The DMAIC Debate
The Six Sigma Improvement Model (SSIM) is made up of the DMAIC approach, Define, Measure, Analyze, Improve, Control. According to Lighter, 2011 the Define portion of DMAIC is “the creation of high-level project goals and mapping the current process” (Lighter, 2011, p. 298). “Measure” is to “determine key aspects of the current process and collect relevant data” (Lighter, 2011, p. 298). Define and Measure are key elements to the DMAIC process as they define the purpose of the project the “characteristic for improvement” and the measure phase is the collection of the information for how the process currently works, how it is supposed to work at an optimal level, where the current breakdowns are and a summary of the baseline data. There are several sources of private standard-setting organizations available for health care workers and quality improvement personnel to access developed methods of performance measures. The National Quality Forum (NQF) by its own definition is “a private sector standard-setting organization whose efforts center on the evaluation and endorsement of standardized performance measurement” (National Quality Forum, 2014). The NQF provides a forum for standardized performance measures that can be shared between many health care organizations There is current debate about the necessity of developing the “Define” and “Measure” phases of the DMAIC for quality improvement projects. Some quality improvement professionals feel that the performance measures developed by organizations like the NQF have sufficient information embedded into their review process that development of the Define and Measure phases of the SSIM are now unnecessary. In my opinion, the NQF serves as an excellent resource for quality improvement professionals and clinicians to share information and clinical practice guidelines, but should not be substituted for the Define and Measure phases of the SSIM. The NQF contains high quality process measures that may be comparable to the quality improvements that other organizations are attempting to institute, but they do not have the individualization and precision outcomes obtained by completion of the entire DMAIC process. Much in the same way that physicians have argued that standardization in health care limits their practice to “cookie cutter medicine”, the process measures developed by NQF are more standardized than completion of the DMAIC process. Define and Measure phases of DMAIC allow for performance improvement measures that are consistent with specific customer demands and organizational strategies companies may be missing if they try to substitute standardized process measures and clinical practice guidelines. It is my opinion that completion of the full DMAIC process, including the Define and Measure phases, is more worthwhile and cost effective for the organization. The NQF can be a very useful tool for generating ideas and comparing clinical practice guidelines, but the quality improvement gained from customer and organization specific measures developed with DMAIC far outweighs the money saved by cutting corners and using only standardized measures developed by the NQF.