving sound operational and change acceleration mechanisms. The level of performance within a health care institution can be defined using four metrics. These include the service cost, service level, clinical excellence and customer satisfaction (Munro 44). The challenge posed by such metrics is that they are only applicable in healthcare centers whereas very difficult to use in the health care setting. Despite the significant challenges involved in the utilization of the six-sigma model within the health care sector, most hospitals manage to achieve their goal, which is to improve customer satisfaction.
Other studies conducted on the utilization of the six-sigma method are that involving caregiver burnout in the HIV/AIDS field. Through the six-sigma approach, several factors were identified to increase burnout among health caregivers involved in the HIV/AIDS care. More often, younger health care workers were observed to have a higher risk of experiencing burnout than older caregivers due to the amount of time they are left to spend with the patients. Additionally, the older health caregivers have a higher sense of control over their patients and tend to employ coping strategies to overcome stress making them less likely to experience burnout. Following the implementation of a six-sigma approach, other factors such as gender, occupation role, sexual orientation and marital status were found to have no effect on healthcare givers (Munro 77). By doing so, hospitals were able to come up with strategies of reducing such scenarios and eventually managed to reduce cases of burnout among the AIDS health care givers.
In this research, it is more appropriate to utilize both the qualitative and quantitative methodology while incorporating and deductive approach of conducting a research. Additionally, the research is more theoretical than empirical in its approach to the research question and objectives.
The appropriate research design in implementing the six-sigma approach is the action research design. At the initial stages, an explanatory stance has to be adopted, and an understanding of the research problem is build up. The characteristic flow of the research design continues with planning on the intervention strategy during which pertinent observations in due time are collected. The essentials of the design progress to integrating the proposed interventional strategies into action through a cyclical process of repeats until the implemented solution for the problem is attained. This research design is iterative in nature, thereby providing a deeper understanding of the problem from the conceptualization to particularization via several evaluations and interventions. In doing so, the six-sigma approach would be utilized in solving the problem in the health care sector through a series of repeats (Ima et al. 114).
Additionally, in order to actualize the goals of this research, the adaptive and collaborative design would encompass both the quantitative and qualitative approaches. Observation of behavior and conducting interviews as well as utilizing data sets in the research would help in making it a success since the philosophical approach is realistic and constructionist in nature. Some of the data used would be literature-based while encompassing both the primary and secondary analyses. Moreover, the research design would be deductive in the sense that it works by proving the six-sigma approach is useful in solving problems within an organization and industries (Munro 77). This strategy links the theory in question to previous surveys and data sets. The research design could further be classified as an empirical research since it involves some kind of a qualitative research with a closer analysis of statistics. Basing on all these approaches, the action research methodology proves to be applicable and most productive in actualization of the research objectives and ultimate success.
Data for the research would be obtained from a wide range of sources. Secondary sources including scholarly written articles on the implementation of six-sigma approach in various organizations, their potential benefits and the problems experienced in the healthcare industry. For instance, the six-sigma approach on radial forging variables displays the integration of the six-sigma approach in an organization and its usefulness in understanding and solving potential problems. Other articles such as the one written by Thomas help in developing the six-sigma method in management(Six Sigma Based 284). This would help in achieving the first goal of the research, which is to be able to implement the six-sigma approach in health care services. Magazines would also be used as data sources.
Primary sources would also be used in the research such as conducting interviews with hospital management, as well as use questionnaires in various institutions within the area. This would include interviewing the medical superintendent, two nurses, two patients, an obstetrician and a gynecologist. Conversations with these individuals would be recorded using voice recorders. Moreover, observational techniques would be utilized in this research, where the behavior of the interviewees would be noted down as well as the gestures they display in order to rule out cases of being biased or providing false information (Desai 74). From these identified individuals, it would be easier to attain necessary first-hand data pertaining to the research. Additionally, data provided on the internet would be useful in identifying some of the problems faced in the industry including the figures of the stated overused amount of money on unnecessary procedures. Different websites provide the data, information regarding hospital spending, and most of them help in determining whether the expenses are necessary or not. Furthermore, hospital records would be used in confirming the stated figures of hospital spending. The data collected would be used in estimating the potential benefit of implementing the six-sigma approach through the solution it would provide.
In order to obtain data from scholarly written journals, one is required to visit the institution’s library and select related articles, which pertain to the research. This activity would be done on 7 September in the library between 9 am and 1pm. Other related articles can be retrieved from the internet on the same day in the afternoon between 2pm and 4 pm. Readings from such articles would help in the formulation of questionnaires and interview questions. Semi-structured interviews would be used in collecting the data. Before conducting the interview, the researcher should borrow permission from the librarian in order to conduct the activity inside the library. Upon receiving permission, the interview will take place on 8 September inside the library due to the quiet and peaceful environment provided in there. The structure of the questions would have a cordial tone while still following protocol as illustrated with a sub-sample attached in appendix A. This structure helps in giving room for exploration of the health care provider’s answers and seeking clarification would be made easier. The healthcare providers would be interviewed one at a time while the conversations would be recorded using a voice recorder placed on one of the tables as the researcher notes some of the gestures made by the interviewees. After the interview, the results would be complied together and prepared for analysis.
