title: Six Sigma in healthcare delivery.
abstract: OBJECTIVE
  The purpose of this paper is to conduct a comprehensive review and assessment of the extant Six Sigma healthcare literature, focusing on: application, process changes initiated and outcomes, including improvements in process metrics, cost and revenue.
  
  
  METHODS
  Data were obtained from an extensive literature search. Healthcare Six Sigma applications were categorized by functional area and department, key process metric, cost savings and revenue generation (if any) and other key implementation characteristics.
  
  
  RESULTS
  Several inpatient care areas have seen most applications, including admission, discharge, medication administration, operating room (OR), cardiac and intensive care. About 42.1 percent of the applications have error rate as their driving metric, with the remainder focusing on process time (38 percent) and productivity (18.9 percent). While 67 percent had initial improvement in the key process metric, only 10 percent reported sustained improvement. Only 28 percent reported cost savings and 8 percent offered revenue enhancement. These results do not favorably assess Six Sigma's overall effectiveness and the value it offers healthcare. Results are based on reported applications. Future research can include directly surveying healthcare organizations to provide additional data for assessment.
  
  
  CONCLUSIONS
  Future application should emphasize obtaining improvements that lead to significant and sustainable value. Healthcare staff can use the results to target promising areas.
  
  
  CONCLUSIONS
  This article comprehensively assesses Six Sigma healthcare applications and impact.
authors.affiliation: Villanova School of Business, Villanova University, Villanova, Pennsylvania, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Liberatore
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration* / Q000592:standards; D017598:Efficiency, Organizational; D006801:Humans; D061214:Patient Safety; D011787:Quality of Health Care / Q000592:standards*; D017749:Total Quality Management / Q000458:organization & administration / Q000592:standards*