title: Application of Six Sigma towards improving surgical outcomes.
abstract: OBJECTIVE
  Six Sigma is a 'process excellence' tool targeting continuous improvement achieved by providing a methodology for improving key steps of a process. It is ripe for application into health care since almost all health care processes require a near-zero tolerance for mistakes. The aim of this study is to apply the Six Sigma methodology into a clinical surgical process and to assess the improvement (if any) in the outcomes and patient care.
  
  
  METHODS
  The guiding principles of Six Sigma, namely DMAIC (Define, Measure, Analyze, Improve, Control), were used to analyze the impact of double stapling technique (DST) towards improving sphincter preservation rates for rectal cancer.
  
  
  RESULTS
  The analysis using the Six Sigma methodology revealed a Sigma score of 2.10 in relation to successful sphincter preservation. This score demonstrates an improvement over the previous technique (73% over previous 54%).
  
  
  CONCLUSIONS
  This study represents one of the first clinical applications of Six Sigma in the surgical field. By understanding, accepting, and applying the principles of Six Sigma, we have an opportunity to transfer a very successful management philosophy to facilitate the identification of key steps that can improve outcomes and ultimately patient safety and the quality of surgical care provided.
authors.affiliation: Department of Gastrointestinal and Hepatopancreatobiliary Surgical Oncology, Tata Memorial Hospital, Mumbai, India. pjshukla@doctors.org.uk
authors.forename: P J
authors.initials: PJ
authors.lastname: Shukla
authors.forename: S G
authors.initials: SG
authors.lastname: Barreto
authors.forename: M S
authors.initials: MS
authors.lastname: Nadkarni
mesh_terms: D006801:Humans; D017063:Outcome Assessment, Health Care; D012004:Rectal Neoplasms / Q000601:surgery*; D017792:Surgical Stapling / Q000592:standards*; D016896:Treatment Outcome