Progressively, administration of questionnaires would follow on the following day. A group of selected and mentioned caregivers would receive a questionnaire in which they would fill out the answers. The questionnaires are restricted to selected health caregivers such as those dealing with HIV/AIDS patients, chronic disease departments and elderly patients as well as an obstetrician and a gynecologist. The open-ended questionnaires would be given to these health caregivers on 9 September in the hospital outpatient section at 9 am, and they would be collected at 10am. This method allows the interviewees to express their views freely pertaining to the questions asked, which enables the researcher receive appropriate results. These questionnaires would then be put together awaiting analysis. Additionally, the questions presented in the questionnaire are similar to those asked during the interview. These methods of data collection proved to be more appropriate since they are easy to conduct and are not time-consuming. Furthermore, they concur to my personal abilities and weaknesses while conducting research. Time keeping is a major personal issue and thus conducting a research that takes up much time would rather be more inappropriate. Nonetheless, I possess excellent abilities in conducting interviews due to my extroverted personality that helps in adding confidence in the work and improving communication with fellow interviewees. The experience gained in conducting research from past episodes is vital in a complicated and complex project since more skill is required.
3.4Issues of Reliability and Validity
Agreeably, one question that arises when conducting research is whether one can believe the findings and if the research can stand up and out rule scrutiny. By definition, reliability refers to conditions and requirements of a specific measurement having to result in consistency. In this research, issues of reliability are managed and dealt with accordingly in order to result in consistent, equivalent and stable results. The research would be tested according to the three measures of reliability(Essentials of Lean Six Sigma 178). The data collected and used is appropriate and precise to the point that if the same data is used with the same procedures in several other researches, it is evident that the overall result would be consistent indicating its test-retest reliability. Moreover, the six-sigma approach is a technique, which has been used for several years in many industries and bigger companies. Therefore, selecting this technique proves to be more appropriate and for researchers who aim to obtain similar results, they can utilize other reliable techniques, making the research inter-observer reliable. Furthermore, the answers to a set of questions on the six-sigma implementation topic are related and associated. Through such a method, the multiple questions and answers are used to measure the same technique. Hence, the research displays high signs of inter-item reliability.
The second important concept is determining the validity of a research. Despite the complications associated with assessing validity, there are potential ways through which it can be determined and measured. From the experiment, it is evident that the research seeks to utilize the six-sigma approach in the health care sector, which is present throughout the proposal making it to be face valid. Secondly, the approach encompasses various facets such as its processes, the stages involved while developing it as well as its association with industries. All these factors have been explained in the research making it content valid. In addition, the six-sigma approach has been used by other industries in the past, and related literature indicates that it could be used in the future in solving management issues within any organization. Through its well-established future use, the research turns out to be valid in terms of the criterion. Finally, the six-sigma approach is a technique that has been used to identify and solve problems within the management sector of many organizations in the past. This shows that the methodology is pertinent in the health care industry. Thus, the research is constructed validly. Having established and displayed a higher sense of validity all through the validity tests, it is evident that the research is indeed valid. Ideally, the tests indicate that the research is both highly valid and reliable; hence, yielding consistent results while accurately reflecting the research’s objectives.
The purposive sampling technique would form the basis of sample selection in this research. Also known as selective, subjective and judgmental, the purposive sampling technique can be referred to as being non-probability in nature. In other words, the sample selection entirely relies on the researcher’s judgment when selecting people to be involved in the research. Ideally, this technique was suitable for this research since the sample in question is rather small. Unlike other sampling techniques, the main aim of purposive sampling is to place focus on a small population’s characteristics, with which the results would help in answering the research questions. An important key factor is that the sample selected in this research is not a representation of health caregivers but selected individuals who have similar and interrelated roles in hospitals and they have a close relationship with the research problem.
A close focus on the sampling technique is the utilization of the maximum variation purposive sampling technique. From the research question, it is evident that the sample for the research should be drawn from different sectors. This idea coincides with the maximum variation technique, which allows capturing sample from a wide range of viewpoint relating to the research objective. In this research, much interest is placed in identifying and establishing the truth behind the misuse of healthcare funds on unnecessary strategies. A variation of the units, in this case, health care professionals, would be useful in providing data for the research. Additionally, the research would be limited to healthcare providers in the chronic, HIV/AIDS and elderly departments. The participants would be selected in random from those clinics together with two patients from each department. An obstetrician and gynecologist would also be chosen for the research. Most importantly, gender balance would be placed into consideration. Meaning, the number of male counterparts would be equal to the females present.
3.6Definitions of Key Terms, Concepts and Variables
Throughout the research, there are specific key terms that need to be defined. These include:
- Six-sigma approach- these are tools and techniques used in the improvement of processes.
- Caregiver Burnout- refers to the complete emotional, mental and emotional state of exhaustion that affects the attitude of an individual to change from a caring and positive to being unconcerned and negative.
- Reliability- is the measurement of the degree to which an appraisal tool produces consistent and stable results.
- Validity- refers to how appropriate a specific test measures what it is supposed to measure
- ANOVA- is a statistical approach of analysis that means analysis of variance.
3.7 Data Analysis and Interpretation
Analysis of data is the next important stage after collection. Having administered questionnaires and conducted interviews as well as research from relevant readings from the library forms the initial stage of analysis. An important fact to be put into consideration is the fact that all the data collected should relate to the implementation of the six-sigma approach in the health care system. Systematically, the data would be collected and compiled in a manner where comments with similar themes would be grouped together while discarding any information that does not pertain to the research. Progressively, there would be an attempt of interpreting the data collected through various methods such as drawing tables, pie charts and graphs. These figures would help in providing a visual representation of the results obtained in an arranged format.
Having attained a visual representation of the results, further interpretation of the results would be made. This would be achieved through mathematical techniques, which help in calculating data and providing in-depth information pertaining to the study. Basing on the data obtained from the collection process, the analysis can be calculated in different forms to structure the analysis. This would include using the ANOVA approach, which means the analysis of different types of variances including conducting measures of central tendency, standard deviation and correlation. From the results obtained, conclusions can be drawn and serve as the analysis of the research.
Ethical codes and practices have to be adhered to when conducting the research. The most important factor is that the participants would have informed consent of their actions where they understand the risks involved. Secondly, the participating individuals would not be put under any form of pressure. In this case, they should participate in the research only if they have agreed. In doing so, the data collected would be more appropriate and precise rather than when people are made to participate unwillingly. Every individual’s autonomy should be respected, where everyone has the liberty and freedom to make his or her decisions. Furthermore, no harm should be presented to the participants in the cause of the research. The confidentiality and autonomy of the participants would be maintained throughout the research. Finally, particular care would be made when dealing with vulnerable groups such as the disabled and mentally challenged persons.
Confidentiality is an important key factor when conducting research. During the collection of data, it is important to make the participants as anonymous as possible. This helps in protecting the identity of the participants when dealing with personal information such as their job title, name and other strong expressed opinions. Confidentiality refers to protecting the data collected with the aim of ensuring that the research is able to identify and access private concerns, feelings and stories, which would have potential importance in the research. Additionally, the research promises high levels of anonymity due to the sensitivity of the research problem.
Before taking part in the research, the participant should understand the importance of the research. Thus, before the research, each participant would be given an information sheet, which would provide him or her with information about the study. In the sheets, the following information would be provided:
- The name of the researcher, location and current profession
- Inform the participants why and how they were invited to take part in the research
- Offer information that despite having agreed to take part in the research, they could change their mind at any given time
- Explain the level of anonymity and,
- Offer information on how the information would be stored and used.
3.8.3 Provision of debriefing, counseling and additional information
On 6 September 2014, the involved individuals would meet in the lecture hall and discuss how the research could be done. The information on debriefing would be communicated through personal phone calls, emails and text messages. The intended participants would be counseled after the briefing in order to prepare them for the research in progress.
In order to pre-test the study, sample questionnaires would be sent to the head of department. It is after the confirmation of the lecturer that the research materials can be put into further tests. These may include sampling some of the questions during lecture sessions and the participants in this case are classmates. From their comments, it is easier to identify if the research sampling details, questionnaires and interviews are applicable in research. Furthermore, the said dates would be confirmed against the school calendar in order to ensure that they do not interfere with the institution’s important dates.
| STEPS IN THE RESEARCH PLAN | DEADLINE FOR COMPLETION |
| Submission of the proposal | |
| Design of a research plan | |
| Gaining access/getting permission to work in a particular area/have access to data, etc. | |
| Literature review | |
| Defining of a universe, a sample frame, sampling OR setting up of selection criteria, etc. | |
| Design and testing of questionnaire, if appropriate | |
| Design of a final questionnaire/schedules, etc. | |
| Interviews/posting of questionnaires, etc. | |
| Editing of completed questionnaires, grouping and coding of data, entering data into a computer | |
| Design and testing of a computer program | |
| Raw tabulations/draft analysis of qualitative data | |
| Analysis of data | |
| Report up of findings | |
| Presentation of final research product(s) |
Appendix A
Sample Questionnaire
- What do you think about the current healthcare standards in the country?
- Do you think that the healthcare expenditure is appropriate?
- If not, what are the few loopholes do you think exist in the healthcare system
- Do you believe that the healthcare sector is overspending money on unnecessary strategies?
- If yes, what makes you think that the strategies are unnecessary?
- Do you think the problem emanates from the management?
- What are your personal views about the implementation of a new approach that would help in saving more money and reducing unnecessary spending?
- Would you support such strategy?
- Why would you support it?
- Do you believe there could be potential benefits involved with the implementation of a new approach towards healthcare management?
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